Hansard -- Tuesday, March 2, 2004 a.m. -- Vol. 21, No. 3 (HTML)

The following electronic version is for informational purposes only.
The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY


CONTENTS

	Routine Proceedings
		Page

Committee of Supply		8925
	Estimates: Ministry of Health Services
	Hon. C. Hansen
	J. Kwan

Hon. G. Abbott: I call Committee of Supply to debate estimates of the Ministry of Health Services.

Hon. C. Hansen: Before I start with some opening remarks, I would just like to introduce some of the officials that have joined me in the chamber at the start. On my right is Dr. Penny Ballem, who is the deputy minister. Also, on my left is Dave Woodward, who is the deputy minister, strategic initiatives and corporate services. I am also joined at the outset this morning — other officials will be coming and going through this process — by Stephen Brown and Dr. Peter Van Rheenen.

I would like to just take a few minutes off the top to make some introductory comments about the ministry and the challenges we face and some of the successes we've seen to date. The mission of the Ministry of Health Services is to guide and enhance the province's health services to ensure that British Columbians are supported in their efforts to maintain and improve their health. The top priorities are renewing public health care while providing sustainable, high-quality public health services that meet patients' most essential needs. Health care leaders in this government and the provincial health services authority and the five regionally based health authorities around the province and in communities generally throughout the province have been working together to redesign and re-engineer our health care system.

The B.C. health budget this year accounts for more than 42 percent of the entire provincial government budget. B.C.'s health care cost pressures are currently growing at a rate of about three times faster than our economic growth. I think part of the good news out of the budget is that we're starting to see our rate of economic growth come up, which will help make our health care system more sustainable. But clearly, if we were to continue with the status quo of 7 percent to 8 percent increases a year, that health care budget would not be sustainable with those pressures as we go forward unless some fundamental changes are made. Together we are taking responsibility to make the best use of taxpayers' dollars, to get the greatest value for the investment that is part of this budget for health services that is being presented to you today.

Other valuable government services must not be eroded by the continuing demands on our health budget. Government has a responsibility to deliver in three major areas when it comes to health — that the public health is protected, that patients get timely access to the medically necessary care they need and that we plan well for a dependable and sustainable health care system into the future. We are making progress in every one of these areas. In many of them, we are in fact leading in all of Canada.

The Premiers met just last month as part of the Council of the Federation, and they are actively discussing the future of health care. That will be an important part of their agenda in their deliberations later this year. All agree that many of the traditional approaches to health care are simply not sustainable. We had to make some tough decisions, and B.C. is already well on its way to re-engineering and redesigning the health care delivery system that will sustain us into the future.

British Columbians are beginning to see the results of the planning and hard work that is being invested right now across our health care sector. We're beginning to see positive results for patients throughout B.C. The provincial health services authority is strengthening the coordination abilities of the entire health care system in the province by reducing overlap and duplication and clarifying lines of responsibility. Two of the PHSA agencies — the B.C. Centre for Disease Control and the Michael Smith Genome Sciences Centre — are placing B.C. at the forefront in Canada and indeed in the world in identifying and controlling communicable diseases.

Provincial health officer Dr. Perry Kendall and the six B.C. health authorities have built a tightly integrated communications structure that is fast, flexible and effective. Evidence of success was brought home to all of us one year ago when the B.C. Centre for Disease Control experts first advised a network of public health officials around the province to be on the lookout for an influenza-like illness, particularly in patients who had travelled to China. That alert, which came out on February 20 of last year, was almost a month before we even heard of that acronym we now know as SARS. In the months that followed, British Columbia had three cases of SARS arrive in this province, and we had one secondary transmission. All four of those individuals survived and recovered. In Toronto dozens of people succumbed to the virus, and hundreds were infected.

The reason behind our different experiences came down to much more than fate. First was the undeniable strength of our public health network, led by Dr. Perry Kendall as the provincial health officer. That network grows stronger each and every year. Second, our state-of-the-art B.C. Centre for Disease Control, the only centre for disease control in any province in Canada, and its team of scientists — who were instrumental in anticipating, tracking and managing the outbreak, to-

gether with our authorities and the front-line staff — is truly one of our assets in this province that we should be proud of. Third was the linkages to the world-class B.C. researchers at the Michael Smith genome centre, who managed to sequence the SARS coronavirus for the first time anywhere in the world — again, science and scientists that we should be very, very proud of.

Our capacity to respond continues to be tested — as recently as only two weeks ago, when an outbreak of avian influenza was identified in a chicken farm in the Fraser Valley — and it is a testament to all of the fundamental changes we have made to the foundation of our health care system that we have the ability to respond quickly and effectively as new public health threats emerge.

B.C. has a strong health care system. Surveys and research tell us that British Columbians as a group are the healthiest people in Canada, and they have some of the best health outcomes of anywhere in the world. Advancing science, combined with the changing makeup of our population, means that if we are to maintain these standards, we must redesign our health care system for the future. We have been doing just that. We recognized early that any redesign of the health care system had to begin with ensuring that B.C. has the right number of well-trained health care professionals. The B.C. government heard from specialists that many of them were providing on-call without pay for that service. They are now being compensated for being on call throughout the province.

The government heard from rural communities that they were having difficulties attracting and keeping medical staff, so we continued to support a generous package of rural incentives to make sure the needs of patients in those communities are met. That is why B.C. continues to benefit from a net in-migration of doctors, and that is why B.C. continues to provide a budget for doctors that is the highest per capita of any province in Canada.

B.C. launched a $59 million nursing strategy that included almost 2,000 additional spaces to educate nurses in this province. Programs put in place to enhance training and opportunities for nurses have helped to encourage over 90 percent of the nurses educated in B.C. institutions to in fact stay and work in B.C., and many more come to B.C. than ever leave this province. More than 3,000 nurses were supported with additional education in intensive care, mental health, emergency room practice and community health. B.C. now attracts more nurses educated in other parts of Canada than any other province.

We recognized the need to redesign our system to better meet the health care needs of rural and regional communities. We are finding better ways to support and offer the services of our highly specialized practitioners in a number of smaller centres. One example of this building of centres of excellence is the direction we are going to establish centres of excellence in thoracic surgery in Vancouver, Victoria and Kelowna. These centres of excellence allow our small number of thoracic surgeons to effectively combine their skills with the expensive infrastructure required to support them. As a result, these important services are brought closer to communities where they are needed, and we are successfully recruiting new specialists as they are needed. Another such centre is planned soon for the Surrey–New Westminster area.

Our re-engineering and redesign initiatives are resulting in a significant expansion of renal care around B.C. Government and health authorities have worked hard to expand this life-saving service beyond just the major urban centres, moving kidney dialysis services closer to patients in areas like Kelowna, Penticton, Creston, Terrace and Nanaimo — just to name a few. Community dialysis units are now in place on the North Shore and in Richmond, providing patients with kidney failure with care closer to where they live, where they can benefit from the support of family and friends.

Similarly, a redesign of technology is allowing us tremendous opportunities to effectively overcome barriers of distance and geography. Consider the success of the B.C. NurseLine, part of the comprehensive B.C. HealthGuide program. Through the NurseLine, British Columbians have 24-hour toll-free access to a registered nurse specially trained to provide confidential health information over the telephone. It's accessible to anyone anywhere in British Columbia. Since it was implemented in the spring of 2001, the NurseLine has responded to over 500,000 calls, ensuring that B.C. families across the province have the right information at the right time to help them make informed decisions about their health. In fact, in the past year alone, the volume of calls to the B.C. NurseLine has grown by 51 percent.

Consider these statistics: 1,500 calls to 911, over 1,200 ER visits and close to 20,000 doctor visits were avoided altogether since 2001 as a direct result of the establishment of the B.C. NurseLine. At the same time, the registered nurses at the NurseLine have also been instrumental in steering thousands of patients to immediate medical intervention, often when patients felt they weren't in need of immediate medical care.

Consider the experience of a 29-year-old Kamloops woman, and I'll call her Helen. On December 3 of this last year Helen was diagnosed with a blood clot behind her right knee, and she started her treatments at home as prescribed by her physician. Later that day she started having mild discomfort between her shoulders. Because of the clot, Helen phoned the NurseLine and explained the situation. The NurseLine staff listened to Helen's story, questioned her about her symptoms and immediately urged Helen to call 911, as the symptoms she was experiencing could in fact be the sign that the clot had moved into her lungs. At the hospital, Helen was indeed diagnosed with clots in both of her lungs, and her situation was grave. While she is now completely recovered, Helen credits the NurseLine for encouraging her to go to the hospital that night. She in fact wrote a letter in which she said: "The staff at the NurseLine may have helped to save my life that night. I am so thankful that they are there."

Stories like Helen's are not unique, and the NurseLine is fast becoming an invaluable resource for patients across the province. In June of last year we made the service even stronger by adding a pharmacist referral service in response to British Columbians' need for after-hours answers on medication-related questions.

We've also seen rapid growth in the use of telehealth technologies, linking patients, general practitioners and specialists in ways we simply never imagined before. As an example, the use of telehealth technology allows newly diagnosed cancer patients from the central Vancouver Island area to be able to be linked with a cancer agency oncologist by connecting to a site in Victoria from the site in Nanaimo, saving them that travel between the two communities. That service and advice means a lot to cancer patients and to their families. That's what we mean when we say we're putting the needs of patients first.

B.C. has made substantial progress in the area of mental health and addiction services over the past two years. I will leave it to my colleague the Minister of State for Mental Health and Addiction Services to provide many of the details, but I would like to commend and thank the work that was done by the previous minister of state in this particular area, because over the past two and a half years the previous minister led a team of Health ministry staff, professionals and community leaders to revitalize British Columbia's mental health system.

We believe it is crucial and critical to provide British Columbians with the information and support they require to make informed, effective choices about their personal health care and lifestyles. That's important to parents who are teaching their children the basics about nutrition and exercise. It's also important to seniors who wish to remain as healthy and independent as possible as they age.

It is a fact that the fastest-growing age group in British Columbia is those over the age of 90. We often think of the baby-boomers as the fastest-growing. It may be in absolute numbers, but when it comes to percentage growth, it's those over the age of 90. That age group is expected to grow by 40 percent in the next three and a half years alone.

The positive news for our 550,000 seniors is that they are leading much healthier lives than they would have 20 years ago. Life expectancy has increased from about 75 years of age in 1980 to about 80 years of age today, and I am told it is expected that life expectancy will grow by about one year every three years as we move forward. In the years to come, that increase is expected to continue.

We must plan to ensure that supports and services will be in place to enable people to live long lives in good health. We need to plan for the best care and the best quality of life for these seniors, their families and their communities. I must thank the former Minister of State for Intermediate, Long Term and Home Care for her leadership during the formative years of the strategy.

Most health care planners and seniors and their families would agree with the general principles we are applying — that health care should be provided in the most appropriate and cost-effective settings. Seniors should be able to be independent for as long as possible, often by providing care in their own homes. People who need a high level of 24-hour professional care must be well served. Private sector investment in housing must be considered along with both non-profit and for-profit groups.

As we age, we are more likely to be impacted by chronic diseases. When that happens, people need a range of options to assist them. Again, these options must effectively maximize the opportunities for the patients to be independent, and they must be good value for the investment of public funds. B.C.'s current health care system is well designed to support acute and episodic care, but changes are needed to better support the complex task of managing chronic diseases such as cancer, diabetes, pulmonary diseases, congestive heart failure and depression. Partnerships that span the entire health care system have emerged to support the nearly one million British Columbians who are today living with chronic diseases. These partnerships include the health authorities, many doctors, professional organizations and a number of stakeholder groups. We are already beginning to measure success in improved quality-of-life outcomes for patients, professional satisfaction and ultimately overall cost reductions.

Research and experience clearly tell us that the most meaningful gains are to be made by investing upstream in health prevention as we go forward. The most important factors determining good health in our senior years is to teach healthy lifestyles to our children today.

I am very proud of the program that's called Action Schools B.C., which is an initiative that was championed by the former Minister of Health Planning. This is a school-based program designed to promote physical activity, healthy eating and healthy school environments. This project is managed by a diverse and inclusive advisory committee which includes the Ministry of Health Services, the 2010 Olympic bid committee, the Ministry of Small Business and Economic Development — the Ministry of Education is involved, obviously — the provincial health services authority, B.C. Recreation and Parks, B.C. School Trustees, the B.C. parent advisory councils, the B.C. Principals' and Vice-Principals' Association, the physical education specialists association, the B.C. Medical Association and LegaciesNow — all organizations that are involved in the success of Action Schools. It brings together principals, teachers, parents and students, and helps them create programs and activities uniquely tailored to individual schools and students.

In the 11 months since Action Schools was implemented as a pilot project in nine lower mainland schools, we have seen a 6.5 percent increase in physical activity levels among students. School districts in Kamloops, Nanaimo, Prince George and New Westminster

have also come on board and are working with the Action Schools program in those communities. Most importantly, it is a program that celebrates active living regardless of the physical skill level of the individual students. In other words, they don't have to be the next Trevor Linden or Charmaine Crooks to participate. At a time when childhood obesity has tripled across Canada, this program is an important prevention tool helping to establish healthy living patterns that can last a lifetime.

In conclusion, Mr. Chair, I would just like to say that research tells us that patterns of health and disease are largely a consequence of how we live and how we work. Long-term choices in social policy; physical activity in schools; innovative, flexible housing options; pensions for seniors — all can have profound implications for our health. A well-functioning, publicly funded health care system is an essential contributor to a healthy society.

A key focus must be to keep people as healthy and independent for as long as possible. That long-term health begins early, helping our children make good choices about nutrition, exercise and lifestyle. Our health care system must continue to evolve to meet the changing needs of British Columbians. Our health care system must be well managed to deliver value for the significant investment of public funds that must be made. Changes are happening and beginning to show results. We are moving forward together thanks to the dedication, knowledge and hard work of thousands of people in government and in the research community, health care professionals and community leaders across our province.

Just before I turn it over to my other colleagues in the chamber for their questions, I would just like to say that since I became Minister of Health Services a little over two and a half years ago, I think one of my big surprises and one of the things I continue to be so impressed with is the quality of expertise we have in the Ministry of Health Services, which now includes the former Ministry of Health Planning, but also in our health authorities throughout the province. The dedication of our health professionals — whether it's the doctors, the nurses, the physiotherapists and all of the other health care professionals that provide that front-line, hands-on care to individual patients across this province….

At the end of the day it is all of that expertise that comes together to help meet the needs of the individual British Columbian — the Freds and Marys — in communities throughout this province who need care today for their particular illnesses that they are trying to cope with, but also in terms of designing a health care system into the future that will make sure that all of the Freds and Marys around the province have a health care system that's going to meet their needs ten years from now and 20 years from now — a way that will help to keep them healthy and keep them out of the acute care system in a way that really gives them healthy and fulfilling lives.

J. Kwan: Thank you to the minister for his opening statements. For the minister's information, I would first like to canvass with the minister issues around long-term care, and I have quite a list of questions related to that. I don't know whether or not the minister would…. I think my staff had advised the minister of the areas we were going to canvass this morning. So we'll begin with long-term care first, and then we will move on to some of the hospitals in terms of the cuts. I think that will probably tie up the morning, I would assume, if we can get through all these questions to begin with.

Before I start my question, let me just say this as well. I would concur certainly with the minister's opening statement regarding the assistance of the 24-hour NurseLine. I myself find it extremely helpful. I am grateful that the previous government started this. Since having my little girl of 11 months, there's many a time when I phoned that health line in the middle of the morning with a panic of some sort or another. In fact, just two weeks ago my little girl broke out in a high fever at about 3 o'clock in the morning. Actually, at one point she had a fever of 40 degrees Celsius, and I was in a big panic at 3 o'clock in the morning, wondering what I should do. I think it was a Wednesday night. I phoned the health line, and they asked me to watch all these symptoms, and so on and so forth. In the next couple of days, her fever did come down. It turns out she had a thing called roseola. It was actually in the book, the HealthGuide book that walked you step by step — all the symptoms of it.

I find those resources very valuable. I'm grateful that the previous government started that and grateful that this government continues those services. I think that it also helped to save health care costs overall, as well as giving peace of mind to the people who are trying to deal with the situations they're faced with.

Having said that, let me now turn to the long-term care issues. Just by way of background, Mr. Chair, let me start with this. During the 2001 election the Premier, the former minister of state for seniors and the rest of the Liberal candidates — now MLAs in the House — had committed to "work with non-profit societies to build and operate an additional 5,000 new intermediate and long-term care beds by 2006." This promise, of course, was made in the New Era document.

The former minister of state for seniors had been insistent that she had not broken that promise. On May 26, 2003, she said: "I have not broken any promise. We are well on our way to meeting this commitment. The commitment is to provide 5,000 beds by the year 2006." We note the change in language by the former minister of state — the omission of the word "additional" and the omission of the word "build" from her previous statements. I believe that she was forced to change the language because the government is not building 5,000 new beds. Of course, she has since then stated that some of those beds will be conversions as well as rent supplements.

On April 22, 2002, a presentation was made by the former minister of state which illustrated the breakdown of the 5,000 beds. They are as follows: 3,500 beds will be supported-living units, 1,000 of these will be rent supplements in the private market, 1,500 will be new apartments built, and 1,000 of those units will be converted from existing non-profit housing and health developments. Therefore, of those 3,500 beds only 1,500 are actually new beds. Then, of the 5,000 there will be an additional 1,500 new residential beds. That was the information that the former minister of state for seniors had provided. That's the base we're working with.

Before I go further on that, I first would like to ask the minister to please confirm these numbers. Is the former minister of state correct with these numbers, or have there been changes since? If there have been changes, what are the actual numbers so that we can start with that information?

Hon. C. Hansen: The commitment we made in the New Era document for the 5,000 beds is a net increase of 5,000 beds. We're not talking about if there are facilities that in fact have been temporarily closed because they've been old and out of date and are being refurbished. That doesn't count as new beds unless there is a net increase in the number of beds.

What we are doing is trying to benchmark where we were in terms of the number of beds in the province as of 2001. What we are projecting is that by the end of 2006, we would have a net increase of 5,000 beds. What I found sometimes in these discussions is that people tend to look at…. I remember there was one document that came out where people had got information from each of the five regionally based health authorities and added up all those numbers and said: "Well, it doesn't come up to 5,000."

This is not a job that is just falling to the health authorities in the province. It is, in fact, an objective of government as a whole. It includes beds that are being funded or supported through B.C. Housing, which is the Ministry of Community, Aboriginal and Women's Services. We also recognize that the private sector is building a significant number of beds that would fit into what we had previously known as intermediate care or long-term care. We are looking at how we can provide health care support to some of those facilities.

The bottom line, when you look at how we define a bed, really comes down to those beds that do have a publicly funded health care component to them — whether it's directly through the health authorities or through not-for-profit agencies. Can I give you an exact breakdown of what those numbers are going to look like by the year 2006? No, I can't. As I think the member indicated, there are some beds that are in fact just a conversion of beds that existed in the past. There are others that are being built as brand-new beds. There are some facilities that are being closed and not even renovated, just because they are out of date and not in locations that are necessarily appropriate to the needs of the population that live in those areas. So, does the commitment stand? Yes. Can I define for the member exactly what the breakout is going to be by the end of 2006? No, but we are actively working to make sure that we meet the commitment that we made to the public.

J. Kwan: The language in the New Era document is actually very clear. Let me just quote that again for the minister. It reads: "Work with non-profit societies to build and operate an additional 5,000 new intermediate and long-term care beds by 2006." That's the language that I'm going with, the New Era document — not other documents, not the health authorities' documents or anything like that, but what this minister campaigned on, what the Premier had campaigned on and in fact what the Liberal government had campaigned on in the 2001 election. That's what I'm going with. The language is explicit. It talks about 5,000 additional new beds — new intermediate and long-term care beds — by 2006.

The minister just responded by saying that there would be a net increase of 5,000. He says that, if I heard him correctly, the net increase would not include conversions — as an example, beds that have been outdated and needed some sort of upgrading. Those conversions would not be accounted for in those 5,000 new beds. That's what I heard the minister say. Let me just stop here. Did I hear the minister say that correctly? I just want to be absolutely certain so that we don't sort of go off on the wrong path in our discussion here.

Hon. C. Hansen: I thank the member for the opportunity to clarify on this. If there is a conversion…. If you start with a facility that may have been built 35 years ago, and it was designed for a personal care environment, and that facility is no longer meeting the needs…. Let's say it was 100 beds. If we then convert that facility, or the not-for-profit organization that owns it or the for-profit organization that owns it converts that facility into a new, let's say, 100-bed assisted-living space, that would be a reduction of 100 beds and an addition of 100 beds. To say that that would not be a net increase….

In fact, I'd better back up a little bit. That example is not a good one, because I used the words "personal care." If it was a facility that was 35 years old and was no longer meeting the needs for what we used to know as intermediate care level 3, for a better example…. Say that is being converted into an assisted-living space, modernized with perhaps new, wider doors for washrooms — those types of things. If it was 100 beds when it started, and it then gets renovated and it is 100 beds when it's finished, that would not be a net increase in beds. It would not count towards the net increase of 5,000 beds in that respect.

J. Kwan: That contradicts directly, then, what the former minister of state for seniors — I think was her title — had provided. She had said on April 22, 2002, that the breakdown of the 5,000 beds…. The 5,000 beds we're now talking about are the new beds, the new-era

commitment of the new beds. She broke down those 5,000 beds into 3,500 supported-living beds. Of those 3,500 she included 1,000 beds which are conversions, converted from existing non-profit housing health developments. That would be the example the minister used — an existing facility that needs to be converted or upgraded somehow. She included those 1,000 as part of those 3,500 new assisted-living beds, which is out of the 5,000 new beds.

That's a direct contradiction. What the minister is saying — and I want to be totally clear about this — is that those converted beds would not be counted as new beds. They would not be counted as new beds — those 1,000 conversion beds. The former minister of state for seniors is wrong in including those 1,000 converted beds as part of the 5,000 new beds to be increased in the promise made by the Liberal government. Am I correct?

Hon. C. Hansen: Maybe I can try to clarify. At the time of the last election, we were using definitions around intermediate care 1, intermediate care 2, intermediate care 3 and then extended care. The comparable definitions that we're moving towards are around complex care for those who require 24-hour-a-day, seven-day-a-week care in an institutionalized setting, which we used to refer to generally as extended care. But it would also include some aspects of dementia care which previously, perhaps, may have fallen into that IC 3 category.

If you had a facility that in the past did not fit into the definitions of IC 1, IC 2 or IC 3 and it was being converted to a facility that was now assisted living, then that might be a net increase from what it was before. But if you've got a facility that is being converted from what was within that definition of intermediate care in the past to a new model or a renovated model, then that would not be a net increase.

There is a lot of work. There is the work that's being done through Community, Aboriginal and Women's Services and B.C. Housing around the 3,500 beds that are being done exclusively by the not-for-profit sector in the province. Many of those are now under construction. Some of them, I believe, are in fact open. There are others. I just read a press release last week of one where there is a groundbreaking that either took place last week or is about to take place. So that is evolving.

In the case of conversions, it really depends on what it was defined as before the conversion as to whether or not it would be part of the net increase or not. The bottom line, just to back up and restate, is that what we are doing is benchmarking the number of beds that we had in the province that fit into that intermediate and long-term care category as of 2001. Our goal is to make sure there is a net increase in that type of housing stock with a health care support provided to it and that there be that net increase of 5,000 by the end of 2006.

J. Kwan: Is the minister now saying this, then? Under the different definitions of the beds, some are level 1, level 2, intermediate, long-term, etc., and when a facility closes…. Let's use the example of a long-term care facility of 100 beds. When that closes or, I should say, is converted to assisted living…. In fact, I know of some facilities where that process is taking place right now. When that conversion takes place, does the minister then count that conversion as new beds — because the definition of what type of beds it was and what it is being converted to is different and so therefore is deemed to be new beds?

If that is the case, quite frankly, that is just trickery, because it is not actual new beds in the community. I'm sure the minister understands what I'm saying when I say it is trickery. I hope it is not the case. The language the former minister of state for seniors used leads one to think that the government is up to trickery, because she had included 1,000 converted beds to be part of the 5,000 new beds. In my view, converted beds are not new beds. Even if it meant shutting down an old facility and then converting it into assisted living or some other form, those are not new beds. It's just a conversion, so it's just a wash at the end of the day. I hope the minister will rise in the House to confirm that conversions will not be counted as the new beds. So then, on the basis of the…. Let me just stop there.

Hon. C. Hansen: I just had sent in to me the actual Hansard that I think the member was referencing from my colleague the previous minister of state.

If a unit is converted from what was previously considered intermediate care to assisted living, that would not be considered a net increase. If it was converted from, say, social housing stock, or in some cases you could take an apartment block…. In fact, I understand there are some proposals around the province where they're taking facilities that used to be hotels or motels and converting them into assisted living. I don't know the details about that, but I've heard there are some people looking at that kind of opportunity. Those would be conversions. They could be a net increase of what we would classify as intermediate long-term care under the old definitions.

What it does depend on is what that unit might have been classified as prior to its conversion. If it is being converted from what was an intermediate or long-term care facility and it is renovated and sort of reborn as a new facility with the same number of beds as it had prior, that would not be a net increase. It would count towards…. I guess another way of looking at it is if we look at where we were at in 2001 in terms of the total number of intermediate and long-term care beds, then regardless as to what opens, what closes or what gets renovated, at the end of 2006 what we are saying is that we are working towards there being a net increase of 5,000 beds by the end of that period of time.

I know that the previous minister of state made an attempt to break that down in terms of supported-living units and rent supplements. That is still a changing tally for us. We have not gone out to say there are

going to be X number of assisted living and X number of complex care units that come out at the end of this process, because we are still evaluating it as we go forward to determine what the specific needs of individual communities are. At the end of the day, we will live up to our commitment to see that there is a net increase of 5,000 beds.

That is not a file that rests just with the Ministry of Health Services either. It is a file that actually rests with government generally, and part of it is some of the great initiatives we're seeing coming from the private sector, which are building facilities and supportive housing units in the province that will have health care supports in them to provide for the needs of those seniors. We are now, through the health authorities, working with those organizations and not-for-profit organizations to make sure that our obligations as the Ministry of Health Services are lived up to in delivering the kind of health care supports that the seniors in those units may require.

J. Kwan: What I gather from the minister is that the 1,000 converted beds of existing non-profit housing beds would be counted towards the 5,000. That is to say, in other words, if the government takes affordable housing stock away and converts those into some sort of health facility–related stock — whether it be assisted living or whatever the case may be — those would be counted towards the 5,000 new beds. So raiding affordable housing stock and converting those to health-related facilities would be counted as new beds — that's what I think I heard the minister say — but converting existing health facilities to an upgraded version or a lower-grade version of health facility…. Those would not be counted towards the 5,000 new beds. So, raiding affordable housing from B.C. Housing is counted as new beds for the health facility, but upgrading existing facilities would not be counted. That's what I heard. If I'm correct, let me ask the minister this question. I will have something more to say about the non-profit housing side of things in a few minutes, and I will get to that.

What did the minister then mean — the former minister of state for seniors — when she included health development as part of the 1,000 conversions? What are health developments, then, in that context?

Hon. C. Hansen: The member will have to assist me in the reference to that. I don't know the context of that. I'm not aware of that particular reference.

Just to go back to the point she was making, if you had some housing stock that was affordable housing but did not have an intermediate care or long-term care component to it in the past, but it was converted to a facility that would be, say, assisted living, then yes, that would be a net increase. By the same token, if you have a facility that in the past had been utilized as a long-term care facility, and it is now being decommissioned, renovated and provided as affordable housing in the community, that would be a net reduction towards our goal of the 5,000 beds.

In fact, I know of a facility in the province. The member in that constituency came to talk to me recently about it. There is a brand-new assisted-living facility that is going to be opened in the next couple of months in that facility, and the old facility is going to be decommissioned as an intermediate or long-term care facility. The plan in the community is that they're looking at whether or not they can take that old facility and turn it into affordable housing for seniors, but it wouldn't necessarily have a health care component to it. In that case — where you've got a facility that is being decommissioned from being an intermediate or long-term care facility — that would in fact be a net subtraction from our goal towards the net increase of 5,000 beds.

So, yes, as the member mentioned, if there was housing stock that was being renovated to become assisted living, let's say, that would be accredited towards our goal of 5,000 net increase. By the same time token, if there is an old facility that is being decommissioned and renovated to become affordable housing outside of the definitions as we used to know them of intermediate care or long-term care, that would be a net reduction.

J. Kwan: Following on that, then, under no circumstances would any bed, converted or otherwise, be double-counted either by the housing sector or by the health sector. Am I correct in understanding that?

Hon. C. Hansen: Yes, that's right. It's not a case of going around the province and saying: "Well, this is one of the net increase beds, and this was one of the converted beds." In fact, what we're saying is that at the end of 2006 we will have, according to the definitions that are there in terms of what constitutes complex care, what constitutes supportive housing in the province that would fit into the definitions of what we used to know as intermediate and long-term care…. The total tally in the province will show a net increase by the end of 2006 of 5,000.

J. Kwan: I'll come back to that in terms of what was committed and what constitutes the 5,000 new beds, etc. I'll come back to that.

I do want to follow up on the question the minister posed to me to clarify for him the context in which the former minister of state for seniors had said…. On April 22, 2002, the minister of state made a presentation, and in that presentation she gave a breakdown of the 5,000 new beds and what is to be constituted of the 5,000 new beds the government had committed. She made that commitment in the context of saying that the government is still committed to providing the 5,000 beds by 2006, so therefore it's not a broken promise.

In that breakdown of 5,000 beds, she stated, in the information she provided, as follows: 3,500 beds will be supported living units. Of the 3,500 units of supported living units, 1,000 will be rent supplements in the private market, 1,500 will be new apartment units and 1,000 will be converted from existing non-profit

housing and health developments. That's what she said. Then she goes on to say that 1,500 will be new residential beds.

My question to the minister is: what does she mean by "health developments"? In this discussion with this minister, what he had identified is that conversions of health facilities, whether it be long-term care beds or intermediate care beds…. When those are converted, they will not be counted towards the additional 5,000 new beds, because it's a wash and that would be trickery. The minister has admitted that they would not be doing that. Then what does the former minister of state mean when she says health developments will be counted towards those conversions?

Hon. C. Hansen: I don't know exactly what was meant in that particular context by the term "health developments" that the member is…. I can just surmise that if the reference was to non-profit housing on one hand, then perhaps health developments may be some projects that were actually in the ownership and control of health authorities. I'm just guessing. I think as we move forward on this file….

We didn't start out at the time of the election in 2001 saying that there are going to be 5,000 new beds and this is where they're going to be and this is how many are going to be rent supplements. The commitment we made was that there would be a net increase of 5,000. This is not a static file as we move forward. We are working with communities to identify what those needs are.

It may be that even over the next two months we might realize there are better opportunities for conversions than there are for just simply building a brand-new facility. I have had some examples of that come forward. It may be that rent supplements are going to work better in some communities, because they do work very well for certain situations. It may be that in some communities we should do more in that regard than we do in terms of the other models. The other is just that mix between complex care, assisted living and other supportive-housing environments that all have a health care component to them. What is the appropriate mix for certain communities?

We are doing the demographic work to look at the number of individuals in regions and communities that are over 75 years of age or over 85 years of age to try to anticipate what those needs may be as we go forward. Yes. This is somewhat fluid. To actually give a breakdown of how many fit into what particular pigeonhole would be difficult to do, because it is changing. As I say, we stand by our commitment for the net increase of 5,000 units by the end of 2006.

J. Kwan: Well, I don't mean to be a stick-in-the-mud about this, but it is an issue in terms of trying to clarify exactly what the government is committing and what they're delivering. That's part of the accountability. You say one thing, and the accountability is to match whether or not you have actually done it. Breaking it down to details is particularly important because, as we were canvassing earlier, there could be ways in which trickery could be applied, and then one could pretend that new beds are accounted for when it's actually just conversions of existing facilities. I think that's what the health….

I'm trying to clarify whether or not the former minister of state for seniors utilized that trickery formula to account for the 5,000 new beds. It sounded to me like those 1,000 conversions from non-profits which the minister has clarified — non-profit housing on the non-profit housing side…. Whether or not the health development side…. That question to me is still not clear, but will then scratch the record of what the former minister of state for seniors has said and take from the current record of what the current Health minister is now saying. That is to say, no conversions of existing health facilities will be counted towards new beds of the 5,000 new beds. That's the new record we're now taking, because I think what the former minister of state for seniors meant was that conversion of existing health facilities — what she called health developments — would be counted towards those 5,000 new beds, and that record is now corrected by this Minister of Health Services. I will start from that point.

With that, then let me go to the New Era document. It is on page 25 where it states very clearly in bullet 3…. Headline: "A New Era of Health Services." Point 3: "A B.C. Liberal government will work with non-profit societies to build and operate an additional 5,000 new intermediate and long-term care beds by 2006." Now let me just use the wording here of what the commitments from the New Era document state and work with the exact language from there. It states 5,000 new intermediate and long-term care beds — exactly. The level of beds we're talking about in the New Era document is clearly defined: intermediate and long-term care beds — 5,000 new ones. Are we still saying right now, as the government is embarking on meeting this commitment, that the 5,000 new beds this minister just stated, which will be built or available by 2006, which could include conversions from the affordable housing stock…? Will those still be categorized as intermediate and long-term care beds? That's what the commitment is, and I want to match whether that commitment is being matched by the actions that are undertaken by this government now.

Hon. C. Hansen: Probably the best way to respond to the member's question is to reiterate that what we are talking about is a net increase in the number of beds that would be defined or would have been defined under what we knew of a few years back as intermediate long-term care, so it is a net increase that fits into those categorizations.

It is a commitment of government; it is not specifically an obligation of the Ministry of Health Services. We obviously have an important role to play. When you start looking at what constituted a facility in intermediate care under the old definitions, it came down

to there being a health care delivery component to that housing stock. There are all kinds of different models.

One of the things that's important is what drives our policy directions and our decisions around meeting this particular need, and it is not by looking at the communities and saying: "We've got a whole bunch of facilities. How do we utilize them?" It is saying: "What are the needs and desires of the seniors who want to go into some of these facilities?"

One of the messages we heard loud and clear from seniors is that they want less institutionalization; they want their independence. The big fear seniors would have in the past is that the only choices they had were staying in the family home or the nursing home with its 24-hour-a-day dependence on nursing staff or other health professionals. The new models fit into what we knew before as intermediate care levels 1 through 3, and we are developing those models to maximize the independence for seniors but still give them the support backup they may need in order to enjoy the level of independence they can handle at that particular stage in their lives.

We know that as seniors age, their health care can deteriorate, and they need higher levels of care. We are trying to make for that transition and the flexibility to go from a level of intermediate care that has some health care supports to it to moving, as they lose more independence, to a model that can facilitate their needs in a seamless way….

To go back to the point that the member made, I can reiterate that we're saying there would be a net increase in the number of beds available throughout the province in a tally that would have fit into the old definitions of intermediate long-term care.

J. Kwan: I certainly can appreciate that seniors as they age also wish to maintain their independence. I can really appreciate that. Again, using my own personal example, my mother and father lived in their own home, their own house. A couple of years ago their house was broken into several times in one stretch. My parents are in their seventies, and I was very worried about them. All the kids have moved out. We've all grown up and have our own homes, and so on. I didn't want them, to be honest — being an overly protective daughter, I'm sure, like the way my parents were overly protective with me when I was growing up — to live on their own. I was worried about it.

The house got broken into several times in broad daylight in one stretch, and I thought: oh goodness, something could happen to my parents. I wanted them to move in with me. I went to great lengths to try to make them do that. In the end, I was not successful because as the minister states — and I can really appreciate it — seniors want their own independence as they grow old. They don't want to move into their daughter's home or their children's home necessarily. Anyway, they resisted it, and I caved at the end and bought them a dog. I thought that would be a good compromise and just left it at that. We're getting along happily now, and no more fights about whether or not they should move in with me. So I appreciate the independence question.

Insofar as intermediate and long-term care homes for seniors, there's a time and a place when that is appropriate, and there's a time and a place when it is not appropriate. I appreciate that the role of government should be trying to help the seniors maintain their independence, but at the time when they are no longer able to, for whatever reason, see that the supportive network is actually there. The intermediate care, long-term care homes — a range of care homes with health care support — should be available.

That was precisely the former government's ideology or vision, if you will, in doing that. The housing continuum was such that at the most minimum level, where people don't need any care or health care supports, there would be affordable housing. That's why there were actual affordable housing programs in place. The provincial government funded and subsidized affordable housing units to be built and then subsidized them on an ongoing basis.

That of course, under the Liberal government, has changed. When the government was elected in 2001, one of their first actions was to cancel about 1,000 units of affordable housing that was committed to by the previous government, with no health care. Those are now gone. The second continuum of housing, outside of affordable housing with subsidies, would be the assisted-living housing, and this government is trying to build 3,500 units of what they call supportive living units. That would be one level after affordable housing in providing some level of health care supports to people in these supportive living units. The next level would be intermediate care beds, and then the next care level would be long-term care beds. It is a continuum of them.

Maybe I'm wrong. Maybe I have misunderstood the debate that has gone on before now — that is to say, when the government is building the 3,500 assisted-living units, those will not be accounted for towards new intermediate and long-term care beds. Or is the minister considering assisted-living unit beds, or any care beds that provide any sort of health care component to it, as intermediate or long-term care beds? The degree of care in the range or the continuum of beds varied, and in my view, intermediate and long-term care beds have very specific definitions. Whether or not assisted-living units or supportive living units meet those standards is a question we need to canvass if the minister considers assisted-living beds as meeting the health care standards that have been provided in what is termed as intermediate and long-term care beds.

Maybe the minister can clarify the definitions and the level of care under assisted living, long-term care and intermediate care. That would be vital to try to match whether or not the language that has been used and promised during the election campaign is being met by the actions of this government now.

Hon. C. Hansen: I first of all want to go back to some of the comments the member made earlier around the challenges that I think individual families have with their aging parents and with making sure the needs of those parents and seniors get met. I think one of the things that's really key on this — and the member alluded to it — is options and flexibility. There's no one model that's going to meet the needs of every senior in the province. It really is a case of flexibility.

I am also very aware of the fact that some seniors and some families in the province would not want to consider any kind of institutionalized care, even if it's in an assisted-living environment where there is still some independence. For many families it's the desire to have the seniors come and live in the home of the children. For other families that wouldn't work and may not be in the best interests of either the children or the parents involved. So it really is key that we have that kind of flexibility.

The member mentioned the number of 3,500 supportive housing units. That is as a result of one program that is being delivered by B.C. Housing. To say that of the 5,000, there is a magic number and that at the end of the day 3,500 of the net increase are going to be classified as supportive living…. Not necessarily. We're still looking at those needs, and that is still flexible as we go forward.

I think what's important when it comes to the definition of what would have been referred to in past years as intermediate and long-term care is a purpose-built facility that is purpose-built with a health care component designed into it. It's not just a case of saying that a senior living in an apartment block that was market housing who suddenly ages and now has to have, for example, a community nurse come in every day or home support come in two or three times a day to provide bathing in that individual's apartment…. That would not count towards the net increase of 5,000 beds, because it would not meet the definition of a purpose-built facility that has a health care component designed into it.

From our perspective in the Ministry of Health Services, through our health authorities, we have the responsibility of ensuring that those residents of these facilities get access to the health care component. As you know, there's still user-pay to that. We do income testing, and the vast majority get 100 percent subsidy for those services. Others may have to contribute to it based on their income levels. What we are saying is that there is a health care component that is in fact designed into it, whether it's a supportive living environment or it's complex care. I think, as the member mentioned, there's a whole spectrum of options that fall within those definitions.

J. Kwan: I don't dispute that there is a need for options and for the range of options. As I mentioned, that is exactly the path the previous government had envisioned. In fact, long-term and intermediate care beds were needed to alleviate the hospital beds. In fact, sometimes we have patients taking up the hospital beds when they could be in a long-term care facility or in an intermediate care facility.

The idea around long-term and intermediate care beds was to alleviate the logjam in hospitals. That's part of that vision. Then, for the people who actually don't need that higher level of care like intermediate and long-term care, assisted living would be appropriate. It's a higher level of independence, but it still has some component of health care. The degree of health care is not nearly as extensive as that of intermediate and long-term care. Intermediate and long-term care, as I understand it, actually provide for health support 24 hours a day.

Assisted living is completely different, in that assisted living may mean someone would come to your home and provide some support — but not nearly as extensive as intermediate and long-term care. The definition of this is vitally important in trying to measure whether or not the government is meeting its commitments. That's what I want to get at, so that we're clear on what the government has committed to and what is being done to meet that commitment or what is not being done to meet that commitment. That's the direction I'm going in with this.

I appreciate the range of options that are needed. I appreciate the gentle words the minister uses in terms of health services provided in the range of options, but there is a difference in the level of health supports being provided and what would then be termed intermediate care and what would be termed long-term care versus assisted living.

That's the direction I would ask the minister to clarify, Mr. Chair. Then if in fact the 3,500 units…. Maybe it is not 3,500 units. I know the former minister of state had said 3,500 units. We have already established that the 1,000 units of conversions of health developments are not going to be counted towards new beds.

The former minister of state for seniors is already wrong on that score. We have already established that. Then maybe the former minister of state for seniors is also wrong on the 3,500 supported-living units that would be built by 2006. Maybe she is wrong on those numbers as well. If she isn't, I'll ask the Minister of Health to correct that record. I think I heard the Minister of Health say that it may not necessarily be 3,500 units and that those 3,500 units…. Unless those 3,500 units of supportive living actually meet the definition of intermediate and long-term care in terms of health care provisions…. Unless they meet that standard, those 3,500 units — if they don't meet that standard — would not be counted towards the New Era document commitment of an additional 5,000 new intermediate and long-term care beds by 2006.

Hon. C. Hansen: When the member was talking about her definition of what an intermediate and long-term care facility would be, she described it as being

24-hour-a-day nursing care. Really, the definition is much broader than that. If you start looking at the various definitions of what constitutes intermediate care in the past, it really boils down to there being a health care component — a health care service — that is being provided on a routine basis in a facility that is purposely built to provide that kind of seniors housing.

If you look at the shift that has taken place over the last number of years, it really has created many more options and choices for seniors. As you start looking at the different levels that would be provided and funded by government, the number of those that would in the past have been classified as intermediate care level 1 have really been phased out in terms of funding. They can still get access to their health care supports, but not in the nursing home model as we would have known in the past and particularly not in the nursing home model that I think most seniors really dreaded in the past.

What we have seen is that more and more seniors want a homelike environment. If it can't be their own family home — that is, if they're no longer able to care for themselves in the family home, even with home support — then they have the choice and the option of moving into a facility that still has a homelike environment and still does not have the 24-hour-a-day nurse coming in and out of the room and providing that total dependency — which, again, seniors do not want until they absolutely have to have it. Those still very much fit the definitions that we have known in the past for intermediate and long-term care.

We are being respectful of what those definitions were in the past as we move forward. Clearly, the models of supportive housing, which includes assisted living, that have purpose-built facilities with a health care component to them very much fit the definitions that we have known in the past for intermediate and long-term care.

In addition to that, we still have the complex care environments, but what we are finding as we look forward is that we probably don't need the kind or number of complex care facilities that we've had. We need more modern facilities — facilities that are designed to meet those very high acuity needs — but the number of facilities that really require that 24-hour-a-day loss of independence on the part of the resident is, in fact, not the number we've had in the past. What evidence will show is that if you move a senior who still has some ability for their own independence into a complex care environment where they are given 24-hour-a-day, seven-day-a-week care and are put into that totally dependent environment, they will in fact lose their independence and their ability to maintain the part of their independent lifestyle that they treasure.

I think what we want to do is create the options and the environments for seniors that give them choices, give them options, so that they can in fact maximize their independence and still have the health care support that they may need, which would be provided through not-for-profit facilities, through the health authorities or in fact through the private sector. I think we are, in that context, well on our way to meeting that obligation.

J. Kwan: It's important to get clarification on this point, then. The minister says "health care component," whether it be assisted-living or supportive living housing units — those kinds of things. Where there's a health care component, that's then deemed to have met the new-era commitment of an additional 5,000 new intermediate and long-term care beds.

What does the minister mean by a health care component? What standards is the minister using to determine that a health care component exists? There must be somewhere within the ministry a set of criteria, then, that is being used to determine what is assisted living, what is supportive living, what is intermediate care living and what is long-term care living — more than just the generalities that the minister is providing. If the minister can provide that information to me in this House, that would be greatly appreciated.

Hon. C. Hansen: Again, it goes back to what we would have looked at in the past as intermediate care. That is a health care service where, as I mentioned earlier, some of that health care service gets provided by the health authorities directly by their staff and some of that health care service may be provided by not-for-profit, but in fact some of it gets provided by for-profit facilities in the province. As I mentioned earlier, most seniors who wind up in intermediate and long-term care get most, if not all, of that paid for by the taxpayers, depending on income levels. Higher-income seniors are expected to pay more of a component of the non–Canada Health Act services that they would be provided in those supportive environments.

When we start looking at a facility that is purpose-built for seniors, which has designed into it the ability to deliver a health care service in that facility, then that would meet the definitions that we knew before in terms of intermediate and long-term care. When the member referred earlier to an environment where there is 24-hour-a-day nursing care, you know, that is one aspect. Obviously, a facility in the past that provided 24-hour-a-day, seven-day-a-week nursing care and the total loss of independence clearly fits into the bill. When you start looking at facilities where there is 24-hour support available to the residents to meet their health care needs, then that would meet this definition.

It is a changing environment in that instead of removing independence from seniors, we're trying to maximize independence for seniors but still give them the health care supports. You know, it may be a periodic visit by a nurse. It may be a support service that's down the hall at the end of a call button so that if the individual needs that support, it's available to them. They still are able to live in a homelike, an apartment-like, environment and be supported. It's not the old model — I grant that — but it is a model that maximizes independence and still provides for the delivery of health services in purpose-built seniors housing that is designed and intended to provide for those health care supports, along with the housing that is obviously part of it.

J. Kwan: What I gather from the minister's comments is that assisted living or supportive living would need to have these three things. The threshold for the test would be that the unit or the building is purpose-built for seniors and that it has the ability to provide for health services — bathtubs that are wheelchair accessible, as an example. I'll just use that as one example. The third thing is that the senior living in those units would have to be able to access 24-hour support to meet health care needs — would have access to 24-hour support for health care needs.

Those were the three things I heard from the minister in defining assisted living or supportive living, which would match the definition of intermediate care beds. That's the threshold that's being used to determine intermediate care bed needs. I guess level 1 would be the minimum level of support in the intermediate care facility. I am assuming I'm correct in understanding those three things.

I would say this. The minister goes on…. I really do appreciate the notion of independence, and I'm not trying to minimize or take away seniors' independence — not at all. What was formerly defined as intermediate care and long-term care, I believe, has a higher level of care support than what the minister is now talking about. In fact, I know those care facilities have a higher level of care support than what the minister is talking about. I visited those care facilities in my own community, and I saw with my own eyes what the level of support was for the different groups of people — intermediate and long-term care.

As I mentioned, intermediate and long-term care beds were meant to ease the tension or the pressures, if you will, at hospitals so that those beds that are being utilized by individuals who could be in intermediate care or long-term care beds could be freed up. Part of that pressure with hospitals is that those beds are not being freed up and therefore run into crisis situations. Hospitals are constantly in crisis situations where they don't have enough beds, because those beds are being utilized in a way perhaps not as appropriately as they could be. There was a need to develop more intermediate and long-term care beds, also recognizing that there are some seniors that have a higher level of independence. Therefore, there was a need to develop supportive housing units. The full continuum is there.

Now it sounds to me — and maybe I'm wrong in this — like the supportive living units are being put forward to replace intermediate care beds and long-term care beds. By and large, they are. A lot of intermediate care and long-term care beds are being shut down and are being replaced with assisted living or supportive living, and supportive living and assisted living have a lower threshold of care than intermediate care and long-term care beds.

To determine whether or not the new-era commitment of 5,000 intermediate and long-term care beds is being met by what the government is doing does hinge on how the government is redefining what intermediate care and long-term care beds are. I want to make that point. The threshold that's being used is (a) if it's purpose-built, (b) if it has the ability to provide health services and (c) if there is access to 24-hour support to meet health care needs. That is what the government and this minister are now defining as intermediate care beds, and I do take issue with that.

I have sent a note down to my staff asking to see if we can actually come up with the definitions of what intermediate care and long-term care beds are. I assume the minister has it. Although I did ask for it, the minister was still very vague in his answer. I assume the ministry themselves would now use some sort of criteria — whether the health authority…. Even if it's the health authority, it should still be available to the minister. After all, after GAAP, the health authorities do fall under the responsibility of the Minister of Health, so the Minister of Health should be able to access what criteria are being used by the health authorities to determine the different levels of care — intermediate care and long-term care.

Maybe after the lunch break the minister can provide that information to me in writing, because I would like to see the documentation on eligibility requirements and the criteria in defining long-term care, intermediate care as well as supportive housing and assisted-living housing. I will just set aside, for one moment, those definitions until I actually get those in writing, and then we can come back to talk about that.

I want to just turn for a moment…. In terms of access to 24-hour support to meet health care needs…. Could the minister advise: what does he mean by that — access to 24-hour support to meet health care needs?

Hon. C. Hansen: I might just share for the member some comments by the former Minister of State for Intermediate, Long Term and Home Care, and I believe this was actually in open cabinet on April 22. This may be part of the transcript she was referring to earlier in her remarks, but this additional reference may help to enlighten us on this one. She states: "Clients receiving services at home are not just those that require a low level of service. In fact, a significant number of persons with very complex care needs are being cared for at home. In fact, 23 percent are assessed at the very highest levels of care. Unfortunately, the corollary is also true, where 27 percent of clients in residential care are assessed as having low care needs. What this really means is that with the right supports, those individuals could be cared for at home." Or, I might add, in a homelike environment.

I think the model in the past that the member was referring to, where she went into facilities that had higher levels of care being provided, isn't always driven by the needs of the patient, but rather it is what is provided in the facility. Where we start with this is looking at the needs of the individual patients. They do get an individualized assessment that is done under the direction of the health authorities, using new assessment tools that are standardizing that across the province. That goes back to an assessment tool that was

piloted a number of years back in North Vancouver and is now being used around the province to make sure we have consistency. Those patients may be defined as being intermediate care level 1, which is a very low level of requirement for health care services, right up through to extended care and dementia care, depending on the assessments that are done by the community nurses.

From there, again, they try to look at the needs of the individual seniors or their families to determine whether that individual would best be cared for in a residential care environment, in an assisted-living environment, in supportive housing with a health care service being delivered to them. As I mentioned, some of that, even for the most complex levels of care required, can still be done in very much a housing-type environment with the health care supports being added. Or in fact those individuals could be cared for in their own family home, again, with the health care supports coming in.

What we are saying in terms of meeting our targets on this, I think as the member indicated, purpose-built housing…. Again, I want to clarify that may be a conversion from a facility that was market housing in the past and that's been converted to an assisted-living complex. That would be purpose-built in my definition. It would be designed to recognize that a health care service would be provided to residents.

I think when we talk of access to 24-hour support, that is driven by the needs of the individual patient. It's saying that there are some patients that are going to need a visit by a community nurse on a periodic basis. It's not saying that a registered nurse is going to be camped outside their door 24 hours a day. It is basically recognizing the individual needs of the resident of that facility, and it is driven by the assessments and the opinions of the community nurses, using these assessment tools to determine what level of health care support that particular individual may require. It is very much driven by the needs of the individual, not simply coming up with some pigeonholes that we're going to move our seniors into.

One other thing I should add before I turn it back to the member is that when you look at assisted living, all of the assisted-living complexes that are being built in the province today and conversions to assisted-living model would fit into this definition of intermediate and long-term care. In the case of supportive housing generally, it may or may not fit the definition, because you can have supportive housing that is just providing safe, secure housing for those individuals and really has no health care component being delivered to it. We can't simply say all supportive housing that's being done in the province fits into this category of what we used to know as intermediate, long-term care. Some of it may, and again it depends on the degree to which there is a health care service that is being provided in that purpose-built housing.

J. Kwan: I guess one of the points that the minister made points out again that the information that was provided by the former minister of state for seniors is wrong, because the former minister of state for seniors actually stated that 3,500 supportive living units will be counted towards the 5,000 new intermediate and long-term care beds.

Now the Minister of Health Services is saying: "No, not necessarily so." Assisted-living units will be counted towards the 5,000 new beds because those will have the three criteria of purpose-built, designed with the ability to provide health care services and access to 24-hour support to meet health care needs. Those would be assisted-living units, but supportive living units may not necessarily have those three conditions and, therefore, may not necessarily be part of the 5,000 new intermediate care and long-term care bed commitment.

So, the former minister of state for seniors is wrong on that score. She was wrong on the conversion score, and she is wrong now on the supportive living units score. Am I right? Maybe I'm just getting confused because I'm building my questions based on what the former minister of state for seniors has stated. It seems to me that as we continue with this discussion, new information is coming forward to repudiate what the former minister of state for seniors has stated.

Am I right in understanding, then, that she's wrong in saying that 3,500 units of supportive living units will be counted for the 5,000 new intermediate care beds? That's wrong. Only some of them may. Some of them may not, but all of the assisted-living unit beds will be counted towards the 5,000 new intermediate and long-term care bed commitments.

Hon. C. Hansen: As I think I mentioned earlier, at no time did we write this commitment down in 2001, saying that this is going to be the precise breakdown. Quite frankly, I don't think it would be appropriate for us to lock ourselves into a model that says there are going to be X number of these and X number of those, because we are trying to be flexible to meet the needs of seniors in communities throughout the province.

So the exact mix of what is complex care, what is assisted living, what is supportive housing with a health care component to it…. That whole mix is still evolving because we are working with the communities. We're not coming in here pretending that we have got sort of the magic recipe that's going to meet the needs of seniors all throughout the province. We're trying to be sensitive to the needs of individual communities and to make sure that we can meet their needs as we go forward.

At this point, I honestly can't tell you what the tally is going to be at the end of 2006 in terms of what might be categorized as assisted living or what might be categorized as complex care or what might be categorized as supportive housing with a health care component to it. I know that the previous minister gave a breakdown at that point in time. What I'm saying to the member is that we are trying to be sensitive to those particular needs.

I think, when the member was talking about the initiatives, the specific 3,500 supportive living units

that are being developed by Independent Living B.C.… That is the number — 3,500 supportive units. Of those, 1,000 have rent supplements attached to them as a way of meeting the needs of seniors in those communities.

J. Kwan: Well, this Minister of Health Services is not providing how the 5,000 new bed commitment would break down. He is not providing that, but the former minister of state for seniors provided that information. We canvassed that last year. She broke it down, so now I'm trying to establish…. The information that she gave, it seems to me, is erroneous.

It seems to me that what this Minister of Health Services is saying is: "Those numbers — disregard them. The definitions or the terms that are being used — disregard them. They were wrong. Here is the lay of the land now." If that's the case, all I ask from this minister is to tell me that is the case so that I can move on, because it is confusing, truth be told — what the former minister of state for seniors has stated and put in writing and put on record versus what this minister is now saying. Am I right in understanding that the 3,500 units of supported living units that the former minister of state for seniors has said would be counted towards the 5,000 new intermediate and long-term care beds is wrong? Let me just ask that question.

Hon. C. Hansen: I think I have to come back to something I said before. That is, when we talk about the net increase of 5,000 beds, I cannot and will not be able to go around the province and hang a little tag on the front door of a senior's assisted living and say that this is actually one of the net increase. You know, what we are saying is that by the end of 2006 there will be a net addition in the province of housing facilities for seniors that have a health care component designed into them or that are purpose-built facilities that would fall into what we used to know of as intermediate and long-term care in the province. At the end of the day, we will hit that target.

I think, as the previous minister was reporting on almost a year ago, she gave a breakdown of some of the progress towards achieving that goal, and she talks about the 3,500 units that are coming from B.C. Housing. If you want more details on the specifics around that, you may want to canvass the Minister of Community, Aboriginal and Women's Services when we get to that stage.

Our responsibility, in terms of the Ministry of Health Services, is to look at the facilities that are purpose-built and where there is a health care service being provided to it. That is what my responsibility is and the Ministry of Health Services' responsibility is. We are working with those various organizations to make sure that happens. If you go back and look at what the minister said almost a year ago, of the 3,500 supportive units, 1,000 are with rent supplements, 1,500 are newly built apartments and 1,000 are conversions. That is one of the programs that come out of Independent Living British Columbia. Independent Living British Columbia is a partner with us and with the health authorities as we move forward. There are other partnerships obviously. That's not the one and only program that is being put in place towards achieving that goal.

I think the minister, a year ago, was trying to provide an update in terms of progress that has been made on that particular front towards meeting our 5,000 goal. Clearly, we have a lot more initiatives that are underway and will be underway to make sure we achieve that target. A lot of it is programs that don't really require the direct intervention and initiation of government — whether it is through B.C. Housing or through the health authorities — because what we see is that the private sector is recognizing there is a market they have to build towards. In many cases, those projects get underway, and they will start working with the health authorities around the availability and how they can design those facilities so they support the needs of community nurses, for example, that may have to come in to provide that health care service.

There's lots of work being done. Can I paint for the member the absolute picture as to how the tally is going to look at the end of 2006? No. Am I confident we're going to meet the goal of an additional 5,000 beds in the province through those various players coming to the table? I am confident.

J. Kwan: Let me just be clear, because the former minister of state for seniors made the statements about the 3,500 supported living units in the context of the 5,000 new beds. I can appreciate that they're new programs and different programs, and they are all sort of happening across government and so on. Some of them would apply towards those 5,000 new beds, and some of them would not.

This minister, Mr. Chair, just clarified that what would not count towards those 5,000 new beds would be supported-living units necessarily, because some supported-living units may have the conditions I laid out and the minister laid out earlier and some of them may not have those conditions. When they don't have those conditions, then they would not be counted. Those units would not be counted towards the 5,000 new beds.

But what the former minister of state for seniors stated was that the 3,500 units of supported-living unit beds would be counted and are, in fact, considered part of the 5,000 new beds. That's where I believe, based on today's discussion, she was wrong.

She was wrong on that information, just like she was wrong on the information about the 1,000 conversions of health developments, which I take to mean institutions — health institutions, existing health-related facilities. Those conversions would not be counted toward the 5,000 new beds, but she'd accounted for them in her information that was provided to the public on May 22, 2002. If I am correct with this information, then we can start anew with where this minister now is saying where we're going.

That's what I'm trying to establish, because it is confusing when you have a former minister giving you information that happens to not coincide with what this minister is now saying today. And in addition to the base, I will take…. Unless this minister stands up and corrects me, then I will take what the former minister of state for seniors has said about the 3,500 supported living units — that that's incorrect information…. I will take what this minister has now stated in this House to be the correct information and start with that base.

With that, let me ask the minister this — because, again, this is information that the former minister of state for seniors had provided. That is that the base number that the ministry is working with is roughly about 25,000. Am I correct in understanding…? Well, is the former minister of state correct in making that statement — that, roughly, the base number in terms of beds that we're talking about is about 25,000?

Hon. C. Hansen: This was a challenge to try to get that benchmark number, but that is still the number that we're working with.

J. Kwan: I'll have more to go on in terms of the numbers, particularly, and I'll give the minister a heads-up now with this information that I will be requesting. He had advised that during this debate, he can't predict what will happen by 2006 in terms of how those 5,000 new beds would break down and what it looks like and what are the components within it. But perhaps he could, after the break, give the information on what it is now, in terms of the lay of the land now. We're only a year and a half away from the election, and that is the commitment to which, presumably, the public will have some level of measure in terms of how this government is doing in trying to meet that commitment by 2006. If the minister can provide that information after the break, then we can carry on the discussion.

Noting the time — I do get carried away, and there are lots of questions here around this — I move that the committee rise, report progress and ask leave to sit again.

Committee of Supply B, having reported progress, was granted leave to sit again.

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