Committee of Supply

Proceedings in Section C

ESTIMATES: MINISTRY OF HEALTH

(continued)

On Vote 31: ministry operations, $22,042,385,000 (continued).

The Chair: Good morning, everybody.

I’d like to start by recognizing that I am participating today from the traditional territory of the Lək̓ʷəŋin̓əŋ-​speaking people, now known as the Songhees and Esquimalt. I’m very privileged and honoured to live and work on their land.

We are meeting today to continue the consideration of the estimates of the Ministry of Health.

Minister, did you have any opening remarks today?

Hon. A. Dix: I’m ready to go.

The Chair: I recognize the member for Richmond South Centre.

L. Reid: Thank you very much, Madam Chair. I want to begin by making some opening remarks. Please allow me to express my heartfelt condolences to those families and caregivers impacted by COVID-19. British Columbians have felt such anguish for their loved ones during these unprecedented times.

During my opening remarks, I will take a moment and reference an article written by Jim Mann and published in the Vancouver Province on May 24, 2020. It was my pleasure to recognize him recently as a recipient of an honorary doctorate from the University of British Columbia.

He writes in his article, which was published on May 24: “Long-term-care residents provide urgent lessons.” He talks about person-focused care, resident-focused care and how we can be kinder to folks as they experience these unprecedented times. In fact, we’ve seen examples of iPads and tablets aiding communication between residents and family and friends through this period of isolation.

I think the minister and I would both agree that loneliness is certainly an issue in care and only compounded by these unprecedented times. Creative thought and a little patience, it would seem to me, would be all it would take to provide quality of life to our long-term-care residents. This must be part of a new vision for nursing homes after the pandemic.

The time to change the model of care to be resident-focused with long-term-care staff recognized for their skills and abilities is now. I know we can do better. It’s time we talked and acted. That will be the tenor of my remarks as we go forward: how we make changes that will, in fact, improve the lives. For me, it’s about quality of life, no question.

My thanks and gratitude to Minister Dix and to Dr. Bonnie Henry and deputy minister Stephen Brown. You have delivered a unified message in tumultuous times. Please extend my thanks to your staff as well.

You will know the official opposition has called for independent review of seniors care in British Columbia. There are some lessons to be learned in these times, no question. But there are also models of care to be explored, and that work shouldn’t wait. Introducing vibrancy and stimulation into seniors care is necessary. Weaving previous lives into care delivery is necessary.

I have received much correspondence on the need for family councils, and I know the minister has as well. Certainly I take a moment to recognize the work of Cheryl Fraser, residential family care councils, and all her correspondence to both of us.

The minister continues to make decisions in seniors care based on who pays the bills. Services delivered by people with the same training do not garner the same response. Quality of care is not determined by whether it is family or the public who pays for the service. In the words of the federal Seniors Minister: “When seniors are respected, valued and included in our communities, their health and well-being is enhanced, and our communities benefit.”

I believe the same with the workers who share their lives with seniors. I look forward to the minister’s comments, as I know he’s received much correspondence in this regard of which I’m happy to put on the record.

[9:35 a.m.]

We believe British Columbians should have a choice when it comes to seniors care. It is interesting to note that we are discussing a hybrid care model in B.C. during a hybrid legislative session currently underway in our province.

The federal government stepped up to provide a $4-an-hour lift in pandemic pay, and this provincial government is restricting who receives that lift. I’m wondering how the minister justifies discrimination against employees with the same education doing the same work, often side by side, yet receiving a different hourly wage during this pandemic. Out of 88,000 long-term-care workers in our province, approximately 31,000 of these hard-working people are not eligible for full pandemic pay. Disrespecting one-third of the workforce is simply wrong.

Additional costs associated with this pandemic include PPE and increased cleaning costs. Some reports cite a cost of $8 to $11 per day, per resident. In other provinces, operators or care homes receive reimbursement monthly. I’d be interested to know why the minister has kept this sector waiting almost five months in British Columbia.

I understand the Interior Health Authority has agreed to advance dollars to sites in amounts of $40,000, $60,000 or $80,000. Can the minister confirm these amounts and provide criteria and a timeline for these allocations? We will return to these questions during the course of this debate.

The independent living sector is a benefit to health authorities. British Columbian seniors deserve to have choices on where they reside. We would appreciate those choices in our own families. I thank the minister for the changes he made in offering families the choice of three care homes in the long-term-care sector. The minister knows that the independent living sector was required to comply with the single-site order and costs related to that order but have not since been told…. They are not eligible for pandemic pay.

In these unprecedented times, there have been many domino effects. The sectors are to be commended for pulling together around labour adjustment. It was uplifting for me to visit care homes in each of the health authorities last autumn. The care and diligence shown to residents and their families warmed my heart. I’m grateful to those who deliver care in our province, often under very trying circumstances. To see the bond between caregivers and residents is to be applauded.

Many of our seniors rely on their caregivers for connection and care. Many seniors outlive their family members, and many family members reside in other provinces. Loneliness has long been a factor in care delivery, and it’s hugely complicated by this pandemic. Therapeutic partnerships with families during these unprecedented times are important. What steps have been taken to honour that bond between family members? Can the minister tell this House how many visits have taken place in each health authority since resumption of visitation was announced?

The minister has spoken of $160 million for care homes to hire three additional staff members. Can the minister provide a status report as to the new hires? How many operators in each health authority will receive this new funding? And re the opening of adult daycare, does the minister have a plan or a date when adult programs in each health region will reopen?

Much of this discussion is about who cares for the caregiver. Can the minister update the go-forward plans with respect to respite care?

B.C. health human resources will continue to challenge our province. The single-site order has highlighted the need for increased training of health care aides and health care assistants. I asked the minister in last year’s estimates how many high schools are delivering the health care aide curriculum. I’d like to know the number of graduates in each of these programs. Accolades to the B.C. care providers who are stepping up delivery training programs.

Wage-levelling has started. What is the methodology to get those dollars into the hands of operators as quickly as possible? Other provinces have been paying these costs monthly, i.e., Alberta and Ontario. What has allowed for the delay in British Columbia?

And we’ll certainly have some questions on how regularly care homes are inspected.

I will conclude my opening remarks by recognizing the senior COVID response hub workers across British Columbia. In Richmond alone, Richmond Cares, Richmond Gives processed 200 senior referrals, shopped and delivered 839 grocery orders, delivered 960 frozen meals and provided 22 prescription pickups and deliveries. Their volunteers completed 301 phone check-ins and 227 virtual visits and much more. Thank you to Ed Gavsie and your legions of volunteers, and thank you to the myriad of volunteers who delivered this program across the province in 24 different hub locations.

Minister, I look forward to the estimates debate. Ultimately, this debate is about quality of life.

I will take us through to noon. The members for Vancouver-Langara and Cariboo North will follow this afternoon.

I put my concerns on the record, Minister. I thought his staff would have some time to review those while we start with the questions, unless he wishes to make a response at this time.

I’m in your hands, Madam Chair.

Hon. A. Dix: Just a few things to start. We’re, I think, referring…. The member suggested that we were being disrespectful in some ways. I think the reality is exactly the opposite of that. And, I gather, disrespectful in comparison to other jurisdictions. So what I would say about that is that I think from the beginning, we’ve operated from a principle of respect in every way.

[9:40 a.m.]

There has never, from us, unlike many other jurisdictions in Canada, ever been any blame expressed to anyone. We have worked together with everyone. We’ve had a team B.C. approach with respect to long-term care, and we’ve done things before other jurisdictions that made a real difference in people’s lives. I say this understanding that 110 people have passed away in long-term care since the beginning of the pandemic, including one that we announced yesterday.

This has been a difficult and challenging time for everybody, but from the beginning, we’ve engaged with all of the partners in care. We’ve treated people with respect. We’ve had regular meetings and engaged with them. We’ve included long-term-care homes, for example, in the PPE supply chain of the provincial government, significantly, before other jurisdictions. That was important.

We provided direct supports for what you call capital or other costs to the B.C. Care Providers Association and their EquipCare program in advance, early on in the pandemic. We provided supports directly for extra costs between April and June, during the pandemic. We instituted a single-site policy that was entirely paid for and has been entirely paid for by the provincial government, which lifted the wages and allowed us to fully implement an extraordinarily complex single-site arrangement.

As the member will know, we didn’t just receive reports on long-term care. We acted on them, including in a special…. There were reports from 2008 and 2012 with respect to staffing in long-term care, which were raised up at the end of this fiscal year to 3.37, on average, hours per resident day, which meets the provincial standard, a promise that was made in 2008.

All of that is about respect — respect for everyone, respect for the opposition, respect for the care providers, respect for Denominational Health, respect for those who work in health care, whose rights, whose labour rights, which had been stripped from them, were restored by unanimous vote of this Legislature in 2008.

While I appreciate we have debates here, what we’ve tried to do in everything we’ve done in long-term care, in this extraordinary time and before it, is to operate with respect for everybody — the providers, the workers but, most especially the residents of long-term care, the residents of assisted living, the people who receive home care and home support, the people who go to adult day programs.

I think that that context, that requirement of respect and that requirement to ensure that people are able to live their lives, even sometimes as their health leaves them, in a respectful way and to the full extent of their liberty, is what has guided our seniors policy since I’ve become minister. I know because…. We frequently talk about these things — and the member from Richmond East. We speak about them and the importance of those things. These principles of respect are things that she shares and believes in as well.

I would just say that I think that sometimes there’s a question when there are disagreements about policy matters that suggests that people aren’t being respectful. I think our entire record with respect to seniors care can be summarized by the word “respect,” and I would suggest that’s an important principle to keep in mind.

L. Reid: I thank the minister for his remarks. He will know that the disrespect has been felt by individual workers in the system today, who work side by side. Some are receiving full pandemic pay, and some are not. He knows that. He has received correspondence. I have been copied on that correspondence.

That was the point, and if it’s not well taken by the minister, perhaps he needs to review the correspondence. That disrespect is being felt by individual care workers today in long-term care, who have workers, side by side, doing the same work with the same credential and not receiving the same pandemic pay.

I’m happy to continue. The minister has continued to provide $26.5 million to cover additional COVID-19 expenses incurred by care providers between March and June, such as purchasing additional PPE and enhanced infection control measures.

Can the minister please tell me how the government calculated the $26.5 million per year and what is considered an eligible expense?

[9:45 a.m.]

Hon. A. Dix: On June 30, 2020, the government, as the member will know, announced a new visitation policy. She’ll recall that on March 17, the provincial health officer and myself announced the limits on visits to what were defined essential visitors in long-term care at that time.

During the period of April to June, we did ask care providers who provide public long-term-care beds in B.C. to keep track of costs and so on. So we provided, on June 30, when we made the announcement, a series of substantive measures in addition to, of course, the considerable investment in the single-site order that we had made to address costs related to COVID-19 expenses from March to June.

The funding was intended to address cost pressures that were cited by operators: additional screening, for example, so that only those approved enter facilities, which is obviously a cost; costs incurred due to sick time and to self-isolation; costs related to increasing reporting requirements; costs for changes in services, for example, delivering meals to rooms or staggering meal times to ensure physical distancing, which was a challenge; additional housekeeping and enhanced cleaning; and infection prevention and control costs.

We also announced, on that day, $160 million for long-term-care and seniors assisted-living operators to hire up to three FTEs to support visitation and ensure infection prevention and control measures were in place to ensure that the expansion of visitation, which is obviously a singularly important thing to the lives of people in long-term care, is maintained. With respect to the $26.5 million retrospectively, those are the costs it was designed to address. That came as a direct request from providers and covers some of their costs during that time.

I might also note other costs, as the member will know, in general — things such as PPE. Under the way that we contract long-term care and have done for a long time with private care providers, be they profit or non-profit, those costs and, in fact, the obtaining of those things have generally been viewed as the responsibilities of the care home. In fact, they’re contractually viewed that way.

Clearly, during this period of COVID-19, those supply chains, for everyone, for the province and for everyone else, were interrupted. So the provincial government included long-term-care homes, private and non-profit long-term-care homes, in our supply chains for PPE.

As of now, and in this period, that PPE has been provided without payment or without cost to those homes so that we can ensure the protection of the residents in those homes and the workers that work in those homes. That was an approach in British Columbia that was taken only later in other jurisdictions and, I think, is generally viewed as an innovation and an idea that was, of course, generated by people such as Denominational Health care providers and the Hospital Employees Union, but was implemented by our government and by action of our provincial health officer.

L. Reid: I thank the minister for that answer. I’m not certain that I heard how that $26.5 million sum was arrived at. I’ll reference, again, Alberta. They’ve set aside $14.2 million per month, which is roughly double what we have set aside. So give me a sense, again, of how the $26.5 million figure was arrived at.

Hon. A. Dix: Again, I would suggest that if we want to make apples-to-apples comparisons to other provinces, I think the member would do well to remember that the single-site order, which is an annualized cost in the neighbourhood of $165 million a year, is being picked up entirely by the province of British Columbia. That’s because we believe that that protects seniors and protects workers and will bring about a better seniors care system during this time of pandemic.

The system that had developed principally over the previous 15 years with dozens and dozens of collective agreements and a significant amount of chaos, with respect to the staffing of care homes, was the wrong model to engage in, in times of pandemic. I believe it’s the case that the provincial government in Alberta gave some small stipend to try and encourage its orders, but nothing like what we did in B.C.

[9:50 a.m.]

If the member wants to compare us to other jurisdictions, we can have those comparisons, I suppose, but we’d do well to include all of the elements of comparison. I think the record of British Columbia in supporting long-term care — the record in terms of visitations, the record in terms of providing direct and retrospective support, the $10 million to what used to be called the SSQIP program, the support for PPE and the support for single-site — represents an extraordinary investment. I suspect it’s more than comparable to any other jurisdiction in the country.

I’d be happy to talk about the block funding system that arrived at the $26.5 million. It’s allocated by health authorities in a block grant, based on the number of beds in a facility. I’d be happy to share it in detail. I could read all of it into the record. It would probably take five to ten minutes with all the different allocation amounts, but I can give the member the numbers by health authority.

That’s $4.9 million in Interior Health; in the Fraser Health Authority, $2.97 million, and this is for long-term care; $320,000 in the Northern Health Authority, understanding that in Northern Health, it’s principally supported as health authority–owned and –operated, which would have received funding in a different way; $3.41 million in the Vancouver Coastal Health Authority; $3.98 million in the Vancouver Island Health Authority.

Equally, with respect to assisted living, that’s $3.21 million in the Fraser Health Authority, a total, for both, of $6.18 million in the Fraser Health Authority; and $3.15 million in the Interior Health Authority, for a total, combined with long-term care, of $8.11 million. It’s $600,000 in the Northern Health Authority, for a total of $920,000; $1.65 million in Vancouver Coastal Health Authority, for a total of $5.06 million; and in Vancouver Island Health Authority, in assisted living, $2.33 million, for a total of $6.31 million.

That’s a total long-term-care and assisted-living allocation of $26.52 million allocated through block grant, which provides, I would argue, a much simpler approach, and much simpler to receive for facilities as well, than detailed application processes. That’s the allocation by health authorities. Should the member wish, I can certainly provide this to her. It includes the different block grants, the number of facilities and the amount given for less than 50 units, for 50 units to 100 units, and then for over 100 units. That’s the nature of the distribution of the money.

L. Reid: Thanks to the minister. If you don’t mind, Minister, I’d be pleased to receive that at your convenience. That would be excellent.

You referenced that that was dollars payable in March through June. Will there be additional coverage for those expenses after the end of June as care providers continue to adapt to COVID-19?

Hon. A. Dix: As the member knows, we announced the $26.5 million retrospective, in addition to, over that period, roughly $37 million to $45 million for a single site and $10 million for the SSQIP program. I think I detailed on Monday at a public briefing the very substantial costs that we have spent on personal protective equipment. That includes long-term-care homes in our supply chains.

On the day that we announced the $26.5 million, a further $160 million in addition to all of that — which, I have to say, is a staggering sum but an important sum of money — to support infection control measures and additional infection control measures. That represents, on an annualized basis, about $13.33 million a month, I believe — I might be wrong on that; anyone who has a calculator can divide 160 by 12 — in terms of additional resources.

[9:55 a.m.]

We’re continuing to work through this with the people who work with us in the sector. I think what we’ve seen here is a response commensurate to the importance of the issues. I’d add to that, of course, the ongoing and increasing funding to meet the 3.36 hours per resident day, which I’m sure we’ll be discussing shortly. If you look at it in the balance of things, that’s a record, in addition to, I think, the extraordinary measures we took collectively on infection control.

I particularly want to highlight in that regard the work of Vancouver Coastal Health and its medical health officer, Dr. Daly, and medical health officers across the province, but especially Vancouver Coastal Health. The member will know, from the work that’s been done by Dr. Henry and our public presentations — it should also have been sent to all of the caucuses in B.C. from the provincial health officer — that we faced a situation of transmission of COVID-19 in B.C. as a result, largely in long-term care, of travel back and forth to Washington state in March. That hit Vancouver Coastal Health first at the Lynn Valley care home and then at Haro Park and Royal Arch Masonic.

I think the staff of Vancouver Coastal Health — in every case working closely with the care home operators — did a phenomenal job under the circumstances. Still, there was a very significant cost. There was the investment. There were the policy decisions that were made early on. I think there has been a team B.C. approach. We’ve worked closely with them, as we will continue to do as the pandemic goes along.

As everyone knows, while we’ve added visits in long-term care, the situation is far from returning to normal. We are still in a pandemic that has the consequence, for people in long-term care, of significant risk to life, as 110 people, or approximately 22 percent, of those residents who had tested positive for COVID-19 in long-term care have passed away. That is something that, obviously, is very affecting for everyone involved, from families and friends to communities, care workers and operators and to me.

L. Reid: I thank the minister for his response. Can he tell me how much of that dollar — what percentage of that dollar — is actually in the hands of operators today?

Hon. A. Dix: Well, I’m not sure what the member means. With respect to the dollars spent, for example, on PPE, those dollars have flowed, obviously. They’ve been paid for by the province of B.C. and the taxpayers of British Columbia.

With respect to the 3.36, that money has flowed consistently and disproportionately; 86 percent of 3.36 amount dollars has gone to private non-profit and for-profit care homes to increase staffing standards, which were, in many cases, dangerously low. That money has flowed.

The $26.5 million will be flowing soon, and the care providers know how much they’re going to get, by institution, from that base of money. That money, to long-term care and to assisted living, will be flowing soon.

With respect to the moneys for single sites that go through the operators to workers, to essentially raise workers who were below the HEABC amounts, that money is likely to flow in August, remembering, as the member no doubt does, the complexity of the care system that had been established, including dozens and dozens, just under 100 collective agreements that had been put in place subject to the changes from 2002, which the member would be aware of. That money is taking some time to flow, but the money is retroactive. The workers know that it will be coming, and it will be coming shortly.

The $10 million for EquipCare flowed on March 31, 2020. Certainly, the hiring under the $160 million proposal will happen. As the hiring occurs, we’ll have more to say. That will require, of course, a significant recruitment of new workers in long-term care. We’ll have some announcements to make about that in the coming week or so.

[10:00 a.m.]

The money is available and has been made available. Very importantly, the PPE and other things have been made available to care homes. Of all of that money I’ve listed, some, of course, has flowed, and some will be flowing. I think the pandemic pay, which the member has referred to, will flow, also, in August.

The member referred to it as a federal government proposal. It’s a federal and provincial government proposal. It’s a matching grant proposal. Nowhere in Canada, I believe, has it been distributed so extensively, if I may say so respectfully, as in British Columbia. Many of the workers are receiving that coverage in B.C., and other jurisdictions are not receiving the pandemic pay at all.

That’s the approach, and that will happen in August. The reason for that is it requires the calculation of paid hours, which we have to do accurately. People would expect us to do so.

All of that demonstrates a respect, as I say, for workers and for care operators, who we meet with on a weekly basis. Our senior staff — including our assistant deputy minister, Teri Collins, who has done an outstanding job in this period — meet with the Care Providers, the Denominational Health Association, the B.C. Seniors Living Association, SafeCare B.C. on a regular and ongoing basis. I’ve met with them, of course, and the Deputy Minister of Health is in regular contact as well, both with individual organizations and groups.

L. Reid: I thank the minister for his response. He will know that there have been operators struggling since March to cover those costs. So I appreciate the response, when he says soon.

Can I assume that any of that dollar will flow to them by the end of July or that all of that dollar will flow to them by the end of August? They deserve to know the timeline.

Hon. A. Dix: I wasn’t sure if that was a question.

We’ve been in regular contact with them about additional expenses that have been arrived at during the COVID-19 pandemic. I think we really should remember the extraordinary and rapid response that has taken place. I know some people sometimes will say: “Not soon enough.” But a rapid response, not just by the government but by care providers in this area.

The care providers and everyone involved know exactly the situation with respect to these grants. We have regular meetings, and we consult with them. I think the very positive response from the Care Providers, Denominational Health and the Hospital Employees Union and many others to our announcements on June 30 and our previous announcements reflect that.

L. Reid: I agree with the minister. They have appreciated the announcements, but they still have maintained to me that what they’re concerned about is the dollars have not found their way into the hands of the operators yet.

I know the minister has now referenced July, and he has now referenced August. Can he confirm that those dollars will be in their hands by the end of August?

Hon. A. Dix: I referenced different times on different funding sources. The $10 million to the B.C. Care Providers arrived on March 31, 2020. The moneys around the 3.36 have been arriving consistently and throughout the time. They’ve been expensed, and they’ve been disproportionately to private and non-profit care homes. I’m very thankful. I think everyone’s very thankful that those reforms occurred.

The funding from the $26.5 million should arrive shortly. I would expect it to arrive this month.

With respect to the money for workers, the reason why it takes a long time to deal with a single site is the sheer complexity of a system that has relied on subcontractors and different contract rates for a long time. It takes some time, under those conditions, to calculate. That process has been led by HEABC, and I think it’s an effective process.

That money will be in the hands of workers, which is important. Knowing that money is in the hands of operators is important but so is money in the hands of workers. It will be in their hands, we hope, in August. Really, it’s the complexity of the system. We want to, obviously, distribute the money appropriately and to raise salaries up. That’s when that will happen.

[10:05 a.m.]

There are different funds, and the flow of money is significant and has been significant. The member will know that significant improvements in care standards in long-term care but also in care hours and other parts of senior care have occurred. That money has consistently flowed.

This has been, as everyone knows, a worldwide pandemic. I think the response of the government has been consistently expeditious. We’re working patiently and in touch regularly at a minister level, a deputy minister level, an assistant deputy minister level, at a staff level, at a health authority level and with operators.

Obviously, there have been challenges, and no one suggests otherwise. When you have circumstances, such as the one that exists currently at Holy Family care home, where 32 staff members have tested positive for COVID-19, those situations are very disruptive and difficult. But I think people have, in those circumstances and others, worked extraordinarily hard under those conditions.

If the member is saying that there are some operators who are unhappy about what’s happened, I accept that that would be the case, and I know it’s been very difficult. But I would also say that the response on the long-term-care crisis in British Columbia has been an exceptional response. It’s not because of me, but because we’ve taken a team B.C. approach, and that’s been reflected in everything we’ve done.

L. Reid: I appreciate the minister’s remarks. He will know I referenced earlier that some province’s have chosen to make a monthly payment as opposed to a one-time-only payment.

I would ask the minister that if, indeed, he’s not able to meet the July to August one-time payment, that he, indeed, top up some of those operators so those dollars can be in the hands of workers. He and I are on the same page when it comes to workers who are feeling completely compromised, having been promised those dollars three, four, five months back and still not seeing a single dollar in their hand.

If he can turn his mind to perhaps topping up some of those situations today, as they work through the very complicated process, I would appreciate that.

Hon. A. Dix: Well, five months back was February. In any event, we made a commitment around the single-site proposal. We are delivering on that commitment. Money has been set aside. The reason it’s taking a long time, if we want to have a discussion of that, is because there are close to 100 collective agreements, subcontractors, and that’s the nature of the long-term-care sector that I inherited as Minister of Health.

Part of the challenge with that was Bills 29 and 94, which were the means by which that system was put in place. We, by unanimous vote of the Legislature — the members supported that, and I appreciate that as well — got rid of Bill 29 and got rid of Bill 94. Their effects were pernicious not only on workers but on the whole sector. Certainly, this pandemic has exposed some of those challenges.

When we announced the single-site proposal in April, that it would be fully applied…. Week after week after week, we brought forward the progress we were making in detail at public press conferences. We said that from the day that order was applied by a medical officer of health to the provincial health officer that that pay would be raised for all of those workers, the tens of thousands of workers, who were getting paid sometimes substantially below the HEABC levels.

Yes, there are complications in that. But those complications are the complications of the system. Those workers are going to get that money, and it’s money that they deserve.

By the way, if we’re talking about the cost of that, the $15 million a month, or just under $15 million a month — between $10 million and $15 million, adding up to $165 million a year — I would note that that money is the amount below HEABC wages, as a result, largely, of the structure of the system before that — that workers were being paid every month, in advance of that.

L. Reid: Five months ago, Minister, was actually March, as we go forward. So anything you can do would be much, much appreciated.

[10:10 a.m.]

Moving on to the single-site order. Early in the spring, the provincial health officer issued orders for the staff movement between long-term-care homes, and now all care staff have been assigned to a single site. While there is consensus that this is the right thing to do under these extraordinary circumstances, these orders do infringe on the ability of care workers and may pose challenges for care homes looking to fill vacant shifts.

Has the minister been happy with the outcome to date, and is there any site still operating with workers attending multiple different sites?

Hon. A. Dix: The single-site order, of course, as noted, took a while to fully implement. It involved 8,800 workers working at multiple sites across 501 facilities. The member will know that that single-site order, which initially came at particular sites as early as March and then later across the health care system, took some months to apply, but it is fully applied now to those 8,848 workers.

I think that’s a singular and significant achievement of the health care system. We went week by week. As members will note, that order applies to long-term-care and to assisted-living facilities.

Just in terms of the cost, our estimated cost is more precise. I said $165 million; it’s $162,248,861 in overall costs. That relates, of course, to the raises on an annualized basis. That involves the raising of salaries to HEABC levels, which was one of the key elements of it. That doesn’t, of course, apply just to the 8,848 workers who are at multiple sites. It also applies to other workers at that site.

You couldn’t have a situation where you insisted on single-site and people were working under one of the many, many different collective agreements, some considerably below the HEABC level. You would never have anyone working at the sites that had the lower pay, if people had to choose between the sites, if we hadn’t put in place that single-site measure. It’s why single-site has worked more effectively in British Columbia than anywhere else.

I believe that the single-site order is complied with. That doesn’t mean that there aren’t health care workers working at multiple sites, particularly in acute care. But in the long-term-care system, the single-site order, according to the Ministry of Health — for 100 percent of employees previously working at multiple impacted sites, the 8,800 across the 501 sites — has been applied.

L. Reid: Can the minister comment on the scope of the single-site order?

Many have noted that while health care workers are limited to working at just one long-term-care home or assisted-living residence, no such limitation has been placed on acute care hospitals. This means that a worker could work a shift at a COVID ward in a hospital and then cross the street to pick up a shift at their local care home.

Will the minister support an order to expand the scope of the single-site orders to include acute care?

Hon. A. Dix: As the member will know, we’ve faced a very significant challenge in long-term care. The member will also know that in the thousands, I believe….

Between 5,000 and 6,000 people died in long-term care in the jurisdictions of Ontario and Quebec. They don’t even count those numbers in the United States anymore. They are staggering, and they are very affecting. And 15,000, I understand, in France. So we took action in long-term care because the system of long-term care forced workers to work in multiple sites.

Even the changes of Bill 47 and the changes that we’ve brought forward to increase staffing in care homes, where we often and significantly transformed part-time workers into full-time workers, had left a situation where we had 8,800-plus workers who were working in multiple sites. So the reason the focus on long-term care was there was that it was a dramatic situation in long-term care.

We are looking at acute care as well, although the situation in acute care is somewhat more complex. The member will know that many doctors and nurses, in the ordinary pattern of things, would work at multiple sites and at multiple acute care sites — from specialist doctors to others — so the situation is more complex. We continue to review that as we review outbreaks and the risks of COVID-19 in acute care.

[10:15 a.m.]

I’d also note that the changes in the visitation policy that have occurred in long-term care have not yet occurred in acute care. We made changes in that visitation policy in May in response to advocacy, in particular, from the disability community, who had, I think, legitimate issues to raise. I was in touch with the member for Surrey South about that question and the member for Kelowna–Lake Country, who raised that question, in particular, with me. But in acute care, those limits on visitations continue to exist in general.

There are two areas that we are looking at: the areas of alternate level of care patients, because, effectively, ALC patients have a lot in common with long-term-care patients; and families with children in acute care who are there for extended periods. So we are looking at reviews of that. Those are part of the differential measures we take in acute care to keep those hospitals safe, with some exceptions.

People will note significant outbreaks at Lions Gate Hospital, a small outbreak at Richmond Hospital, an outbreak at Ridge Meadows Hospital, one at Abbotsford regional general hospital and a more recent one, in recent days, at St. Paul’s Hospital that have been declared.

We’ve had relatively fewer outbreaks in acute care, and the management of those institutions is slightly different than it is in long-term care. Long-term care is essentially set up to have multiple sites because, as the member will know, it was very challenging for workers in many of those sectors to support their families on relatively lower wages. That’s the system we had, and that’s the system we were responding to.

I think those decisions in long-term care and assisted living were the right decisions. The situation is one that we continue to look at, with respect to people who work in acute care and the risks involved in that. That’s why you’re seeing differential responses in the way we deal with an acute care hospital.

L. Reid: I thank the minister for his response. Understanding the complexities of this situation, is it the minister’s intention to make the single-site order permanent?

Hon. A. Dix: The single-site order I expect to be in place for a significant period. The COVID-19 pandemic has — as the member knows and as she’s probably heard me say several hundred times by now — no cure and no vaccine. So it’s my expectation that the orders of the provincial health officer and the orders of local medical health officers will be in place for some time.

This is also an opportunity for us to engage with the sector with respect to funding questions and to see, where there’s competition in long-term care, that this be about raising the quality of care. This is a fundamental principle that, I think, all of us who are involved in the question, from whatever point of view one has, have to focus on now — how we improve the quality of care.

For a long time, I think the only question was one of costs. This led to, of course, the circumstances that we knew in long-term care, where facilities, not necessarily of their own accord, were encouraged and incented to contract out, encouraged and incented to contract flip.

We need a different…. This is a different time. The pandemic has shown that in long-term care. We need a time where the focus of government contracts and its relationship with long-term-care providers is one of ensuring a higher quality of care, and that’s our focus. I think it’s the focus of the providers as well.

This lengthy period, where we’re going to see this order in place…. There hasn’t been an end to the provincial state of emergency, but should the provincial state of emergency end, the order will continue to be in place, as will, I expect, the public health emergency that will continue to be in place for some time. These are orders by the health officers. The reason is COVID-19. The reason is the vulnerability of people in long-term care. That’s why I would expect to see these provisions and these orders in place for a very, very long time.

[10:20 a.m.]

L. Reid: I thank the minister for his response. Revisiting a little bit, in terms of the pandemic wage lift, I know the minister talked about $13.3 million a month probably being something that would be closer to getting us to the $160 million or the $165 million. There has been some discussion about making this wage level permanent. Is that something the minister can comment on today?

Hon. A. Dix: I think, for the moment, that that raise in wage to the HEABC level will be concurrent, and is concurrent at the moment, with provincial health orders that will be in place for a long time. So as we plan, in this budget year we’re in, I have no expectation of a raising of those orders and of that policy in this fiscal year at all.

That question of whether to make it permanent and whether to see a focus in long-term care, as I said, on quality and not on a race to the bottom in terms of wages…. I think that’s a public policy that I generally support, and I think people in the sector do.

As I talk to people in long-term care, there are some of the same frustrations with the contracting system that was in place in many places at the time of the outbreak of COVID-19. They certainly expressed that frustration to me. I think people who run long-term care homes would like to run long-term-care homes and not have different groups come and join them together. Those are broader issues and ones that we’re going to be raising with the sector over the next number of months.

As the member will know, there have been multiple reviews of long-term care, most recently one published in January of 2020 by the seniors advocate, who makes a number of suggestions in terms of improvements to accountability both for health authorities and for providers. We’ll be working through those recommendations, as we have in other things, in partnership and in consultation with long-term-care providers, with assisted-living care providers where appropriate and with unions such as the Hospital Employees Union, B.C. Nurses Union.

L. Reid: Thank you to the minister.

The minister has referenced a review. Will he continue to support reviews to ensure that all care homes are appropriately funded? I certainly want to have a more detailed conversation regarding that on a go-forward basis.

Hon. A. Dix: I agree that when you have a public long-term-care system where people have some choice but not unlimited choice — there are 29,000 publicly funded beds — there is a requirement to have equal standards. The member will know this, and I think this might be leading into a discussion of hours per resident day.

I’ll just say that when I became Minister of Health, again having not been Health critic for a while, I was surprised that there were 75 care homes in B.C. funded under 2.9 hours per resident day, which is 0.46 hours below standard. Many of them were well below, at 2.7 and 2.69 — publicly funded beds, when there was a first-available-bed policy. So people did not have a choice as to where they would go. Publicly funded beds under 2.9. There were 75 publicly funded — public beds — care homes in B.C. that far below standard.

There are, as the member will know because we canvassed this last year, zero of those today — none, zero. There were a further dozen or so under 3.0, which is also significantly below standard. There are zero of those today. It’s why we focused 3.36 funding on private care operators, to raise care standards for public beds in private care homes up to close to public levels, because I believe in that. I don’t just believe in that. We enacted policies to put that in place, policies that I believe the member supports and members of the House will support.

[10:25 a.m.]

Absolutely, that’s the distinction, if you look at the results of that policy, of the movement from approximately — on average, provincially, including in public care homes — an average of 3.10 to an average, at the end of this year, of 3.37. A dramatic equalization such that 84 percent of the dollars, approximately, went to those private care homes, and only 16 percent of the dollars went to health care–owned and –operated care homes. I don’t just say that I believe that there should be common standards. We’ve actually acted to make it so.

L. Reid: Workers who are not in positions already funded by the government — i.e., seniors whose families pay for their care — are not eligible for the $4-an-hour pandemic wage lift. These include health care assistants, housekeeping or food preparation staff in homes that are either private-pay or a mix of funded and private-pay beds.

That was the point I made earlier, Minister. Workers side by side, same credentials, same job, often serving the very same patient, will not all receive the same benefit.

Workers [audio interrupted] for those who provide private home care or health and independent living services. All were impacted similarly by the pandemic and the resulting provincial health orders. Each of these employees provides the same or similar work as their counterparts in the publicly funded care homes or as community health workers.

I am asking that the minister commit to reviewing the eligibility requirements to include all front-line workers in the seniors care and the seniors living sectors for the one-time pandemic pay benefit, and I would ask if the federal government is aware that the province does not intend to pay for individuals who are not working in publicly funded facilities.

Hon. A. Dix: The pandemic pay provisions were fully negotiated with the federal government. As the member will know, they’re not just federal money. It’s provincial money as well.

Detailed questions about pandemic pay, of course, are in the purview of the Minister of Finance, whose estimates are coming up. But I am happy to respond, in the way that I try to do all the time, that we’ve applied pandemic pay more significantly across the board than in most jurisdictions. The principle here, not just in this sector but in others, is that publicly funded facilities would be eligible for pandemic pay.

There are other workers who I fully believe deserve our respect and deserve compensation — for example, people who work in the grocery sector and in other sectors. Some of those did receive pandemic pay from their employers, who received all of their money and are self-supporting businesses.

The principle that was employed here — and it was pretty consistently employed across the country — was to focus pandemic pay, through the provisions put forward and through the negotiations we had with the federal government and others, to publicly funded institutions. But not just direct publicly funded, so not just employees of health authorities but employees of Providence Health Care and employees of Park Place and employees of Retirement Concepts who work for publicly funded beds. That was the standard that we put forward.

There are, of course, always going to be limits and people outside of those limits of pandemic pay. Many, many people are deserving. But that was the balance that was struck here — that, in the case of fully privately funded institutions, with respect to the pandemic pay, that would be the responsibility of the employer. We took a broad view of our role as employer, in terms of long-term care, to ensure that funding was put forward to publicly funded beds across the province, whether they were public or private.

For the privately funded care homes, which are…. Well, they’re regulated institutions of the provincial government. The privately funded care homes, of course, could provide pandemic pay as employers, just as others could.

The decision was made to set that as a parameter. But I would say that it is a dramatically wider parameter than just about any other jurisdiction in the country.

L. Reid: Can the minister assure this House that, indeed, workers who work at centres that are funded and have both public-pay and private-pay residents will receive those dollars? I think the minister would agree that working side by side, sharing the same patient, working in the same home, deserves the same recognition.

[10:30 a.m.]

Hon. A. Dix: I think the rules are fairly clearly set out. In some institutions, there are people who do provide care in both. That’s part of the reason why the challenge in calculation is made.

The funding, though, for pandemic pay is related to a publicly funded bed. In contrast, the single-site funding we’ve put forward does not limit that, because the single-site funding that we’ve put forward and the single-site orders we’ve put forward involve private care homes. We ordered them to do so. In that case, we absolutely took responsibility for the entire sector.

The member will understand the distinction. In one case, this was an order of the provincial government, and one that I strongly believe in, needless to say — that health care workers should be paid appropriately, particularly in a time of pandemic. In that case, it was applied across the board. Those supports have been applied and will go to workers across the board under the Community Care and Assisted Living Act. That’s the distinction there.

With respect to the pandemic pay, it was — and sometimes this involves challenging calculations — provided by the federal government and the provincial government by agreement. In every province, it was applied differently. In B.C., it was applied extremely widely. Ours is one of the largest agreements there was. That was related to our decision to fund our share of the agreement. That’s how we did it.

Of course, if there are private care beds, that becomes — for the pandemic pay question but not for the single-site question — the responsibility of the employer.

L. Reid: What I take from the minister’s comments is that this government negotiated with the federal government to exclude workers.

That does not warm my heart. It certainly does not warm the hearts of those who work on the front line each and every day, side by side with workers who, indeed, will be receiving pandemic pay that they will not now be receiving. There needs to be some continuity when it comes to supporting workers who work in the same facilities and perhaps have a commingled seniors population.

I would trust that the minister will at least review his contention that somehow that is different work. It is the same work, and it’s valuable work. It’s respected work in our province, and I know that he respects those workers. How is it, indeed, he can ensure that those dollars are spread more widely to ensure that they all feel valued in the sector today?

Hon. A. Dix: British Columbia ensured distribution of pandemic pay that was dramatically wider than most other jurisdictions. It applies to everyone involved in publicly funded beds across the province. That was the decision that was made. Had we expanded it more, conceivably we could have done that to other sectors of essential workers who were not directly supported by the provincial government. But the intention of the pandemic pay program was that….

For example, I think all of us would say, and all of us would agree — all of us who shop at grocery stores — that those workers deserve additional support. Those workers have gone in. In fact, that occurred, as the member will know. Some grocery store companies gave $2-an-hour pay increases and bonuses and so on to their workers.

What I would say is that under the pandemic pay program, one could have imagined expanding the program in that way, just as one could in terms of private care in B.C., to include those workers. But what we did, which is an ongoing and longer-lasting program than 16 weeks, with respect to the single-site order…. It went across the board.

When the member says we negotiated to exclude people, we had the most…. We had a broad and inclusive pandemic pay proposal, understanding, of course, the continuing necessity to focus on people, from small business to people working in the private sector, who are suffering under COVID-19 and who are facing extraordinary challenges at present.

We have to balance off all of these considerations. There are always going to be criteria in any program. We had some of the widest there were. It was linked to, in this case, the publicly funded beds. That was the decision we made.

[10:35 a.m.]

We could have expanded it more broadly, I suppose — the idea of pandemic pay to other sectors and to other people who did not receive that pay. There are others who certainly have a claim to that and certainly feel they have a claim to that in the system. But this was the very expansive and, by the standards of other provinces, wide-ranging pandemic pay proposal that was negotiated by the Minister of Finance with Mr. Morneau, the Minister of Finance in Ottawa.

L. Reid: I would simply ask the minister to revisit that decision. It shouldn’t matter if the bed is paid for by the public purse or paid for by the family of that senior. It shouldn’t matter. There should be opportunities for this minister to acknowledge that he represents a government that, frankly, believes in treating workers equally and fairly. This is not a shining example of that. So I would trust he will revisit.

When it comes to personal protective equipment, during the peak of the pandemic, 70 percent of operators in the seniors care sector reported that they were critically short of necessary personal protective equipment. While acute care hospitals were prioritized, many organizations providing care to older adults were left to fend for themselves for weeks.

Minister, what action do you plan to take to ensure a sufficient supply of personal protective equipment for any second wave? How much budget allocation should be made for PPE in advance, and can we expect to see seniors living in care providers prioritized for PPE?

Hon. A. Dix: The member will know, of course, of the extraordinary efforts — and I’m happy to report in full on those efforts — to obtain PPE, personal protective equipment, for health care workers across B.C., regardless of sector. The member will know that and know those efforts.

Should she be interested, I’ll just remind her of the approach that we’ve taken, which was an approach that included a very significant investment — in the hundreds of millions of dollars — to provide PPE. We can go over…. I can refer her to Monday’s press conference. We can go on in the efforts to do that.

In the end of March, there was a provincial health order respecting the use of PPE in long-term-care homes and assisted-living homes, and an inclusion, I think at the beginning of April, of long-term-care homes and assisted-living care homes in the PPE supply chain of the provincial government.

Why was that? It was because those supply chains, worldwide, had been interrupted. It would have been, I think, incorrect policy just to assume and leave providers, regardless of whether it was in their contract to do it or not in their contract to do it…. Basically, it was in their general contract in the way that we fund long-term-care homes, with which the member will be familiar, to do so, to leave them to their own devices, because we would have been leaving residents in long-term care to their own devices. That would not have been the right course.

We included people in long-term care, even though, as the member knows, our responsibility technically, under the contract, wasn’t that. But practically, morally, ethically and in response to a pandemic, we took a different approach. We took that approach in advance of other jurisdictions.

I would say, while I know the member has referred to other jurisdictions and how they’ve dealt with long-term care, we’ve also seen other leaders in other provinces attack private long-term-care homes, attack their providers, attack their workers. That is something that has not happened in British Columbia. We’ve worked together. We included people in the PPE supply chain. The cost of that across the system has been staggering because of the increases in costs of PPE that we’ve seen in recent times, well beyond their previous value. I reported on that, I think. In many cases of PPE, it ranged from five to ten times the previous levels.

We did that because ultimately, we felt we had to get out. We had to deal with our own problems. There had been talk about the federal government purchasing PPE. They made big announcements about orders they’d made. But ultimately — in terms of N95 respirators, for example — the federal government provided about 5 percent of the total amount we were able to procure. In other words, 95 percent of that amount, we procured on our own and through the supplies that we found ourselves and through meting out and measuring out our pandemic supplies that we held before.

We included long-term-care and assisted-living homes in that supply of PPE. Ultimately, I think that was the right decision. We made changes, and we put forward policies about the usage of PPE because we were also running into, as they were in long term care, burn rates with PPE that were eight, nine, ten times what they’d been prior to the pandemic because people were justifiably filled with anxiety about the circumstances.

[10:40 a.m.]

The policy on PPE…. I’m happy to go through, in detail, my public reports on this question, which I’ve given every Monday to the people of B.C. I’ve given them every Monday when the results were tough and difficult and every Monday when they were better, and I’ll be giving one next Monday as well.

L. Reid: I thank the minister.

Certainly, he will know that B.C. Care Providers, B.C. Seniors Living, Safe Care B.C. have all asked to ensure that there are, perhaps, regional stockpiles of PPE product, that they be regardless of employer type and that they be included in the pandemic supply chain for PPE. I’m thinking the minister is actually nodding in agreement. Comments?

Hon. A. Dix: Well, I’m saying that they were and that occurred. During this time of pandemic, it was a necessary step and, I think, one we took as a model. We certainly engaged with other jurisdictions in Canada about a model of how a health system has to conduct itself in a time of pandemic.

I think what we’ve tried to do on a regular basis is work with our partners in health care to have a team B.C. approach to work with everybody. I think people have responded in an extraordinary way, and PPE is an example of that. I mean the Hospital Employees Union; the B.C. Government Employees Union; and the B.C. Nurses Union; of course, the care providers in Denominational Health; and others. That supply and that inclusion of people in the PPE supply chain has been significant.

What does it cost? Well, the cost has been significant as well across the sector. What have we spent to acquire PPE? It’s $114 million in this time of pandemic with more to come, because we are determined that our health care workers and our residents who benefit from the work of those health care workers are protected to the maximum extent possible.

We know the risk, even with the best of possible circumstances, and that COVID-19 is relentless. It doesn’t barter with us, and it goes in. For example, the Holy Family care home, provided by Providence Health Care, is generally considered, I think the member would agree, an outstanding care home with relatively high historic levels of staffing and with unique supports for spiritual care and social activities and a single site from the beginning. And they were in the HEABC contract. Yet COVID-19 came there.

That’s why we have to take measures across the board to do our absolute best. We know what the risks are, and those risks are considerable.

L. Reid: I thank the minister.

If we can move on to a discussion of infrastructure. Some of the comparisons made in British Columbia to what was transpiring in Ontario and Quebec, I thought, were completely unfounded. The majority of the homes I visited in British Columbia are single-occupancy rooms, much more contemporary, much more modernized, larger hallways, larger dining space, making it more appropriate and possible to physically distance.

In terms of the current announcements underway for the building of new care homes — certainly, there are lots underway in the province — they will all be better able, better equipped, I believe, to handle any future pandemic that comes our way.

Can the minister give a sense of how many rooms in British Columbia are still more than a single-bed occupancy?

Hon. A. Dix: I will get that information in a moment for the member.

I agree. I think if you look at the evolution of long-term care in B.C., you see two significant facts. One is the transformation of the sector that occurred for better or for worse. There’s always a discussion of these things. I like to focus on what is and not what has been. But we have had relatively little investment for a long time, for periods of decades, in health authority–owned and –operated care homes.

We had a situation, I think it’s fair to say, [audio interrupted] where health authority–owned and –operated care homes have a higher staffing level than private care homes that tended to be older. Some of our best health authority–owned and –operated care homes have multiple-bed rooms still. I’ll get the details in a moment about the actual numbers, and I’ll share that so as not to interrupt the flow of estimates.

I think, as we look forward at the care home sector, two of the areas we have to focus on — one, health human resources, which I’m sure the member will be raising shortly, and capital investment.

[10:45 a.m.]

That capital investment, it seems to me, has to take two forms. One is the provision of new beds — for example, the 495 care beds that are part of the RFP involving Nelson, Penticton, Vernon, Kelowna and Kamloops, which we prepared last week.

Then, in addition to that, we have to see the remediation and, sometimes, the rebuilding of existing care homes. Those are more typically in the non-profit and in the health authority–owned and –operated care homes, which tend to be older care homes. Those in the non-profit sector, perhaps because of less access to capital, were less able to compete in the RFPs of the previous decades. Those tend to be the older care homes. What we need, it seems to me, in the future — and what I’m looking, as you’d expect, aggressively to see — is an investment in our existing care homes.

I’ll just give you an example. The member has visited Evergreen care home, which is co-located with Lions Gate Hospital on the North Shore, in North Vancouver, and, I think, in the riding of the member for North Vancouver–Lonsdale. That care home has several hundred care beds. I think it’s 300. It has been around for a long, long time and clearly needs to be replaced.

That’s a massive investment in care that doesn’t increase the number of beds but, I think we’d all agree, is necessary. We need to bring our care home sector into the 21st century, just as we are now, with significant effort, bringing our hospital sector into the 21st century.

Those areas, in terms of investment and capital…. I agree with the member that we have…. I think our care homes have good infrastructure. We often have some of our most loving and longest-term non-profit and health authority–owned and –operated care homes that do a very good job.

Over the next period, I think we’re going to have to focus in on bringing those care homes up to modern standards. A care home that was built, say, in the 1960s is unlikely to have the same standards as one that we would build today, and we are building today. One of the key standards to that, it seems to me, is single-bed rooms. These, after all, are not just places of care, of health care, but they are places where people live.

L. Reid: I thank the minister.

We know that restrictions required to prevent the spread of COVID-19, such as physical distancing, have made it more difficult for some recreation activities to be maintained. This comes at a time when seniors are experiencing increased isolation. Will the minister make sure there is adequate funding to make sure that recreation programs can be safely delivered for the duration of the pandemic?

And the second part of that question. Over the course of the pandemic, seniors living in long-term care have been facing acute isolation due to physical distancing and restrictions on visitors, with devastating effects for both emotional and physical health. Will the minister consider providing seniors care and living providers with additional funding for tools and technology to address the social isolation of older adults?

Hon. A. Dix: Of course, we have provided $10 million, for starters, to the B.C. Care Providers for their EquipCare program. That has an interest and focus on addressing issues around, of course, infection control but also the purchase of other equipment to make lives better in the homes of people in long-term care.

The member will know…. Her colleague the member from Prince George–Mount Robson and her colleague the member for Richmond-Steveston have been involved in that. That was $15 million from the United Way, but there’s a whole set of social activities that need to be supported in communities as well.

The member is right. COVID-19 is a huge challenge in care homes. She’ll know, if she has followed the briefings we provided to the public…. It affects my family as it affects others. I feel sympathy and empathy for families and for residents who are going through this. It’s very challenging, and it’s going to continue to be challenging for a while. There’s not going to be a new normal for a while.

I don’t think, for example, that one visit a week, which many people are getting now in care homes, a short visit, a supervised visit — it feels supervised, even if it isn’t — is adequate. It’s what we can do right now, and that’s what we’re doing.

[10:50 a.m.]

One of the areas, for example, that we want to see reinstated and that is, the member will know, one of my most important priorities in seniors care is the resumption of adult day programs in B.C., which were essentially stopped around the time of other actions taken around the pandemic, around March 16.

All of those areas are important, but they’re very challenging right now. I think our providers are doing a very good job, under the circumstances, of trying to maintain elements of social activity in these difficult infection control environments.

It’s an ongoing challenge, and I think everyone involved in the sector is working on them. I don’t think it’s simply a question of money, however, although the money that has been provided for seniors care in the pandemic in B.C. has been extraordinary by any standards and will be challenging going into the future. But I think there is also a matter of infection control in these environments. They face not just people in long-term care but people in every walk of life.

L. Reid: I thank the minister.

In terms of capital infrastructure, seniors care homes are not able to access and benefit from the new federal infrastructure investments, including the national housing strategy. In fact, the federal government’s housing strategy excludes long-term-care residences for seniors. Has the minister asked the federal government to include long-term-care homes in the eligibility criteria for infrastructure funding? If not, would the government be allocating funding for care homes to make the necessary renovations?

My second part. In addition to larger renovation repairs, many of B.C.’s assisted-living and long-term-care homes require investments in smaller infrastructure projects, such as sprinklers and ceiling lift installations. Automated medication management, online training technologies, security in data collection — does the ministry have any plans to make such investments?

Hon. A. Dix: I mean, the short answer is…. As the member knows, we have — at least, at the level of the acute care program, which is no small amount of money — $10 million.

We’ve, obviously, had lots of discussions with the federal government. The federal government, when it hears the Prime Minister’s briefings and others, has expressed a lot of interest in long-term care and a lot of talk about long-term care. We’re, obviously, engaged with them to see whether that interest includes working with us on some specific responses.

As the member will know, and in fairness, the federal government has provided a significant amount of money to the province to deal with COVID-related investments that are required. They include things such as contact tracing and testing but also other supports that we put in place.

Yes, we’re talking to the federal government. But it’s not my intention to wait for the federal government. I think that there needs to be, in the coming years, as there has been in the acute care sector, a significant capital investment in the long-term-care sector. I won’t repeat my previous answer, which I know the member heard, but I believe that’s the case.

Obviously, when we’re contemplating that kind of investment to bring our older care homes up to the level of what we would expect today, and what we’d want our parents and our grandparents and our loved ones and our friends to live in, any occasion to partner with other levels of government….

I would add to that municipal governments, because I think there has to be a significant effort. This seems a very pre-COVID discussion — a significant effort, especially in our cities, in a time of increasing density, to find spaces for seniors, both in long-term care and assisted living, but also seniors-friendly communities, which are going to become more and more necessary.

There’s an engagement with the national government. There’s engagement with local governments, which sometimes come into play on issues of zoning but also on seniors-friendly communities that are necessary.

These discussions, of course, are happening. But while we’re hopeful about federal support and their inclusion of our issues in their program, we’re not waiting for it.

L. Reid: I thank the minister.

The Conference Board of Canada projects that British Columbia will require an additional 31,000 new long-term-care beds by the year 2035 to meet the demands of our aging population.

Minister, has your government or the regional health authorities performed an analysis on the number of long-term-care beds which we will need to be required over the next ten to 20 years? If so, what is the data telling us needs to be done? How many beds are forecast to be added to the system over the next five years?

[10:55 a.m.]

Your government announced it would add an additional 495 long-term-care beds in the Interior Health Authority by 2021. While these are welcome investments, the Interior is not the only region facing an aging population.

What will the government do to address the needs of an aging population all across the province with respect to the number of long-term-care and assisted-living beds? What will the role be for the private sector?

Hon. A. Dix: I think our intention and our approach, health authority by health authority, is to consider…. The health authorities have different circumstances.

The member from Prince George is on the committee, and she knows, as I do, that in the Northern Health Authority, the funded beds, the long-term-care beds, are disproportionately public beds. That’s partly because of a lack of market interest, I think, in Northern Health, which is over time.

Some proposals that were originally RFPs, I think, in the period between 2010 and 2017, were transformed into public projects, for example, for that reason. Our intention…. My focus is twofold. I’ve been pretty clear about this everywhere. I think there has to be significant public investment in the improvement and rehabilitation of existing health authority–owned and –operated care homes, that we have to…. That is something that really hasn’t happened for 20 years and needs to happen — that investment.

A lot of that investment, including in the member’s own community…. I think her colleague from Richmond-Steveston will be talking to me about this later, with respect to a project in the community — how often that involves the rehabilitation or the replacement of existing facilities. That’s where I see the public investment.

Then we see significant needs for new beds. The member will know that I got some heat for this last week, on the 495 beds, but there’s also a role for the private sector as well, working with us as partners. You see that reflected in the RFP in the Interior, where more than 100 beds in Kelowna and 100 beds in Kamloops and Penticton and Nelson and Vernon…. All are receiving significant new long-term-care beds, all being done by RFP.

The only different proposal amongst those proposals is the one in Nelson. The 75 beds in Nelson are going to be built under a design-build arrangement with the private sector and then run by the Interior Health Authority, at least backed by the Interior Health Authority, which will be co-providing, on that site, public health facilities, as well as operating those beds. I think that reflects our pragmatic approach to the need to have more long-term-care beds.

I want to add to that that all of these people have different views about where the priorities should be in seniors care. Certainly, the massive investment we’ve made just in the last two months in long-term care…. If it was viewed out over two years, we’re talking about many hundreds of millions of dollars to support the long-term-care sector in light of the pandemic, to support the workers and the operators but mostly the residents in long-term care. It shouldn’t change the fact that we need to continue to invest in other forms of care, in other forms of support, in other forms in the community.

The initiatives that I’m most proud of, even though we’ve done a lot in long-term care, especially on raising the standard of care — which was, in some places, dangerously low in long-term care — are the investments in adult day programs and programs in the community. I think we’re living longer. I think we need to live better, longer as well, and that’s why so much effort and so much focus about what we’ve done is the addition of adult day program spaces, the addition of respite care, which I think is central to, at least, the government’s vision of where seniors care needs to go.

We’re going to see in many communities, communities such as Surrey, which are now young communities…. They’re going to be rapidly becoming more typical communities in terms of the age distribution, with large numbers of new seniors in the next 20 years, and communities in the north — Fort St. James, with a 186 percent increase in 20 years of people over 75 while the rest of the population stays stable.

We have to create communities, not just expand long-term care for people who are often struggling profoundly — communities in the society that support seniors through the many stages that we hope to go through after we reach the age of 65.

[11:00 a.m.]

While we want to invest more in long-term care — I appreciate the calls for that, and we have done that — we’ve got to be careful to maintain and to focus on investments outside of long-term care, which are always a priority for me and, I think, for most people looking at seniors care. For some people, anyway, the experience of living longer is not a positive thing for them because, of course, the challenges are so profound. We’ve got to address that.

I believe people should be able to live to the full extent of their abilities and their freedoms and to express those freedoms even when our bodies fail us, and that’s the way we have to approach seniors care.

L. Reid: Would the minister support a review of funding in long-term care to ensure that it is fair and equitable? In particular, would the ministry support a review of funding lifts in per-diem rates to better ensure consistency and fairness while also ensuring the sustainability of the sector?

In a previous report authored by your ministry in 2017, it was recommended that, by January 2018, the government move towards a standardized funding model for long-term care to be based on resident complexity, quality standards and flexibility. Can the minister provide a status update on this work, and is the ministry able to provide an update on the recommendations made in the action plan for a home and community care for seniors report?

Hon. A. Dix: As the member will know, we have in front of us the report of the seniors advocate, dated January 2020, by Isobel Mackenzie, which deals with a number of these questions. What we’ll be doing over the next six months, I believe, along with my colleague the Parliamentary Secretary for Seniors, the member for Courtenay-Comox, will be to work on these very questions, the recommendations of the report.

We’re doing this work in isolation from care providers and from health care workers and residents, but with engagement of them. We want to move, I think, to a higher level of care, and we’ve done that. And those are, I think, extraordinary achievements that all people in British Columbia should feel credit for because all people in British Columbia contribute to them.

The raising of care standards, the 3.37, is not a panacea but a necessary step, and it will have occurred 11 years after those standards were set. It’s a really significant achievement. The member will know that, overwhelmingly, that involved new funding to hire new staff for publicly funded beds in private care homes.

We are going to review and make efforts over the next while, because I think there’s insufficient standardization and understanding of contracts. We’ll be working to standardize contracts and reviewing the funding model with our providers. I expect that review to be completed and implemented by the end of this fiscal year.

L. Reid: I thank the minister.

Can the minister provide an update on the outcomes of the new long-term-care access policy that replaced the first-available-bed policy in 2019? Has there been an improvement in the number of seniors who are admitted to a preferred care home at initial admission? Can the minister provide any information on how many seniors achieve their preferred placement within six months of initial admission?

The office of the seniors advocate reports the number of people on the wait-list for long-term care increased from 1,400 older adults in 2018 to 1,800 in 2019. What is the minister’s plan to address the wait-list for long-term care?

Hon. A. Dix: Of course, we keep pretty clear records on some of these issues. I’ll talk about the issue of the access policy more generally.

Clients admitted to long-term care, on average, waited over a month, 35 days, if their wait-list started in hospital. Clients admitted to long-term care from community — e.g., from home care or assisted living or other non-acute-care settings — waited approximately 86 days. The wait times have stayed pretty consistent over the course of this year.

When we’re looking at long-term-care admissions from community and from acute, 42 percent of clients were admitted directly to long-term-care homes. Broken down, 32 percent of the admissions to long-term care are from acute care, and 54 percent of long-term-care admissions are from community, like to a PCH. Clients admitted to…. In short, those are the stats, and there’s a long set of them here. I was thinking of reading them all out, but I don’t think that would be desirable. Why don’t I just send them to the member so she has them?

With respect to the access policy, I think it’s an important change. I’ll give her, first, the anecdotal report. This issue, more than any other, is the one that people come up to me in grocery stores and are thankful about — their opportunity to engage, to review care homes, to visit care homes, to create their own list of care homes they desire to be in.

I think this change really required a lot of imagination and effort on the part of health authorities and providers to put into place — to be able to put a list of three care homes. I think we’re developing a report on that soon. That’s on the impact of that access policy. I would expect to have that soon, and I’ll provide it to the hon. member.

The Chair: Members, we will take a very short recess. We will resume at 11:10. Thank you.

The committee recessed from 11:05 a.m. to 11:10 a.m.

[M. Dean in the chair.]

L. Reid: I thank the minister.

I want to move on to…. I want to know if the minister will be looking at needs-based assessment, which is performed by the resident health authority to determine their eligibility for publicly funded assisted living. In B.C., public assisted-living residents do not receive access for free incontinence aids like they do in long-term care. Will this be reviewed in light of this report?

The CCPA report notes that the government also modestly increased funding for assisted living to increase staffing and care coordination. Can the B.C. government provide an update on funding and increasing staffing care coordination as it is considering providing additional funding?

Hon. A. Dix: First of all, just in response to the member’s earlier question, 88 percent of long-term-care homes are single rooms at present, 8 percent are double rooms, and 4 percent are multi-bedrooms.

As I noted to the member, a disproportionate number of multi-bedrooms are currently in health authority–owned and –operated long-term-care homes. In the case of health authority long-term-care homes, they’re just older care homes. I guess that’s the best way to put it. Whereas 92 percent of contracted care homes are single-occupancy beds, only 76 percent of health care–owned and –operated care homes are owned and operated beds.

That’s the focus in the health authority–owned and –operated sector. It’s going to be as much on the remediation and rehabilitation of existing care homes as it would be in the building of new care homes. That’s obviously an issue that we’re taking forward into the future.

With respect to assisted living and the associated areas of home support, there have been significant increases, as the member will know, both in hours and in supports in recent years. The CCPA report does argue for some different models and for significant advancement, increase and investment in assisted living. Certainly, there’s lots to argue for in that regard. I’m taking a look at the CCPA report and at their recommendations. As we work on assisted-living issues, that will be something that we certainly take into account.

I think, clearly, as we work forward through the pandemic period, we’ve also involved and supported workers and operators in the assisted-living sectors in all of the ways I’ve described for long-term care and integrated them into our activities. I think there is some opportunity to advance that sector. It’s a challenge, but because we’re facing an investment challenge in long-term care, I think the need for more publicly funded assisting-living beds….

There’s a balance between public and private that the member will know. The significant changes we made, bringing into force legislation that was passed by the previous government to increase inspections and to change some of the requirements and the eligibility for assisted living, I think, are going well, but we are going to have to do a regular assessment of the impact of them on both assisted-living residents and operators.

[11:15 a.m.]

L. Reid: I thank the minister.

The latest report from the office of the seniors advocate, A Billion Reasons to Care, examines the expenditures of non-government long-term-care homes in the province but provides no comment on government-owned and -operated care homes. Does the minister consider that an oversight, and would he be willing to conduct his own review of publicly owned and operated long-term-care homes to ensure value for money?

As part of that, the current B.C. seniors advocate was appointed to the position in April, 2014 and has held the position for six years. Does the minister know if the current officeholder is subject to any limits on her term? Does the minister know if the office of the seniors advocate is subject to any regular review of her office’s performance?

Hon. A. Dix: First of all, let me just say for the record that I think she’s doing a great job. I say that knowing that she, Isobel Mackenzie, who I think is an extraordinary person in B.C. — and of course, a great appointment, a really tremendous appointment of the previous government — often criticizes the Minister of Health and the Ministry of Health and all kinds of other people in the course of her work.

That’s what she’s there for — to provide independent criticism. She’s not there to be loved by established interests, including me. She’s there to do her work.

I just want to note — I know members of the House were part of this work — that that’s why, at the beginning of the pandemic, when we were facing a significant challenge in the community of ensuring that seniors had access to services, sometimes really basic ones like groceries and support or a phone call, we combined the seniors advocate with five members of the Legislature: the member for Richmond-Steveston, the member for Prince George–Valemount, the member for Courtenay-Comox, the member for Cowichan Valley and the member for Burnaby North, who’s with us today.

All of whom were engaged in this process with the seniors advocate. I think all of them would say that that process was respectful and showed why the previous government made such an extraordinary decision in appointing Isobel Mackenzie to that post.

I am not surprised that sometimes Ms. Mackenzie gets criticized by people who don’t like her criticism. I resemble that remark from time to time, because I get criticized by her all the time. But I think she genuinely does an extraordinary job, as you know, in her ongoing work on and reports on care homes, which include reports on publicly funded and owner-operated care homes. In the reports and the information she provides — the surveys she provides — she’s expressed views and criticisms on those questions. When she does her report on the contracted sector, I’m not surprised that it’s only about the contracted sector.

I think, certainly, that suggestion that the member has made to the seniors advocate, who I’m sure will be listening to this discussion, is a good suggestion. I would be very open to her having a look at the entire sector. That’s what her office is doing, and I think it’s doing an excellent job.

I have great confidence in Isobel Mackenzie, but more important than that, I think seniors across B.C. do, as someone who, as I say, has a strong point of view and doesn’t pull her punches. I know some people are critical of that, but I think that’s why we have the job of the office of the seniors advocate. That’s why the previous government put it in place in response to the inquiry of the Ombudsperson in 2011 and 2012. It’s my hope that the office will continue to function and function well for years to come.

L. Reid: I thank the minister. I didn’t hear an answer to my last few questions, which were: are there any limits on the current officeholder continuing? Indeed, who evaluates the work undertaken in her office?

Hon. A. Dix: No. And I think it’s the people of B.C.

L. Reid: Talking about home support, in 2019, the Minister of Health expropriated home support services. It is unclear as to whether the service improved for clients, with some clients reporting less consistency and worse service than prior.

Can the minister provide the following: the total cost of the expropriation, any measures as to the impacts on quality of care and client satisfaction, and the increase in costs as it relates to a new service delivery model? In the minister’s personal opinion, was this worth the expenditure?

Hon. A. Dix: First, a definition of terms. I realize that when we use particular terms, it sort of tips off what people think of certain decisions.

[11:20 a.m.]

As you know, home support contracts were ending, some of them after a very long period of time. The government decided to bring those contracts back into health authorities. As members will know, those contracts, the public ones, were generally done under contract, principally with the B.C. Government Employees Union but others. In Metro Vancouver, in the Fraser Health Authority, in the Vancouver Coastal Health Authority and in the Vancouver Island Health Authority where those changes were made, those changes have occurred and, I think, have been put in place quite effectively over the last number of times.

We would’ve had, of course, to renegotiate those contracts with providers with new contractual arrangements had we decided to continue the contracts. Instead, we decided to bring those contracts in-house. I would say this: that what it meant…. During this time of pandemic, where home support was profoundly tested — and home support surely isn’t perfect in B.C. — it, I think, made more sense to have a single system provided by the health authorities than eight different contracts.

With respect to the question of expropriation, the member will know that there was essentially an agreement, outside of any decision to bring contracts back in-house, which is what happened, when contracts end. Contracts that end on a particular date don’t need to be expropriated. They end.

The decision was made, in the interests of the public, based on the analysis of the publicly funded health care system, that it made more sense to have them in-house. I would say, as a general rule, that having one system across Metro Vancouver makes a lot more sense than having eight, and it surely makes a lot more sense in times of pandemic. So if the question is: do I think it was a good thing that it was brought in-house? The answer to that question is in the affirmative.

L. Reid: I thank the minister. I did not hear an answer to the costs of that decision, that direction. If the minister needs to send it to me at a later time, I will accept that.

In February of 2017, the federal government, in a joint statement with the province, announced a ten-year, $785 million investment in home care in B.C. Has any of the approximately $80 million in increased annual funding been spent to date? If so, what new programs and services have been provided as a result of this investment? If not, how will this funding be used in the future, and how are we sure that any investment is in keeping with the priorities of British Columbians?

It is my understanding that the government, as part of the agreement with the federal government, was to report to the public on how these funds were invested. Has this been done?

Hon. A. Dix: The answer to the last question is pretty simple. It’s: of course. There is regular reporting on all such agreements.

Just to put this in context, home support, including assisted living, in 2016-17 — we’ll use that as, sort of, my baseline: 10,792,000 hours. In the subsequent year, 2017-18, that was actually down to 10,750,000 hours. In the most recent year, in spite of the challenges of COVID-19, in period 13 of the recent years, that number was up to 11,000,436 hours — in other words, a massive increase in home support, including assisted living. But that’s not all.

With respect to community-based professional services, which are essentially another form of home support, the number of hours in 2016-17: 1,372,254 hours. The number of hours in this period, even though there was some reduction in period 13, was 1,000,589 hours. Yet another massive increase in home care and home support.

Further, with respect to adult day services, which for me, are an important part of our plan, which includes the federal portion of the plan and our own very significant investment: $1.048 billion over three years. The number in 2016-17 was 236,437. That was our baseline.

[11:25 a.m.]

The number of this past year: 290,232. That’s an increase of 54,000 hours in two years, and that includes a reduction of 13,000 hours because those services, in that ultimate number, of course, were suspended in the middle of March. What we’ve seen is a very significant expansion in hours across the sector. Including and in addition to that, of course, is our significant investment in respite care.

What we’ve seen is a building of supports in the community and organization of a system, particularly in the Metro Vancouver area, because of the repatriation of contracts that occurred, which, I think, was a useful thing in terms of organization going forward and allows us to connect those home support services better to primary care and to primary care networks and to other services provided by the health authorities, including adult day programs.

This is a coherent approach, which has seen — and you can see it there — a dramatic increase in the amount of services provided to people, and that demonstrates the profound interest we have. That’s more than a 10 percent increase in hours a year in adult day programs since I became Minister of Health.

That reflects our desire, working with the federal government and our partners, to increase the amount of care in community. There are significant challenges to that and challenges in the home support sector. There’s no question about that. We’re both personally and generally familiar with the challenges in that sector.

We’ve seen — as a result of our agreement with the federal government, substantial provincial investment and substantial federal investment in these areas — improvements, and we’ll be producing our regular reporting on that soon. It should be said that that includes the very significant portion in contribution from the federal government to those agreements and, of course, our own significant additional contribution as well.

L. Reid: For many, the public home support system does not meet their needs. What will the government do to support British Columbians who access non-government home health care for independent living services? For example, B.C. care providers and EngAge B.C. have recommended 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 are eligible to receive a refundable tax credit of $2,500.

What is the minister’s response?

Hon. A. Dix: Certainly, I appreciate the suggestions and recommendations that are made by the B.C. care providers and others on a regular basis. It’s why we’ve taken the steps we have taken to improve long-term care, to improve home support, to improve adult day programs and to improve community-based professional services, which are so important for people to be able to stay at home and to live to the full extent of their resources.

I think there are other options. I’ve heard other options in terms of supporting or allowing seniors to essentially use their own means more effectively, to support their own living, not just care but living. I’ve heard proposals from the seniors advocate, from care providers and others, and certainly all of those are being considered as we move forward.

Certainly, we’ve seen — I think it’s just indisputable — the most significant investment in seniors care in a very long time, in the last couple of years. That doesn’t mean that the system is perfect. Far from it. We have way more seniors now than ever before. We’re going to have way more seniors than that in five years and then ten years and in 15 years.

We have to consider all the options. I don’t reject, out of hand, any of them. But I think that we’re making some progress. This has been an enormous effort, but there’s so much more to do. Many people, for example, still struggle, even when they receive maximum hours of home support, to function properly. I hear them. I hear their concerns. They contact me, just like they contact the hon. member. We have significantly increased hours and supports, but we’re far from the system we want to be at, and that system will be required.

The member referred earlier to the report of the Conference Board of Canada about the requirement for long-term-care beds. I appreciate that report, but one of the ways of ameliorating that situation is by better care and more efficient care in the community to support seniors in doing what most every senior I talk to wants to do, which is to be in their home, in their community, as long as possible.

[11:30 a.m.]

L. Reid: Certainly, staffing shortages have been identified as a major contributor to stress burnout and the inability to respond as best as possible to the spread of COVID-19.

Can the minister provide a quick summary of his plan to address long-standing staffing shortages in the seniors care and living sector? Has the minister determined what the budget allocation, if any, is towards addressing staffing shortages in the seniors care and living sector in B.C.? What, if any, effort has been put into getting the federal government to provide resources to help address staffing shortages?

Hon. A. Dix: Even yesterday the government an­nounced new training spaces for health care assistants in British Columbia, in a press release and in the announcement made by the Minister of Advanced Education.

We are seeing, across the board in health and human resources, a plan, a necessary plan. We’ve seen that the early stages of that have included the transfer of many part-time workers to full-time positions, which is a short-term step and a necessary step.

The increases in spaces in institutions across B.C. — I’m happy to share the full list of those institutions with the member — is because we have a rapidly expanding need and demand for our health care assistant workforce. The very fact of the 3.36, the fact that we’ve raised staffing levels, the fact that there’s an aging population — and the fact that the population of people who work in long-term care is older than the provincial average in terms of the workforce — all need to drive us to continue to increase spaces.

That’s why, on the decision made, by the previous government in 2015-16, through the health care assistant registry process, to limit access to Canadian out-of-province care staff, we made changes to that, to allow people to move to British Columbia who had been working in long-term care as care aides and take up those positions without the significant institutional constraints that had been in place. That had been a recommendation, again, of the B.C. Care Providers.

What we have is a plan, particularly on the issue of health care assistants and across health care, of offering more opportunity. I would say this finally. You see this in our announcement around $160 million, which is a staggering amount of money, in support of our visitation policy, the opportunities that creates in long-term care. Close to 2,000 jobs will be required, incrementally, for that policy. That will require imaginative approaches as well, to help people find the staff to fill those positions, to improve infection control and to allow visitation in long-term care.

The issue of capital investment, the issue of the recruitment of the next generation of health care workers, is a key priority for us. Foundational to that is the restoration, to health care workers, of the rights that all other workers have in society, which we all passed unanimously when we passed Bill 47 and which make a real difference. Whatever one thinks of those policies in the past, in a time of a potential shortage of health care workers, care aides and others, it made no sense now.

L. Reid: In 2018, the minister indicated there was a need for 2,800 net new health care aide assistants over the next five years. Can the minister provide a revised figure on how many new HCAs are required to meet the needs of our aging population? How will retirements impact our ability to staff up care homes and meet the needs of care homes?

I know that last year the government provided $2.26 million over three years for Health Match B.C. to design and implement a health human resources strategy. Can the minister report on the number of new HCAs that have joined the workforce in B.C. since this strategy was implemented?

Hon. A. Dix: Noting the time, I’ll certainly provide that to the hon. member and to report that, as we start at 1:30, with the detailed number.

I would note — this is something we report on regularly — the addition, in the period of the pandemic, of, I believe, 1,800 new registrants during this period in nursing, the majority of which are health care assistants. That shows the growth and the opportunity, as well, in the area.

[11:35 a.m.]

Certainly, for many people who, in this time of relatively high unemployment, are looking for opportunity into the long term, I think the changes and the opportunities provided by the single-staffing order and the decision by the government to fully fund single-site and not just provide a small stipend, as in other jurisdictions, will make a huge difference in terms of recruitment and opportunity.

The new spaces that we offered yesterday and in the many other announcements will make a huge difference, and the fact that people are returning to the field makes a huge difference. For specific statistics of the increased number of people registered — as members will know, we have a registry of health care assistants — I’ll just provide that information to the member at 1:30.

L. Reid: I would just take a moment to acknowledge and congratulate the B.C. Care Providers on their offering of training programs across British Columbia. It’s an outstanding contribution to the sector.

We know that financial barriers can prevent domestic applicants from enrolling in health care assistant programs. Would the minister consider providing bursaries to help qualified candidates enrol in HCA training? I’m happy to receive that information at 1:30 as well.

I also have a keen interest — as the minister knows, because we canvassed it last year — in whether or not high schools can be folded into the process, in terms of graduating grade 12 students with some health care aide training as part of that six-month program. That would give them a leg up, certainly, and give them an opportunity, in their early careers, to explore this work and to, hopefully, become enamored with this work so that they indeed choose that as a long-term career.

Can the minister provide any update at all — I’ll certainly take it at 1:30, if that’s more convenient — on how much time has been spent in encouraging the high school programs in British Columbia to deliver that service?

I’m happy to continue, hon. Minister. Can the minister provide…?

The Chair: The minister might be conversing with his staff.

L. Reid: Okay.

The Chair: Minister, go ahead.

Hon. A. Dix: I’m happy to say that we continue to support the development of dual-credit programs. I think it’s an opportunity. Again, I think the future of health care assistants, of care aides as a profession, has dramatically improved over the last couple of years, and the opportunity and the vision for people to do this extraordinary line of work has improved considerably.

Certainly, the opportunity to follow those programs currently involves nine post-secondary institutions now. B.C. HCA dual-credit programs involve Camosun College, North Island College, Thompson Rivers University, Coast Mountain College, Northern Lights College, Vancouver Community College, Okanagan College, Selkirk College and Vancouver Island University. There are details on FTEs and so on, which I can provide at 1:30, or I can just provide to the hon. member.

L. Reid: I thank the minister. If he, too, at 1:30 could provide the number of graduates from each of those programs, that would be very, very helpful.

I want to spend a minute on the B.C. care aide registry. Experts, such as the B.C. Ombudsman and the B.C. seniors advocate, have expressed concern over the ability of the B.C. care aide and community health worker registry to fulfil its public protection mandate. The Ministry of Health released an independent review in 2013 with some recommendations. What is the minister’s timeline for implementing these recommendations in order to protect vulnerable seniors?

Hon. A. Dix: It’s part of the challenge, I think, with this model. I couldn’t quite make out the last half of that. Perhaps if the member could repeat her question. I just didn’t hear it quite properly, and I want to get that right.

L. Reid: My apologies, Mr. Minister. Talking about the recommendations that were in the report, what is the minister’s timeline for implementing such recommendations in order to protect vulnerable seniors?

Hon. A. Dix: I think there are proposals being made to improve the health care registry. In fact, as the member will know, we just put proposals and amended proposals in place — around the pathway for out-of-province people, in order to maintain standards but also to offer people the work — on January 15, 2020.

[11:40 a.m.]

The member refers to a report from 2013 and what our plans are to implement that report. Certainly, the issue of how we regulate with the health professions, health care workers and other people in more special conditions such as health care assistants, ambulance paramedics and other first responders is part of the analysis that we’re doing in our review of the health care professions. It’s a small part of it. It may not be….

Our initial focus has been on the reduction in the number of health care professional colleges. That’s one part of it, but certainly, we’ve received representation from a number of groups interested beyond the…. Well, the number keeps dropping. It was 22 when I became Minister of Health. We now have 18 health care professional colleges. I’m hopeful we’ll have fewer and fewer doing better and better things in the years to come. That has been part of that analysis, and it’s certainly an ongoing subject of review.

There have been references to the 2013 report that was done, which the member refers to. Certainly, improving standards in the protection of the public is very important. Also, ensuring that we expedite and ensure that health care assistants not just have a high standard but are not discouraged from entering a profession that has so much value to them and to the public is, obviously, something we’re looking at. Thus, the changes we brought in on January 15 in consultation with the registrar.

L. Reid: Can the minister provide this House with the latest statistics from the B.C. care aide and community health worker registry regarding how many investigations have been undertaken, how many HCAs have been suspended, how many HCAs have been removed from the new registry due to misconduct and, again, how many HCAs were permitted to re-register?

Again, I’m happy to receive that information later today, if that works better for the minister.

Hon. A. Dix: It might work better for the hon. member. She’s got a few more minutes for questions. Why don’t I provide that to her. We understand the importance of the question, and we’ll ensure she gets that information.

L. Reid: I thank the minister most sincerely.

As the minister will know, a high percentage of people living in B.C.’s long-term-care homes have a diagnosis of dementia. What financial resources or strategies are being considered to ensure that our care homes are more dementia-friendly in response to the needs of the population? What level of investment is being planned to address physical infrastructure needs, and what funding [audio interrupted] skill set of staff to ensure the high quality of care for older adults living with dementia?

Hon. A. Dix: The member will know — and this is, I think, a truly exciting proposal — of our partnership with Providence Health Care to build a new dementia village in Comox-Courtenay. That proposal, I think, will be reflected…. It doesn’t have to be a full dementia village model to ensure that future builds of long-term-care homes better reflect the needs of people with dementia.

The member will know that the federal government released a dementia strategy for Canada — it’s called A Dementia Strategy for Canada: Together We Aspire — and talked about the importance of person-centred care. Some of this work is being done by my colleague who is on a national ministers conference with the Seniors Minister for Canada this week to build on this call to action, which is a national call to action.

Certainly, in British Columbia, we have engaged in a number of measures, both in the community and in care, to support people with dementia. They include our ongoing funding for First Link in partnership with the Alzheimer Society.

Our funding for a provincial licence for PIECES, the education program for health care providers, through to 2022 supports patient-centred care for people living with cognitive impairment, including, of course, dementia.

The B.C. clinical practice guidelines with respect to cognitive improvement, recognition, diagnosis and management in primary care are a fundamental part of and support for seniors that we see in many of the primary care networks and urgent primary care centres across B.C.

[11:45 a.m.]

The best-practice guideline for accommodating and managing behavioural and psychological symptoms of dementia in residential care has been put forward. Also, developing a provincial dementia care policy outlining required attributes of health authority dementia care services.

Clearly — and we know this — this is going to be a growing area, as we see an aging population over the next 20 years. How we deal with it, how we reflect that, whether it’s in long-term care or in the community, will say a lot about us as a society. It’s why the decision to move forward with proposals such as the dementia village proposal, I think, gives a new vision of where we’re proceeding in long-term care. The ability and the innovative ways we deal with people with dementia will be part and is part of our RFPs going forward for new long-term-care beds in the province.

This is a significant test for us as a society. Of course, the treatment and the assistance of people addressing dementia is a key question. But ensuring that the services are in place to support not just people living with Alzheimer’s and other dementia but their families, who often struggle as much with those circumstances, is something that’s a high priority for me. I know it’s a high priority for the hon. member.

L. Reid: I thank the minister.

On a public timeline shared on the B.C. Care Providers Association website, the association indicates that Dr. Bonnie Henry, the chief medical officer, met only once, on March 2, with the senior care sectors’ leading representatives — including BCCPA, SafeCare B.C. and Denominational Health — prior to the declaration of the global pandemic.

Minister, in your view, should B.C.’s chief medical officer have met more often with representatives of the sector most deeply impacted by COVID-19?

Hon. A. Dix: Well, I can say that our provincial health officer, Dr. Bonnie Henry, who, regardless…. I know there can be criticism like this. There’s criticism of me, and it goes with the territory. But the response of the public provincial health office; of medical officers of health in the regions in support of seniors care; the response of the Deputy Minister of Health, Steve Brown; the Assistant Deputy Minister of Health, Teri Collins; of everybody at the health authorities….

Bringing together a team of people to address the issue of COVID-19 in long-term care is something that people around the world are talking to us about, including this week people from the United Kingdom, who are doing their own review of the catastrophic response on long-term care in that country.

I think the member will understand the extraordinary demands on the time of the provincial health officer who, I think, has taken two days off since the beginning of the pandemic, which is similar to our schedule. She’s met with enormous numbers of people, as have her deputies, as have medical officers of health, including care providers. We meet on a weekly basis. That means the most senior officials of the Ministry of Health with the B.C. Care Providers Association, Denominational Health, the B.C. Seniors Living Association…. In short, I think the level of cooperation and consultation has been extraordinary. Of course, I have as well.

Have I met with the B.C. Care Providers or others as much as I would like to have? I think the answer to that question is clearly no. I mean, I would have liked to have met more.

I think Dr. Henry’s commitment to people in residential care is beyond dispute. Her work on this effort has been extraordinary. That work is reflected in the work of medical health officers across the province, medical health officers in every community in B.C. who have been working with long-term-care homes. The ministry had help from others.

I would add that I think the B.C. Care Providers Association and Denominational Health…. Also, even though they haven’t been raised in the questions, it’s the Hospital Employees Union whose commitment to residents in long-term care is nothing short of extraordinary. The Health Sciences Association, the BCGEU and others have committed themselves to the full to put together these extraordinary changes that we’ve had to do on long-term care in B.C.

I appreciate the member’s question, but I don’t agree with the criticism of the provincial health officer, Dr. Henry. I think she’s been exceptional. I think she’s been open. I think she’s responded to members of the public. She has been available. She has briefed every day. I think she has done an exceptional job.

I know the member agrees with that in general, so I know she’s not saying that in general. But I do think that the reaching out isn’t just, in a health care system like this, that of the provincial health officer but of everyone in the system.

[11:50 a.m.]

I think everyone in the system, from the care providers themselves, the workers, the employees of the Ministry of Health…. I’m proud of all of them. Some of them, under our lines of authority, work for me and others don’t, but all of them have been tremendous. This has been team B.C. We’ve acted like we’re team B.C. You see it in the policies we put in place. You see it in the overall better results we’ve had in B.C.

We also, all of us, grieve together when people are lost in long-term care. We grieve together for that loss, no one more so than Dr. Henry. I’m sure she would say: “I’d love to have met with everybody more.” But it certainly was not because of disrespect or for a lack of meetings with people in the long-term-care sector. I think she’s been exceptional, but I think our whole team has. It reflects well on them. It reflects well on the care providers, and it reflects well on our entire province.

I would add to that, finally, I think the extraordinary role that MLAs have played, and my deep gratitude to the member for Richmond South Centre, my appreciation of the member for Kelowna–Lake Country, which we’ve managed to express, but also the member for Prince George and Mount Robson and the member for Richmond-Steveston, who stepped up on the opposition side and joined with my colleagues from Burnaby North and Comox Valley. This has been, I think, in the seniors sector something that we’ll look back on and B.C. can be really proud of.

Did we get everything right? No, we did not. Could we get everything right? I don’t know. I always try and do better every day.

L. Reid: I thank the minister. I am happy to suggest that the team has done an extraordinary job, and I’m also happy to ask that the minister and Dr. Bonnie Henry find an hour in the next few weeks to contact and speak directly with those sectors I mentioned for the simple reason that they are on the front line, doing the work that we all are intensely and unbelievably proud of.

The minister will know, with respect to examining long-term care in our province, that the official opposition has asked for a review, to promptly launch a thorough, independent review of long-term care in British Columbia, clearly to find where our system has performed well and where it failed.

The review should cover physical buildings and their layouts, staffing arrangements and qualifications and the medical and management responses to communicable diseases, including viral epidemics both now and in the future. Only this kind of review will restore public confidence as we find a path forward from the tragedy of the current COVID-19 pandemic.

Create a comprehensive, long-term human resources strategy to meet the growing demand for staffing in seniors care, which should include: allocating funding to create new training spaces for health care assistants both within and outside the Lower Mainland and improving the credential-recognition process and licensing for internationally educated health care professionals.

Support the residents and staff to implement COVID-19 health and safety measures in long-term care, home care and assisted-living residences, including the purchase of PPE for care workers, staff and all essential front-line workers serving in LTC and assisted-living residences and facilities, and establishing a fund with our federal partners to replace and refurbish older, non-standard long-term-care homes and assisted-living residences, focusing on eliminating multi-bed wards, narrow hallways and any areas which do not comply with physical distancing guidelines.

Review funding sources for home care and assisted living, both public and private, to provide more of our province’s seniors with the choice to remain in their homes while also ensuring that all seniors can expect the same quality of care and support across the province.

Provide British Columbians with a timeline and clear guidelines for additional protective measures to allow in-person visits and family and visitors of seniors residing in LTC, home care and assisted-living residences as outlined by British Columbia’s provincial health officer.

That is the submission on behalf of the official opposition, and I certainly believe that the minister and I both agree how important visitation is to families today and how isolated many seniors have felt and how much anguish family members have felt who were unable to meet with their seniors.

I want to take the last few minutes allocated to thank the minister and his staff most sincerely for the work that has been done on visitation. It has changed lives — the opportunity to return some hope to the process and have people have some contact. He and I both understand that the older care home with a narrow hallway, a smaller dining room, makes it much more difficult to foster visitation in situations where physical distancing is compromised. So any opportunity for us to move forward on creating better opportunities, enhanced opportunities, more opportunities for family members to connect with their seniors, would warm my heart.

Over to you, Minister.

[11:55 a.m.]

Hon. A. Dix: Thank you to the member for Richmond South Centre. The 2½ hours just flew by. I want to say, just on the issue, I appreciate all her work, all the work of all her colleagues.

I think, from my point of view, it’s what has made this period more supportable. Also, our work together on seniors care has created an atmosphere of generosity that is important going forward because of the challenges that COVID-19 continues to present before us. In a province of an aging population, as well, the problems of ensuring that people don’t just live longer over 65 but that they live better.

As the member will know, there was a comprehensive report into seniors care done by the Ombudsperson in 2012. Out of that report came a number of recommendations, the most significant of which, from a cost point of view and from a delivery point of view in long-term care, were the recommendations around staffing levels, which we started to implement, as the member will know, in 2017. Equally, there were reports by the seniors advocate in 2016, regular reports in ’18 and ’19, and a report in 2020. So we’ve had a significant number of reports.

With specifics of the pandemic, obviously, we are deeply into learning lessons. The medical health officers are doing systematic reports on every care home where there are outbreaks — where we can do better, how we can do better. Those changes have been made within days when conclusions are drawn in a pandemic, as the member would expect. We put that process forward.

With respect to the seniors advocate’s recent report in January of 2020, those provisions are being looked at and put into practice, not by diktat but by working together with care home providers in the contracted sector across the province.

What have we done in the last little while? Well, we increased care standards, got rid of Bill 47, increased home support. We increased provisional health services in the community dramatically, well beyond the rate of inflation, in fact — double-digit percentage increase in terms of hours, which made a difference in people’s lives. We got rid of Bills 29 and 94, giving seniors a choice in long-term care.

We brought into force provisions with respect to agency of seniors and consent of seniors that had not been brought into force — passed in the early 1990s and not brought into force by successive governments and a recommendation of the Ombudsperson in 2012. Brought into force by this government, and in this time, I think everyone is supportive of that.

Since the pandemic, of course: single-site, infection control procedures and the involvement of long-term care in the supply chain, significant changes and increased funding for long-term-care providers and now a visitation policy that allows people to return to long-term care.

I agree with the member that we need to do better. We always need to do better, and that’s the approach I take to this position, the approach I take to the issues in long-term care and also the broader issues for seniors. There is a tendency, with the focus on long-term care, to exclude discussions of other issues, to their detriment. We have to try collectively not to allow that to happen.

There have been significant reports about assisted living and home care and home support from the seniors advocate as well. Ones that we cannot lose sight of with the focus during the pandemic, the special focus the pandemic has provided to long-term care.

Finally, I want to say, on the visitation question — the visitation question is an important question — that we’re going to continue to review and hope to expand opportunities around visitation. One of the reasons why the provisions are so tight and controlled…. I want people to understand that when they have problems, or they’d like more people to visit, they should not be complaining about their local long-term-care provider or their workers. They can point the finger at me or at Dr. Henry. These are our provisions, and we’ve asked them to put them in place.

One of the reasons we’ve kept it tight is because, inevitably, some of the hiring and other things won’t happen for some time. It can’t happen immediately. We need to ensure that safety is paramount.

We are reviewing those every day, and we hope to do a first cut at a review of the impact of visitations after a month and see if we can further expand them. Surely we all believe that expanding them, if we can do so in a safe way, is good for everybody. Those are the measures we’re taking, going forward. We’re constantly reviewing these issues.

With that, I’m happy to move that the committee rise, report progress and ask leave to sit again.

Motion approved.

The Chair: The committee now stands adjourned.

The committee adjourned at 11:59 a.m.