PROCEEDINGS IN THE
BIRCH ROOM

Committee of Supply

ESTIMATES: MINISTRY OF
AGRICULTURE, FOOD AND FISHERIES

(continued)

The House in Committee of Supply (Section C); M. Dykeman in the chair.

The committee met at 1:35 p.m.

On Vote 13: ministry operations, $81,636,000 (continued).

The Chair: Before I recognize the minister, I’d just like to remind all members to please wait until they’re recognized by the Chair before they proceed to speak.

I now recognize the minister, as we left off with the member’s question.

Hon. L. Popham: I’m going to ask the member to repeat his question.

M. de Jong: Just prior to taking the break, I directed the minister’s attention to the document that I had provided with her dated March 18, 2021, which is identified as a briefing note for information. At the bottom is a ministerial decision note.

I directed her attention to page 2. I read into the record and quoted from that document, under the heading “Discussion,” the following passage: “The ALC is an independent administrative tribunal. The decision-making framework for the ALC is defined in section 6 of the Agricultural Land Commission Act — see appendix A — and does not include economic and social factors, including First Nations considerations. As such, First Nations considerations are not explicitly part of the ALC mandate.”

I asked the minister to reconcile that statement, that information, that position with the comments she made last week, which I referred to earlier today, where she directly and pointedly contradicted that information. When I made the proposition to her previously — that as a result of amendments that she and the government had introduced, the opportunity to take social and economic factors into consideration had been removed from the ALC — she responded by saying that was not so. I won’t repeat the quotes that I read from her submissions to the committee last week.

I asked her, in short, to explain how it was that she provided information to this committee last week that contradicts entirely and specifically the advice that she was provided with, not in general terms but in a note prepared with respect to this very issue.

Hon. L. Popham: First off, I didn’t contradict anything. My statements that I made last week hold true.

What I said was that the commission must consider agriculture. It must be considered in a way that it’s a priority. I did not say they must only consider agriculture. I said they must consider agriculture. That’s in the act.

[1:40 p.m.]

I’d like to refer to the prior act, before the changes were made. The requirement for the ALC to prioritize agriculture in its decision-making was also a requirement in the former section 4.3. Section 4.3 required the ALC, when exercising its decision-making authority in the former zone 2 lands, to give priority to the purpose of the commission, set out in section 6, above any other consideration in that section.

I’d like to repeat that now the commission must consider agriculture as the top priority, but they mustn’t only consider agriculture. Every application is taken individually. The commission looks at every application as an individual situation, and that’s how they make their decision. There are other issues that come into play. They need to look at other factors when carrying out the mandate, making the decisions based on unique sets of circumstances that exist for each site and the evidence that is submitted by the application.

The member may want to know that there have been approvals, since that bill was passed, that make other considerations — for example, an expansion of a school to accommodate growing school children populations in the city of Chilliwack, in May 2021. The construction of a new fire hall in Thompson-Nicola regional district, in May 2019. The conversion of an existing, unused resort lodge and ten cabins into a treatment and support facility for first responders with post-traumatic stress disorder in the Okanagan, in September 2019. The construction of a temporary work camp, for two years, to serve employees working on the Department of Fisheries and Oceans’ Big Bar fish passage construction project, in January 2021. Approval of the widening and realignment of a 4.2-kilometre section of Highway 1 near Tappen, B.C., in January 2020.

There are many examples that I’ve given, and I’m sure there are more, where other considerations are given to applications. They’re looked at individually. I think what’s happened here is that the member has put a lot of effort into trying to prosecute his case. Unfortunately, the case is weak, and the member has failed in doing that.

M. de Jong: Happily, the minister is not the jury in this case. She may not like the decision that the jury of public opinion renders, but that will be for others to decide.

The note is wrong. I’m not making this stuff up. The minister says: “Yes, you are.” I’m reading from her briefing note, which reads as follows: “The decision-making framework for the ALC is defined in section 6 of the ALC act and does not include economic and social factors.” Is the note wrong? Is the briefing note incorrect? When I put that very question to her last week…. I’ll read it again: “The now-repealed provision of the act allowed for it to render decisions to preserve the agricultural land reserve and to take into account economic, cultural and social values.”

That’s no longer the case. That’s all I’m trying to establish. I asked the minister. “The ALC still has that discretion,” she says, with respect to social and economic factors. Her note says they don’t. It’s a pretty fundamental point, when there seems to be a direct contradiction between what the minister is telling this committee and what her own officials are telling her about the mandate of the ALC.

[1:45 p.m.]

Hon. L. Popham: I have a $100 million budget for agriculture — $100 million — with many, many line items in it, and we’ve spent six hours going over the same exact thing, when I’ve just provided the member with proof that what he is trying to prove is wrong. The ALC has applications which are titled “non-farm-use applications.” In its very nature, it shows that other considerations can be brought in when looking at applications.

The member is absolutely wrong. We can spend the rest of the time in estimates going back and forth. The member is incorrect. I’ll repeat for the member, again, that agriculture must be looked at as a priority. It doesn’t say it must only be looked at. I’ve given the member many examples, and I’m sure there are many more out there.

I guess my question back to the member is: as we go back and forth, is this the best use of time in estimates? With $100 million, almost, in the budget of Agriculture, Food and Fisheries — a lot has happened this year — I would think that the opposition would be curious about how that money is being spent.

M. de Jong: I understand that the minister does not assign the same level of importance that my colleagues and I do to the manner in which the executive council interacts with the Agricultural Land Commission, nor does she attach the same importance to the impact of amendments that she and her government have introduced. That’s fine.

Happily, in the parliamentary democracy we inhabit, the estimates are a time for the opposition to draw attention to matters that are of concern or maybe of interest to the public. Whilst I am happy to know that the minister does not deem this to be a valuable expenditure of time, I differ in my opinion of that matter.

Interjection.

M. de Jong: I’m happy to…. The minister seems to have much to say. I’ll let her say it.

The Chair: Members.

Member, continue your question, please.

M. de Jong: It seems she has much to say but not on the record, Madam Chair.

The note that we’re discussing — the note that says, “The ALC does not include economic and social factors, including First Nations considerations” — appears to have been signed off by a director, an assistant deputy minister and the deputy minister. Is that correct?

[1:50 p.m.]

Hon. L. Popham: Yes, that’s correct.

M. de Jong: On page 3 of the note…. And by the way, the title on page 1 is: “Agricultural Land Commission: ALC Decision Regarding Carrier-Sekani First Nations Treatment Centre.” Just to confirm, it was a note prepared with reference to that particular matter.

On page 3, the note identifies three options, and those options have been severed from the document that I have and have provided to the minister. What were those options?

[1:55 p.m.]

Hon. L. Popham: This note was information for me, and some of that information was confidential.

M. de Jong: I understand that. It is now the subject of a discussion between the minister and I at this committee relating to an issue that is of great concern to many, many people, involving the desire to construct a treatment facility by the Carrier-Sekani Family Services agency. It’s a project that there is universal desire to see occur, and the minister apparently had three options identified for her as to how to proceed. Am I to understand that her position today is that she is unwilling to share any of those options with the committee?

Hon. L. Popham: I’ve said this previously, but I’ll repeat it for the member. I’m not going to be drawn into a conversation about an application or a situation that’s before the Agricultural Land Commission.

M. de Jong: We’ve already established that the document we are talking about was prepared with respect to an application that was ruled upon. Again, I simply want the minister to confirm on the record, if she will, that with the level of interest, the desire to find a solution, she has been provided with three options on how to proceed, but her position is that she is unwilling to share any of that information with the committee today.

[2:00 p.m.]

Hon. L. Popham: The information was redacted for a reason. We have freedom-of-information legislation that’s in place. But I will repeat again that I will not discuss a situation or a topic that is before the Agricultural Land Commission currently. There is an active application. The member continues to try and draw me into a conversation, and I’m not going to do it.

Any more questions regarding the Carrier-Sekani issue I won’t be responding to.

M. de Jong: I have another document I’d like to send over to the minister. The document is labelled at the top: “Brief Update Re: CSFS.” The first date I see on it at the top is March 23, 2021. It appears to be an email. It’s from Don Bain. Can the minister just confirm for the committee who Don Bain is?

Hon. L. Popham: Don Bain is the deputy chief of staff to the Premier.

M. de Jong: In the document, attached to the email from Mr. Bain, is an email from Sam Godfrey, who I understand from the document itself is the senior ministerial adviser to the Minister of Agriculture. That appears to have been the case on March 23. Is Mr. Godfrey in the same position today?

[2:05 p.m.]

Hon. L. Popham: He is my senior ministerial adviser.

M. de Jong: That is what the indication on the document is. So that hasn’t changed. The minister is indicating that it has not changed.

Hon. L. Popham: That has not changed.

M. de Jong: On March 23, he wrote this email to Kelly Newhook: “Hi. MLP was able to speak to the RDBN chair this afternoon.” Then there are redactions. “Attached is the note MLP had for the meeting, as an FYI, but she didn’t need to go into all of the detail.” There’s more. I won’t quote further.

I’m assuming MLP is the minister, but perhaps she could confirm that.

Hon. L. Popham: Yes, I am MLP.

M. de Jong: I thought that was the case. The line that attracted my attention in this email is the one that said: “Attached is the note MLP had for the meeting. She didn’t need to go into all of the detail.” I just briefly wanted to try and reconcile that with something the minister said last week. She said to the committee: “The member’s binder is the first time I’m seeing anything….”

On the surface, that seems inconsistent. The minister last week I think wanted to convey to the committee that all of this was material that she was seeing for the first time, and there’s an email indication that speaks to the notes that we’ve been discussing as something that the minister had for the meeting. Can the minister explain that apparent inconsistency?

Hon. L. Popham: I think what I was referring to were the documents in the binder. I hadn’t seen those documents, that I could recall.

M. de Jong: All right. Thank you. But the minister is not disputing the reference in the email to the documents that she was provided with around this specific issue on March 23.

The Chair: Just a reminder to members to please keep your masks on in between speaking. Thank you.

[2:10 p.m.]

Hon. L. Popham: Which document is the member referring to?

M. de Jong: Well, I’m referring to the email document that I just provided to the minister. It would be for her to elucidate to the committee as to what was being referred to in the document, in the email itself.

I understand the minister’s…. There seem to have been a lot of documents floating around the minister’s office on this matter. So that’s why we’re asking for her assistance to describe the ones she apparently had specific access to.

Hon. L. Popham: It’s not exactly apparent to me what documents are being referred to. I don’t know.

M. de Jong: Well, as I say, I can appreciate the confusion, because the minister apparently had access to a whole variety of documents. Let’s deal with one of them that apparently was attached to this email and, according to the email, one that she had relied upon specifically.

On the second page of the document I just provided to the minister, near the bottom, is the line: “We’ve looked at the problem carefully.” And, again, I should emphasize that these are notes that were prepared specifically with respect to the family services agency application. “We’ve looked at the problem carefully, and the fastest and most efficient way to try and resolve….” And then it’s redacted.

Now, the minister, a few moments ago, basically took the position: “If it’s redacted, I’m not telling anything. I’m not saying anything to the committee.” And she may do that again.

There is a project which was the subject of this application that the government, the minister, various ministries and the Premier’s office have been directly involved in, and the minister was provided with advice about what was termed “the fastest and most efficient way to try and resolve.” Well, I am interested, and I think everyone, the Carrier-Sekani, are interested in what the government believes the fastest and most efficient way to try and resolve this issue is. And I’m hopeful that the minister will share that information with the committee.

[2:15 p.m.]

Hon. L. Popham: Again, I think the member continues to try and draw me into a conversation about a situation that is live right now before the Agricultural Land Commission. He’s trying to build a case out of nothing.

We all know that there is an opioid crisis happening. We have a Minister of Mental Health and Addictions that’s trying to find every avenue and every tool in the toolbox to try and deal with that. You would expect, I believe, the government to be talking about every option available to them. I don’t understand why that would be such a problem to the member. I would assume that his own caucus is talking about that as well. It comes into question period a lot.

It’s an issue that is live to all of us right now. It’s close to all of us. Almost everybody has had somebody that they know that’s been affected by it. So of course we’re talking about it non-stop.

M. de Jong: To be really fair to the minister, more than just talking about it…. On March 23 of this year, the minister and her team, in a document entitled “Key Messages: Carrier-Sekani treatment centre….” They had more than just talked about it. They had settled on what “the fastest and most efficient way” to try and resolve the issue was.

I hope the minister isn’t shocked that I, the opposition and people would be interested to know what the government believed, on March 23, a fast and efficient way to resolve the issue was.

[2:20 p.m.]

Hon. L. Popham: The member will know — he was once a minister — a lot of information comes through. There are a lot of information notes. It’s not all relevant to the situation, but ministries provide as much information as they can when requested.

I guess I’m confused at the problem. There’s an information note that we’ve already discussed. We’ve discussed, over and over again, that there’s a live application before the Agricultural Land Commission. But the member doesn’t seem to worry about that. He continues to try to draw me in. He’s making statements about my thoughts which are untrue. He’s trying to build a case which isn’t there. It’s a weak case.

Of course the government is looking at every option on how to approach the opioid crisis. How could that be so shocking to the member?

M. de Jong: Not only am I not shocked; I am inviting the minister to share the fruits of her labours with the committee.

A decision was rendered with respect to an application on February 26 that denied a group the opportunity to address that crisis through the construction of a treatment facility. The minister was clearly seized of that matter. It attracted a lot of negative attention.

Her and her officials identified…. Prior to the submission of a subsequent application to the ALC, the minister and her government identified what they termed to be, they identified as, the fastest and most-efficient way to try and resolve. The minister, apparently, doesn’t want to disclose what she and her government believed the fastest and most-efficient way to resolve this dilemma was.

I’ll provide the minister with one more opportunity to provide that information. I’m not optimistic. She has, apparently, drawn a line in the sand and, for various reasons, said that’s not information that the committee or the public is entitled to.

There’s nothing I can do about that. I can provide her with the opportunity. I can reinforce the notion that the government, on March 23, had what it thought was the fastest and most-efficient solution at hand. She is unprepared, apparently, to share that information with the committee and the public, but I’ll give her one more opportunity.

[2:25 p.m.]

Hon. L. Popham: I’m going to decline to comment for the same reason I’ve mentioned over and over again. There is an active application before the Agricultural Land Commission. Me discussing issues of what I think is the fastest, the best or whatever, at this time, with a live application, could be perceived as interference. I’m not going to do it, as much as the member would like me to interfere.

I don’t know what the member doesn’t understand about our responsibilities as MLAs around an independent tribunal. I’m not sure what he doesn’t understand. The only thing that I can come up with is that when he was in government, things were handled differently.

We are not going to discuss the application before the ALC or any of the details around that application. There’s a live application. That should speak to the member right there.

M. de Jong: As always, grateful to the minister for her tutorial on the proper operation of a quasi-judicial body. I think we’ll take just a few more minutes to explore the degree to which she has abided by those admonishments.

I’ll pass over a few more documents. These are the Blues from the last day. The one on top refers to an exchange we had about a letter that the deputy penned and sent and ultimately ended up before the Agricultural Land Commission.

The question that was posed to the minister was: “Was the minister aware that the letter was being sent?” She replied — fairly directly, in fairness — and said: “No.” That was her answer.

I’m going to send one more document over. The document I’ve just sent over, again, is another email. This one is dated April 8, 2021 — I guess times on these things are now important — at 12:13:05 p.m. from someone named Jason Craik. It was sent to Alissa Brandt. There was an attachment, apparently, described as “draft letter ALC, re: CSFS5.docx.” Then, below that, the line: “Letter that AFF DMO intends to send shortly to the ALC board and chair. I have no issues with it.”

Then, a little bit further down from there, a subsequent email from Sam Godfrey — again, Mr. Godfrey, whose position with the minister has been described — April 8 at 11:54 a.m. That appears to be an email sent to the minister’s own email address. I can’t use her name, but it’s her name and then what appears to be her government email address. “Forward: clean copies.” Then, from Mr. Godfrey, the question: “Any concerns?”

[2:30 p.m.]

To summarize, what we seem to have here is an email chain that refers to a draft letter from the deputy to the Agricultural Land Commission regarding this matter that we’ve been discussing, which was provided by her chief assistant to her for review. Is that all accurate?

Hon. L. Popham: I don’t know what letter this is referring to.

M. de Jong: In response to the message from her chief senior adviser, I think, Mr. Godfrey, did she have any concerns?

Hon. L. Popham: I just want to correct the record. The member is implying that my deputy wrote a letter to the ALC board and chair. I think he’s implying that. But my deputy wrote a letter to the Carrier-Sekani. So I’m not clear on what this letter is or what this is referring to. My deputy’s letter went to the Carrier-Sekani.

I’m going to say it again, and I’m going to say it for the last time. I’m not discussing an issue that’s before the ALC. The member can stand up and ask more questions if he wishes, but on the record, I’m stating I won’t be answering any more questions about a live application at the ALC.

[2:35 p.m.]

M. de Jong: Just so the minister is clear on this — and she, I suspect, recalls this from her days toiling, as we do, in the opposition trenches — one makes a request for relevant documentation pursuant to the rules of FOI and the pertinent legislation, which was done here. Documents were provided.

I’m asking questions about those documents. They are not documents that I have conjured up. They’re actually documents that her office has sent. So when she says, “I don’t know what the member is talking about,” well, they’re documents from her office.

What we have is a document that refers to a draft letter to the ALC: “Re: CSFS letter that Agriculture Ministry DMO intends to send shortly to the ALC board and chair. I have no issues with it.” Was there a draft letter?

[2:40 p.m.]

Hon. L. Popham: What the member has given me is an email exchange about a letter. He’s implying that a letter went to the Agricultural Land Commission board.

We’ve checked with the ministry office. There is no record of a letter that left from my deputy to the Agricultural Land Commission board. We’ve checked with the Agricultural Land Commission. There is no record of them receiving a letter from my deputy.

M. de Jong: If over the course of our discussion I have inadvertently put words in the minister’s mouth, I apologize unreservedly. That has not been my intention, and I have strived not to do that. I hope she will extend the same courtesy to me.

I’ve implied nothing. I’ve asked questions about a document. It’s the minister who seems to be jumping to conclusions. I’m not sure what she would have us conclude confronted by a document that says…. I’ve concluded nothing. I have merely asked about an email exchange that begins with reference to a draft letter to the ALC about a particular matter and that says this is the letter that the deputy intends to send to the ALC board and chair.

The minister has said: “Well, we can’t find a record of that letter.” Okay.

The minister has gone to great pains over the last number of hours to make this claim of non-interference and the sanctity with which that principle is held. There is a growing body of evidence that the commitment to that principle is a little more selective than the minister would like to lead on. A document like this, referring to a letter that was prepared for transmission to the ALC board and chair about a particular matter, is pretty strong evidence.

The minister shakes her head. “Nothing to see here.” All right. If that’s her story, she can stick to it. “Nothing to see here,” the minister says.

She was asked, by the way, by her senior ministerial assistant, her senior MA, whether she had “any concerns about a clean copy of a draft letter that had been prepared for transmission by the deputy to the ALC board and chair.” Did she have any concerns?

[2:45 p.m.]

The Chair: Members, just before I go to the minister, given the nature of these questions, I want to remind all members to be mindful of the sub judice convention as debate on Vote 13 continues. Thank you.

Hon. L. Popham: I don’t recall having any concerns about a letter that wasn’t sent.

M. de Jong: Well, that’s a remarkably, delightfully clever answer, but it does beg a follow-up question. Is the minister saying she had no concerns when presented with a letter…? It sounds like what she’s saying is that she had no concerns about a letter that had been prepared with a view to being sent to the ALC board and chair about a particular application, under the signature of the deputy minister. If that’s what’s she’s telling the committee, then that’s informative. She’s saying she had no concern about that.

Hon. L. Popham: Madam Chair, after this, I wouldn’t mind having a quick recess.

My response to the member is that we’ve investigated. There was no letter. There was no letter that was sent. There was no letter that was received. Did I have any concerns? I don’t remember. We don’t even have a letter to refer to. I don’t know what this is referring to.

The member continues to build a case on facts that he’s making up. He doesn’t know either, but he’s certainly trying to build a case on it. There are no facts to go with the accusations.

Again, that’s it. I’m not talking about it anymore. We’re now just trying to discuss a document where we have no idea what it’s about.

The Chair: The minister has requested a recess. We do have a changing of the Chair at 3 p.m., so I’m going to call a ten-minute recess now. If everybody could please return and have their cameras back on at 3 p.m.

The committee recessed from 2:50 p.m. to 3:03 p.m.

[A. Walker in the chair.]

M. de Jong: We’ve canvassed a lot of this. I have endeavoured to express some queries and concerns. The minister has said, in a variety of ways, that my expressions of concern are unfounded. A document that refers to a draft letter from the deputy to the ALC chair and board, around a particular matter that now is very much under consideration, that had been ruled upon at the time the letter was being considered and that she had been asked to comment upon — none of that should provoke any kind of inquiry or concern on the part of people or of the opposition.

[3:05 p.m.]

What we do know from earlier exchanges — because we actually have the letter — is that a letter was ultimately sent by the deputy, knowing that it would be part of the file that went to the ALC as part of the package from the regional district, professing support for the project on behalf of the entire Ministry of Agriculture, despite the ministry having earlier provided commentary, on an earlier application, expressing concerns around the application.

I guess the question that, in a general sense, people are entitled to hear the minister’s response to is: what do you have to do to get a letter from the Deputy Minister of Agriculture supporting an application — what’s the threshold; what’s the test — or even, apparently, the preparation of a draft letter to the ALC itself?

I hope the minister understands why people would be curious about that — that in all of her protestations about the independence of the ALC, apparently some applicants, in certain circumstances, are able to get a very specific expression of support that is intended to land in the lap of the ALC.

That’s my question to the minister. How do you get one of those letters if you’re an applicant? What qualifies an applicant for one of those letters?

Hon. L. Popham: Any answer I give to the member’s question is really drawing me into an application that is live before the Agricultural Land Commission. I can’t make a comment on the letter. If I do, it’s interference. That’s my final answer, Member.

M. de Jong: There’s a remarkable irony in that last answer, that in addressing an issue that, in and of itself, strikes most reasonable people as an act of interference, the minister would say to comment is to interfere.

Well, let me perhaps pose this question that has nothing whatsoever to do with the application that has engaged our attention. Has the deputy or the minister written a similar letter of support on behalf of any other application?

[3:10 p.m.]

Hon. L. Popham: We would need time to check the records.

M. de Jong: I would be grateful if the minister would do so and provide a report. I am, quite frankly, troubled by the answer, because it suggests that the minister cannot say with certainty that letters professing support for a particular project in application have not been written on behalf of the ministry previously.

It appears that the minister’s view and position is that there was nothing untoward or problematic, and there is nothing untoward or problematic, about circumstances in which the No. 2 ranking individual in the ministry writes letters articulating support for a project, knowing that the letter is intended for inclusion in a dossier that will be before, and is required to be in a dossier before, the Agricultural Land Commission. The fact that the minister is obliged — I appreciate her honesty in the matter — to tell the committee that there may well be other such examples out there is, I think, very telling.

I have a sense, from some of the minister’s commentary, that she has not viewed this as a particularly worthwhile exercise. She is certainly entitled to that view. I, on the other hand, and I think many others, have found it most illuminating and most revealing about the conundrum that has been created by some perhaps well-meaning amendments to legislation that have created a circumstance in which applications that virtually every single British Columbian would find reasonable and worthy of support are precluded from moving forward.

The minister insists that those challenges have nothing to do with the changes that she and her government made. Documents from her own ministry, I would suggest, paint a very different picture and confirm that those changes have very much influenced the challenge that this and other applicants have faced. We’ll continue to disagree on that point.

Interjection.

[3:15 p.m.]

M. de Jong: Well, the minister will have her moment to rebut. She hasn’t been hesitant to do so. In addition, when she does, perhaps she will make one last attempt at explaining to people who have an interest in these matters how it is that an applicant obtains a declaration of ministerial support at the hand of the deputy minister, how it is that, at one time, there was a document to be sent directly to the ALC board and chair. We don’t know what happened to that document. All we know is that there’s no record of where it went, beyond the approval that it apparently received from the minister and others within the office.

Perhaps she’ll also explain to those that might be interested what the process and procedure is for obtaining from the government a letter indicating its willingness to pass an OIC excluding land from the agricultural land reserve. Of course, in this exchange, we also reviewed documentation to that effect — where it was put on the public record that the government was prepared to go down that route. Apparently, it has not done so to this point. But the relevance of that as a signal of the government’s preferred outcome with respect to this application, I think, speaks for itself.

I’ll end where I began, and that is that the interest in this was provoked by the realization that a group wanted to advance a project that was much needed in the community, the Carrier-Sekani Family Services agency, for reasons that are well known.

I will repeat again — lest my criticism of the government be misunderstood — I have no doubt that there is enthusiastic support within the ranks of the government, as there is within the ranks of the opposition, for this project itself, which makes it all the more frustrating that it has been unable to proceed.

I have offered up my view, in this case, of why that is and how, confronted by that dilemma, which I have characterized as one of its own making, the government has gone to great lengths to try and find a backdoor solution that would address the issue. The material we have seen — the documents, briefing notes, emails — I believe all paint a very clear picture of what has taken place.

I will end simply by saying this. For all of that, I remain hopeful that this project will receive the approval it requires to address the needs and the treatment needs of a community. I know that is the hope of my colleague, the official opposition critic, and the hope of my colleagues who represent the area, including the Leader of the Opposition.

I am, despite what she may think, grateful for the opportunity to have engaged in this exchange with the minister, to the extent that she has been prepared to do so — her willingness to provide answers to my questions.

[3:20 p.m.]

I. Paton: Just before we wrap — I think they want to move on to the next set of estimates — I want to thank my colleague from Abbotsford West. I’d like to thank the Minister of Agriculture and her staff for their time and putting in a pretty healthy three days’ worth of questions and answers. So thank you.

Before we go, I’d just like to pass along some written questions from my colleague from West Vancouver–Sea to Sky regarding some aquaculture items. So if I could pass these along as written questions before we go.

The Chair: Seeing no further questions, I ask the minister if they would like to make any closing remarks before I call the vote.

Hon. L. Popham: This has been an interesting set of estimates that we’ve gone through. I absolutely am willing and able and encourage any discussions that come through during this time. I would have to say I’m quite disappointed that we spent six hours or more — I’ve lost track of time — on one issue when we have almost a $100 million budget before us. We have pressing issues and the most public support that we’ve ever had, I believe, around local production, local food security, food security for British Columbia. It’s unfortunate that we got very little time to discuss those things.

That being said, I’m really proud of the budget that we’ve put forward, and I look forward to the projects that we have underway. I would offer to the critic that our door is always welcome for any briefings that he may want to learn about how almost $100 million is being spent in this province on agriculture, food and fisheries.

Thank you very much.

The Chair: Thank you, Minister, and thank you all, Members.

Seeing no further questions, I will now call the vote.

Vote 13: ministry operations, $81,636,000 — approved.

Vote 14: Agricultural Land Commission, $5,001,000 — approved.

The Chair: The committee will now take a five-minute recess while we prepare for the Ministry of Health.

The committee recessed from 3:23 p.m. to 3:28 p.m.

[A. Walker in the chair.]

ESTIMATES: MINISTRY OF HEALTH

On Vote 32: ministry operations, $23,725,698,000.

The Chair: Minister, do you have any opening remarks?

Hon. A. Dix: Just very briefly. These are unusual moments, I think. This is the first time I’ve sat with the member for Prince George–Mount Robson, the Leader of the Opposition here, in 15 years. It’s the first time we’ve seen each other in person, in a room, in a very long time — I think since February 2020. We’re talking about seniors care, principally, today, and seniors.

In the intervening period, a lot has happened in all of our lives. I just want to pass on my real condolences and the sense of loss that I know the Leader of the Opposition has had. I know it was a year ago, on June 6, that she lost her husband, I believe. She was recognizing that this weekend. I think in that, we can see the losses that so many people have had, personally — all of us here.

[3:30 p.m.]

I’m here with Steve Brown, the Deputy Minister of Health, who’s waiting for some exciting news in his family’s life and isn’t as much a part of it as he’d like to be; and Dr. Bonnie Henry, who has been through so much on behalf of all of us. All of the health care workers, all of the people who’ve lost loved ones…. This has been an extraordinary year.

I’d just say to the Leader of the Opposition…. I try, whenever we discuss these issues, to keep that in mind — to keep in mind, when we get emails that are sometimes critical of us, the experiences that people have had in this time, which has been, I think, profound in ways that we don’t understand. Sometimes people express that through anger, but often that reflects pain that we do not understand.

I think what I try and do — successfully sometimes, not so successfully other times, as the deputy minister will say, when we’re trying to work together on things in a very tense atmosphere — mostly successfully is…. I think British Columbians have worked together well as a team on this, and I include the Leader of the Opposition in that. She took responsibility for some of my file last year at an important time.

I can tell you that when I asked the then member for Kelowna–Lake Country if members of the opposition would be prepared to help us on seniors issues, in community, there was no hesitation from him, no hesitation from the hon. member. I don’t forget these things.

We’re going to have a debate. It’s absolutely legitimate for the opposition to disagree with actions we’ve taken on any number of issues. But I’m very respectful on this side.

I apologize for being a little more emotional than usual, but it’s unusual to have people in the room to see this and be here. It has been a long time. For us, this has been our life for a long time, too, this debate in this place. It’s a significant moment.

I want to acknowledge the Leader of the Opposition and the leader of the Green Party, who will be with us.

For people listening to us, we’re going to be debating seniors care today. Next week, when we do the long debate on health care, which will go multiple days, the Leader of the Opposition will be debating with the Premier in another room of the Legislature. That’s why it’s being done in this way.

I want to express and welcome the Leader of the Opposition. I look forward to answering her questions.

The Chair: I now recognize the Leader of the Official Opposition.

Do you have any opening remarks?

S. Bond: I do. I want to begin by expressing my gratitude to the minister for his comments and also for his kindness and compassion. He was very quick to reach out to me personally during what has been the most difficult year of my life. There’s no doubt about that. I’m very grateful for that.

I have been overwhelmed by the compassion and kindness shown to my family over the last year. I know that that characterizes how British Columbians have reacted, for the vast majority of people who’ve suffered loss in this last year.

I also appreciate the comments of the minister. I will say this. The minister and I have had a long working relationship, and I have developed a great deal of respect for his efforts. I often have said to the minister that he took his time in opposition and did all the right things getting ready to actually take the seat he now has.

One thing I do know: the minister knows his files well. So I’m hoping…. We don’t have a long period of time to talk about what I think is a critical topic, and that is the care of seniors in British Columbia. It is absolutely essential that we have some conversation about that.

I also want to, just for a moment, reflect on something that the minister has talked about today. This is a place of debate. It is a place where hard and, at times, uncomfortable questions are asked. That’s exactly the way this process is designed to work. It doesn’t mean that it can’t be done respectfully.

I have a job to do with my caucus as well. I know that we’re just beginning the journey through Health. There will be a lot of hours spent with other members, including our Health critic and other segments of the Health Ministry.

I’ll just close with this, and it’s a personal observation. Then, hon. Chair, just to give you a heads-up as to where I’m going, the member for Penticton…. I’m going to have him…. He has a question he wants to ask. I thought we’d start with that. Then we’ll work our way through. Later this afternoon….

To the minister and, obviously, Dr. Henry, I want to express, also, my gratitude. I can’t imagine the personal strength that it has taken for you to manage British Columbia through this very difficult time. So I do want to express my respect and gratitude. I can’t imagine how difficult it has been for you.

[3:35 p.m.]

Also, to Stephen Brown, I know how the ministry is such a huge responsibility. I also have appreciated the conversations that we have had over time.

I’ll just let you know that the member for Penticton has a question.

I do want to say this, though. This is one thing I appreciate about the minister, and I think it’s really important that members in this place take every opportunity to remind each other that everyone comes here with the right motive. They come here because they care about British Columbians. They care about women’s issues. They care about child care issues. They care about seniors in British Columbia. How we approach those issues may be different, and that’s the subject of debate. It is not about who cares or who doesn’t.

I can assure you that every member of my caucus cares deeply about health care outcomes, about seniors in British Columbia, about women in British Columbia. Any other suggestion to the contrary is unfortunate, in my view. I know the minister understands that. He has been incredibly respectful in our dialogue and, throughout the pandemic, has taken every opportunity to pick up the phone or have me reach out to him and receive briefings from Dr. Henry, and Stephen as well.

I want to begin this discussion by saying, yes, there will be difficult questions, but they are not meant in any way to undermine the desire that all of us have to serve British Columbians to the best of our ability.

With that, Mr. Chair, I thank you, and I would cede the floor to the member for Penticton.

D. Ashton: On a personal note to the three of you individuals, I would like to thank you very, very much for the incredible burden that you’ve had to shoulder for this province and the citizens of this province, and for the exemplary job that the three of you have done under some incredibly trying circumstances.

To make the questions quick — there are actually three — what I would ask is that maybe your response, because time is of the essence…. The first question. There’s a Chinese company, Anbang Insurance, that owns various seniors homes in British Columbia. There have been some issues in these homes. The issues have been tried to be addressed, although I’m quite sure we’re not there yet with some of them. If I could get a status report on the direction that the province or the ministry is looking at, with the outstanding issues that are in some of these homes from the owners of Anbang.

The second question. Wage parity levels were brought up for for-profit and not-for-profit with those…. I’ll say “facilities.” Those are homes that are run by health authorities. How long will that last? Is there going to be a permanent fix?

The third and final one is on the CCAs, the comfort care aides. It’s my understanding that many of them are hoping to get fast-tracked into the care aide program. I would just like to know where that stands at this point in time.

If I could get an answer in the future, that would be good. Once again, thank you to the three of you for a job well done, so far, under very trying circumstances for everybody. Thank you again.

Hon. A. Dix: Thanks to the member for all his work, especially on seniors issues in Penticton and Summerland. Members will know that he and I are in regular contact, especially about issues involving Summerland Seniors Village. As you will know, the Summerland Seniors Village was put under administration by Interior Health — one of, as the member has suggested, four Retirement Concepts facilities across B.C. that were put in those circumstances on the recommendations of health authority medical health officers.

In the case of Summerland Seniors Village, it has been extended two times now, until July 15, 2021, when it will be reviewed again. A new director of care did start in mid-April of 2021. There has been, in that period — on January 21, 2021 — one critical infraction, but the site is now accepting new admissions — which, I think, is an important milestone for it. In the case of the four Retirement Concepts facilities, I’d say to the hon. member and to the Leader of the Opposition, in the case of the other three, there’s good work done by Retirement Concepts.

[3:40 p.m.]

They are a very significant owner of long-term-care facilities in British Columbia. Because of good work done by them, the facilities in Comox, the facilities in Nanaimo and the facility in Victoria are now no longer under health authority administration, and that is the goal here. The goal is to improve the standard of care and to address the issue that caused medical health officers and health authority boards to take these extraordinary actions, and they are extraordinary.

If you look at the history of these measures, since the current act was put in place and the measures in the current act were put in place, less than ten times have those ever been invoked. The majority of those times were with Retirement Concepts care homes, so they had some work to do, and they have done some of that work.

I’m not going to comment on what will happen as of July 15. But the next day, I would say, for the hon. member to look at is July 15 of this year, because that’s when the administration was renewed too. It’s our hope, and it’s our aspiration that we’re going to get to the point when that’s no longer required with respect to Retirement Concepts.

With respect to the single-site order, that was put in place first, essentially, under provincial health order and some medical health orders in health authorities and then became provincial policy. As the member would expect, it’s extraordinarily important in that it essentially ensured that individuals who were working at multiple care homes would just work at one — the idea of the single-site order. It was combined to make it effective.

The reason it was effective in B.C. and not in other jurisdictions, I would argue, is the considerable investment. It was estimated, at the time, at about $165 million to put in place a single-site order. I think the actuals are closer to $140 million. I’ll get them for the hon. member.

It’s our intention to continue that once the health orders are taken off, at some point, whatever point that is — to continue the principle of the single-site order. That’s part of the work we’re doing with contracted providers in the whole health system now. The idea, I think, of lifting and having the competition that takes place for new contracted providers be on the basis of the care that’s provided and not on a competition around the salary paid to people — I think that’s a good principle.

The single-site order is an advancement on that. There’ll be a debate. There’s always a debate on these things, but I think that’s a useful model. It’s also useful at a time when we need to recruit more and more people to be health care workers. Taking that out of the equation, ensuring everyone meets a base level of compensation for work that’s incredibly valuable, is useful. I have appreciated the support, I think, of the opposition for the single-site order and its principle — and, I think, the support from the hon. member that’s implied in his question.

With respect to the third question, I don’t have that. What I will do is I’ll report back to the House. What I’ll try and do consistently rather than spend a lot of time delaying the debate, is if I don’t have an answer immediately, I’ll report back to the House and provide that information — before the end of estimates, certainly, but probably at the start of the next day of estimates or the next period of estimates.

S. Bond: Just to sort of finish the road map for most of today, I have also invited the Third Party to participate just before six o’clock, so the minister is aware of that. We’ll see how the rest of our day shapes out.

I want to start with the service plan. Of course, we’re focusing on the seniors component. I noted that one of the key strategies, when we look at objective 1.2, is — and I certainly agree with it — about ensuring that seniors receive, and I quote for the minister: “quality, culturally safe and appropriate care.”

Could the minister perhaps give me some sense of what specific funding or resources would be attached to that objective? We know that it’s absolutely essential that there be culturally appropriate care for seniors in British Columbia. I’m just curious as to what specific resources or actions the minister might be considering when it comes to that objective.

Hon. A. Dix: On the issue of quality, I think it starts with care standards. You’ve seen that from the beginning of my time as Minister of Health, where we have sought to increase overall care standards to more than — and now we’ve achieved it in all five health authorities — well beyond, the standard of 3.36 hours per resident day of care, a portion of which is nursing care, a portion of which is allied care, per resident, per day. I think that’s an important consideration that we meet that standard.

[3:45 p.m.]

There is, by the way — because this is, hopefully, a significant debate about what we’re going to do in the future — a national debate around these questions. There are people who feel that 3.36 is insufficient. But that’s the care standard that we’ve been operating under in B.C., roughly since 2008.

That was particularly important, I’d argue, for our contracted providers. At the time when I became Minister of Health, it was about 3.11. I think, at the end of the 2016-17 fiscal year 3.11 was the overall standard. But for private contracted providers, it was closer to three. For the public providers, it was closer to 3.3. Those represent one-third. The other represent two-thirds.

Almost all of the money for that initiative went to private providers. It didn’t go to the providers. It went to raise care standards for the residents, who, generally speaking, don’t have a choice about where they go. They get the choice of three care homes, but many, many, about 22,000, of those residents, are living in contracted providers, and the rest are living in health authority–owned and –operated.

The key is to maintain and increase care standards. That doesn’t just involve money. It involves people. That’s why we have to continue aggressively around the province, because this is going to be a challenge. I think we’ll inevitably — if not today then next week — talk about how we meet the human resources demands of health care, particularly in the north and the Interior. That is, I think, one of the significant challenges facing public health care in the next 20 years — that challenge in general, but particularly in the north and the Interior.

When we talk about that, we’re talking about maintaining and addressing those care standards. To what end? One of the profound challenges, I think, of the COVID-19 pandemic has been the effect it’s had on residents in long-term care because of the very significant limitations that have been put on visitation. This affects, in some cases, people’s care. Let’s face it. People who go in and support their loved ones, their friends and their families in care are a considerable part of the care. It’s not just the social value of visitation, whose value is incalculable, but also, I’d argue, the actual care value of that.

One of the things I believe is that we have to make life better. So much of what we spend money on in long-term care is keeping people safe, making sure people don’t wander, especially with the majority of residents living in long-term care living with Alzheimer’s or other dementias. But what’s critically important to me is the quality of life in long-term care and how we address that, how we address the social aspects of that life. When all of our other facilities to do things have gone away, how do we address that under those circumstances?

Many people living with dementia are otherwise quite physically well. What is that life, and how do we allow people not simply to be bedridden or not be able to move around? Hence, the need to develop more dementia villages. That’s something that, because it’s a major capital investment, will require time, but we’re making some progress on that.

Secondly, it’s the quality of food. If one has eaten…. In terms of the culturally sensitive part, I think food is important in that. Often families can provide some of that care, but I think we need to remind each other — and I’ve been reminded a number of times of this, especially when we made changes in visitation — of the sheer number of people living in long-term care who receive no visitors, whose family is the staff in long-term care.

What’s critical, if you’ve lived a life where you’ve eaten only certain kinds of foods, is to try and find diversity within our care homes. Difficult to do. Sometimes expensive to do. Sometimes impossible to do. That’s why, in Surrey, the Progressive Intercultural Services Society is developing a long-term-care home that will be responsive to the whole community but, in particular, the South Asian community. Organizations such as SUCCESS and others have been successful in doing that. We have to find ways to do that.

Those are important initiatives, but we also have to find ways…. For example, Lakeview centre, which is a private contracted provider in my riding of Vancouver-Kingsway, near Trout Lake, provides a lot of diverse sorts of food. It’s challenging. It’s challenging as we go through our lives. Those of us who learn multiple languages often come back to our only language at the end of our life. So that’s a challenge.

Providing opportunity. That’s what I hope we do when we add staff in long-term care — opportunities to enjoy life. Not just live longer but live better. That, I think, should be central to how we think about long-term care, why we need to, of course, develop supports in the community so that people are not having to go to long-term care but not giving up on that aspect, because people arrive in long-term care at the end.

[3:50 p.m.]

Those are some of the considerations, when I think about it. Of course, keeping people safe; of course, ensuring that they have good medical care; of course, giving them supports, and so on — all of those are incredible challenges.

I think that one of the biggest losses under COVID-19 has been the social experience of people in long-term care, none of whom wanted to be in long-term care but are there. We have to find a way in this period, now that COVID-19 is lessening, to increase the doses of vaccination to allow this to happen, to increase, as we hope, one more time, incrementally, access to visitation and then, in the period afterwards, resolve ourselves that when the lights go away from long-term care a little bit and go on to other issues, we’re going to continue to focus on improving the quality of life.

S. Bond: Thank you to the minister. I share many of those observations. I guess I want to use a specific example. I think the minister has also referenced an incredible project that’s going to take place in Surrey and that is very much focused on the cultural support and the cultural community that people deserve also to have in their latter years.

I want to explore, just for a moment, how the minister works across other government ministries to deal with issues when it comes to seniors in long-term care or in seniors housing. I think all of us were distressed when we went…. I certainly had a large number of people reach out to me about Grace Seniors Home. The minister would be familiar with that. It is a culturally sensitive place that was embraced by the community. It’s for Cantonese-speaking seniors. There are very few spaces available. Those are the kinds of alternatives or models that we want to make sure exist not just in Chinatown but elsewhere.

Maybe the minister could just reassure me that there is a cross-government approach to this. When we hear families that are absolutely anxious and worried that their loved one is going to have to leave some place, they want to make sure that that cultural element still exists. When I read the objective, I was appreciative of the fact that this sounds like it’s more than just a one-size-fits-all approach, and the minister has spoken to that.

Maybe just some assurance that there is a cross-government approach that says: “Together we’re going to make sure that elderly British Columbians have the best possible fit for them in their latter years.” Maybe just a bit of emphasis for me on the cultural side of that. When a situation like that of Grace arises, how does the government actually work across ministries to deal with that?

Hon. A. Dix: Of course, I’ve heard about that. That’s an issue that was dealt with elsewhere. There was lots of advocacy and, I think, hopefully, ultimately a good result — although these things, when you get a good result in the end after controversy, create a lot of anxiety. I understand all that.

I think there is an issue around continuum of care. Why I like the idea of PICS long-term-care home is that PICS, as the member will know, has won a competition — if she hasn’t had a chance to visit it, hopefully when we’re visiting things again — and runs one of the most successful assisted-living homes. In recent surveys, it’s one of the highest-rated assisted-living homes in Fraser Health — the PICS assisted living.

What you had there was some independent living on site and assisted living. Once people had to leave assisted living and could not be sustained and required the care required in long-term care, the care would suddenly change. So you’d have the change of leaving that which had been your home and then the change of going from a very different facility. It’s challenging. Of course, all of our care providers try, I think, to do a good job, and they have significant health standards. Their ability to deal with the variety of British Columbia can be challenging.

I think that’s an example of where you want to create a continuum of care where people can possibly go from independent living to assisted living to long-term care, because at 65 we live, on average, for 23 to 25 years. Even though we talk about seniors as one group, there are many groups.

[3:55 p.m.]

Equally, I think, we need to do that with other language groups. New Vista in Burnaby, another care home in Burnaby, has a floor that was significantly supported in their redevelopment. It’s a non-profit care home, one of the oldest in British Columbia as an organization. They have a new facility that is going to be responsive to the Korean-Canadian community. It’s the challenge of a diverse province.

I think that what we have to try and do is have a care system that, as much as possible, treats people as individuals, that understands that the circumstances of…. I think of one person that I visit every week in long-term care — so I’ll think of that — who is as sharp, thoughtful and critical as a person can be, but whose body has failed her, and she’s in long-term care.

Then other people have different needs. We have to try, in those years, to, I think, target individual investment on the quality of life and opportunities to live, even in long-term care — to live, and to find the things that give life meaning. That means, as much as possible, culturally appropriate care.

It’s difficult. You’ve got a care home like, say, Evergreen in North Vancouver that has 300 beds in multi-bed rooms. We’ll be talking about capital, probably, in a little bit. We need to rebuild that care home. It’s one of the old health authority public care homes on the site of Lions Gate Hospital. It’s 300 people — you can imagine — because it takes most of its people from the North Shore, the diverse community that it represents. How, when you’re managing such a care home, do you provide culturally appropriate care?

Just because it’s difficult, it doesn’t mean we can’t do things to address that. I think we have to. I think our goal, together, as a province…. Coming out of a pandemic that has been in this world, in this province, in this country, brutal on people in long-term care, that’s got to be our commitment to the future years: to make life better.

S. Bond: I know we’ll have some further discussion about seniors in community and seniors in long-term care in just a few minutes. I also wanted to just ask the minister about another strategy that’s included in the service plan. It’s actually related to the use of CareConnect and remote patient monitoring. I’m wondering if the minister could outline for me how seniors are able to connect or to access these particular supports — CareConnect and remote patient monitoring.

Hon. A. Dix: I think there’s some up-to-date information. What I’ll do, if it’s okay with the hon. member, is to come back to that in a few minutes when we get a little bit more information. We’re seeking that now, and then we can continue. I know the member has only so much time.

S. Bond: Well, thank you very much. Another key office that does work related to seniors in British Columbia…. I will certainly say for the record that I have a great deal of respect for the office of the seniors advocate. I’m wondering if the minister could outline for me how the funding for the office of the seniors advocate is determined.

Hon. A. Dix: Essentially, the seniors advocate receives base funding, which goes up, as base funding does. Then she makes requests for special projects that she does. Those two sets of projects in that process would go through the Deputy Minister of Health.

Members will know that the seniors advocate isn’t an independent officer of the Legislature, but I think it’s fair to say that the seniors advocate is independent and has done a good job. She served under the previous government, and she served under this government. Occasionally, lots of people get angry at her, from care providers to others. All those things happen, but I think she does a very good job.

Her way of accessing budget isn’t like an independent officer, who comes here and makes their case to a legislative committee. In her case, she has base funding, which would be kind of ministry core funding. Then, for special projects, she makes cases. As the member will know, recently, during the pandemic, she played a critical role in managing a budget. That wasn’t her budget to manage, but she was given those responsibilities, working with a group of MLAs. That’s the kind of project funding she gets. If she needs funding for something special, she would get that funding.

[4:00 p.m.]

S. Bond: I certainly understand that people do…. I think all of us are in the position that no one agrees with everything we do all of the time. I think that the seniors advocate’s role is absolutely essential. We do need to have an independent person who speaks solely for the benefit of seniors in British Columbia.

I’m wondering if the minister can tell me what funding resources are allocated for the office for 2021-22.

Hon. A. Dix: The base funding is $2.267 million.

S. Bond: So maybe I could just pursue, then, with the minister, if he is prepared to articulate for me, what special projects, for example, the seniors advocate is considering, what she has asked for funding for and whether or not they’ve been approved. Is he in a position to be able to describe those for us?

Hon. A. Dix: Within that base funding envelope she has the flexibility to do a lot of what she does. But I think it’s fair to say, from time to time, she’d seek extra resources. For example, a significant portion of her time went into the development of 211 and related projects this past year. That was one of the things that she did. I think that most of her requirements are held within her base budget, but I don’t think that would be a limitation.

From time to time — quite frequently, actually, over my time as minister — I’ve called on her for advice or for extra information myself, independent of that, because she’s a thoughtful person and she provides a different perspective than just the ministry perspective, which, of course, is excellent.

That’s her base budget, and I think it’s fair to say that if she would want more money or if she needed more money, we’d absolutely be open to that as well.

S. Bond: Could the minister perhaps let me know whether or not there were additional resources, for example, requested? Did she receive funding for the Staying Apart to Stay Safe report review? I know that that’s important work.

Perhaps the minister could indicate…. I think he has done that by saying that. If something emerges throughout the course of the year and there is a special request, is that the kind of process that’s in place? The advocate can make that kind of request. It’s considered, so there may be additional funding provided in addition to the baseline budget throughout the course of the year.

Hon. A. Dix: I think that if those circumstances were required, she’d simply ask the Deputy Minister of Health. I think, based on the importance of the office, that request wouldn’t be denied. She does receive some shared services within the Ministry of Health, as well, I think — support for communications and other such things, when those requirements are in place.

Those reports she does within her funding envelope. They’re considerable, including the guides to long-term-care homes that you see, which she publishes periodically — the report on home support, for example, that she did not so long ago, pre-pandemic but recent pre-pandemic, and so on. She produces a significant number of reports.

She has an advisory group that she meets with regularly around British Columbia that I’ve had the occasion to speak to when she brings people together, from time to time, representing seniors in different communities. She does lots of that work as well.

There was a brief period when there was a lot of criticism of her office, as I described earlier. I think maybe, in previous estimates, we had a little bit of that, with the former member from Richmond east. There was a time when that was the case. There was a time when there were concerns from the B.C. Care Providers about the seniors advocate.

[4:05 p.m.]

I think, especially with the new president of the Care Providers, Mr. Lake, and others, that her relationships, in general, are good. Inevitably, like I say, there will be disagreements. I see those as a positive thing. I think it’s an indication….

There’s some discussion, including, I think, with…. Care providers and others have suggested the creation of another independent office of the Legislature. I think the freedom that Isobel Mackenzie has to speak out on issues, even when she’s disagreeing with the government and with others in the system, is an indication of her independence. I personally think the office is doing a good job and is operating well.

S. Bond: I could be mistaken, but I seem to recall that when the member was in my seat on the opposition benches…. I think they were wildly supportive of the fact that we needed an independent seniors advocate, but I could be corrected there.

I actually think some tension in the system is important. I think that having someone who speaks solely from the perspective of seniors is an important thing. Obviously, we believed that as we moved forward. I understand that not every jurisdiction has an independent seniors advocate. I think British Columbia has done some good work on that front, and I certainly appreciate the office and the work that the advocate has done.

I want to move on to talk a little bit about…. Well, I want to, actually, ask another question about the seniors advocate. It’s in relation to community support and home support. Again, it comes back to the service plan. It’s on page 4 of the 2019-20–2021-22 service plan. It’s under objective 1.2. It reads: “With the guidance of B.C.’s seniors advocate, continue to improve access to home and community care.” It goes on.

I was, actually, surprised to discover that in the same section of the current service plan, that phrase is removed, the part that says: “With the guidance of B.C.’s seniors advocate….” I think that her role is very critical in terms of direction and looking at how we improve access to home and community care and at how we better address the needs of seniors in the province. One would think that having her advice is, actually, pretty important.

It seemed to have disappeared from the current plan. So I’m wondering if the minister could just explain the rationale for removing the phrase “the guidance of B.C.’s seniors advocate.”

Hon. A. Dix: I’m delighted that the member reads the service plan so carefully. I resolve to read it more carefully next year.

The seniors advocate, with respect to home support, has had, I think, in the direction that we’ve taken in community care, in particular, enormous influence, and she will continue to have that. For example, when we increased, especially, the money for respite care, which was a major part of the advancements we made in our home and community plan, starting in 2018-19, that recommendation, even though….

Obviously, it was a government proposal. I announced it at Collingwood Neighbourhood House. I recall the seniors advocate was there and spoke to it. That change, that focus on respite care, was solely based on her recommendation. In fact, it was her primary recommendation to me when I said: “What do we need to do to change that plan?” It was to focus on adult day programs and respite care and to provide more services to people in the community. She has played a central role in the development of that plan.

[4:10 p.m.]

Equally, with respect to the report, a series of the recommendations have been put in place, including the repatriation of seniors’ care, which wasn’t specific of home support care, which, I think, has been largely successful in the province. That change has also received the support of the seniors advocate, and a series of the things proposed in her most recent report are there.

In terms of home support, in terms of respite care, in terms of community care, in terms of community-based services that are provided by professionally based services — all of which increased significantly as part of our seniors plan that we put in the 2018 budget — it has continued on through.

As we develop the expenditure around those plans and the detailed programmatic part of those plans, all of them were influenced by the seniors advocate, and they’ll continue to be, particularly in that area of care. And the member will know that the seniors advocate is the former long-time director of Beacon Community Services in the south Island, so she has both a significant interest and expertise in that area. So she’s someone I rely on.

I don’t know. It may not be in the service plan, but I’ll keep talking to Isobel Mackenzie nonetheless. And I’ll check that out in the service plan, make sure…. You may see it back in.

S. Bond: Well, I certainly didn’t want to imply that I thought…. I was hoping it wasn’t an intentional change. And I think the minister has made clear that working constructively together, whether it’s the seniors advocate or members of the opposition, there is tension in the system, and that’s actually what drives change. There have been, as the minister points out, some very substantive recommendations made by the seniors advocate, and I want to ensure that we, corporately, respect that — the role of the independent officer. And that is to…. That can be uncomfortable at times, but it is still absolutely critical.

I wanted to just spend a couple of minutes talking about the fact that…. We’re going to talk more about long-term care and COVID and the heartbreaking circumstances that families have faced and, in some cases, are continuing to face. But when we look at what…. I actually appreciated the way the minister described the seniors in British Columbia. They’re certainly not one-size-fits-all.

One of the things we know is that most seniors want to live in community, at home, as long as they possibly can, and that matters enormously to me. When we look at the statistics, we know that the vast majority of seniors actually spend their latter years in community. The number of elderly British Columbians in long-term care is actually quite small when you look at the one million people we would consider seniors in this province.

I’m wondering if the minister can just outline for me where that fits in his list of priorities. Obviously, we’re facing a global pandemic, and long-term care has been one of the, I think, most devastating outcomes, and we’re going to have to grapple with that over time. But there are a whole lot of seniors who want to stay at home. They want to be cared for in community. So what types of initiatives is the minister looking at when it comes to keeping those options open for seniors?

While he’s outlining that, perhaps he could include in his answer some comments about the Better at Home program and how that’s working. I know that when I was asked to sit on the all-party committee, that was one of the outcomes: additional support to Better at Home. One of the things we learned, for example, is that it doesn’t work the same way in all parts of British Columbia. We want it to work well wherever it is. So what is the minister’s priority when it comes to helping seniors stay at home as long as possible, making sure they have supports and resources in community?

Hon. A. Dix: I think I’d say a couple of things. First of all, we talked a little bit earlier about a cross-government approach and a cross-society approach. It seems to me that we’re facing…. If you look at the things that government provides in supports for seniors….

[4:15 p.m.]

Long-term care — that’s about 30,000 residents. And 965,000 people over 65 have been vaccinated; 86 percent of those over 65 have been vaccinated. Just think of how many seniors…. Just over 30,000 of those — essentially, 32,000 — are in long-term care.

It’s one important group, and it’s where, of course, we devote the greatest resources — to the people who have the most significant and challenging health outcomes. That’s inevitably the case in a health care system. We can go all of our lives without needing care, as many people who end up in long-term care do. We’d do well to remember that when people talk about the costs of it. Often people have lived for years and never used health services, and then, at the end of their lives, they require them.

So at one end of the continuum is long-term care and assisted living, independent living — what we sometimes call seniors housing. There’s activity and community. There’s validating, I think, and supporting the role of seniors in our society — in other words, community activity and supporting community organizations that will do that.

This is particularly important, I’d argue, for seniors who don’t require needing the health care system. But when we become seniors, as we know — in my case, from my mom or from my mother-in-law, our two surviving parents for Renée and me — that one of the greatest challenges people face is the loss of friends and the community that they knew, whether that is to be people losing the ability to participate in activities, and so on.

What we need, I think, in society, is a continuum both of the health care system, long-term care, assisted living, home support, community-based services, adult day programs, support for seniors organizations. That’s the health care vision, but there’s a broader vision than that — around incomes, around pensions, around housing — and how difficult it is to continue to live and the difficult choices that seniors often have. They’re really challenging choices, and they bring with them, I think, some imaginative thoughts.

Here I’m improvising a little bit, but this is something — I’m talking about Isobel Mackenzie — that she talks about: seniors that have, through their home, significant wealth but are unable to afford to bring people in, and how we can find ways to think about improving that and giving people more access to utilize that. Sometimes those inheriting that wealth maybe have different views about that, and those are the things that rile families sometimes, but it’s a bit of a societal reverse mortgage around circumstances and how we allow that, but also how we plan communities.

In my city of Vancouver, we’re going to require more long-term-care homes, in a city where the price of real estate is beyond expensive. That’s true of many communities. It may not be true in all communities, but it’s true in many communities. How do we plan that, and how do we plan a long-term-care home that goes up, not spreading out, as a long-term-care home traditionally does? How do we allow in our planning in communities for seniors to stay in community and to have access to be able to live in community and live close to the things that they know?

I think it involves planning in cities; it involves the federal government in its role. It involves incomes and the economy, as this group of people in society becomes more important, and, as we’ve seen in a pandemic, a variety of supports that are needed from government. But it’s not just government. I think we have to prepare for a moment, because the number of people….

We talk about this, and we’ll talk about it next week when we talk about cancer — 50 percent more people with cancer by 2035. It’s not because we’re not doing a good job with cancer care in general. It’s because there’s going to be more age-related cancer, and outcomes are going to be better. That creates a problem that we haven’t had in human history before.

Let me just suggest one other thing which is a positive aspect of health care. When I first became an MLA, I had one of those cases — which the member knows because, I’m sure, she’s had cases like this. There was a guy, about 70, whose wife had passed away. They’d taken care of a child, for 45 years, who had developmental disabilities and lived with them. Suddenly…. They had a traditional relationship; he went to work, and she took care of the home and gave the primary support to their child. She passed away, and there was no respite care and no support.

We have people, this aging population — some of the success in our health care system of expanding life expectancy. For example, for people with developmental disabilities who, maybe for the first time in human history, will become seniors, in significantly large numbers….

[4:20 p.m.]

These are societal problems that we have to address, and they present to provincial and federal and municipal governments. But we also have to have a discussion of what our province is going to look like as more of us become seniors in the coming 15 or 20 years. That planning, that thinking, is going to require all of us — not just Ministers of Health or other ministers of government or Ministers of Housing or federal ministers but, I would say, everybody.

S. Bond: Thank you to the minister for his answer. I’m wondering if he could outline for me, specifically related to Better at Home…. One of the things that we are concerned about is the fact that in smaller communities it’s very difficult to access some of the services that we can receive in larger communities. Perhaps the minister can speak to whether or not there is a monitoring process. Do we look at how Better at Home is being administered?

I’m not suggesting it needs to be the same. It’s not a one-size-fits-all program, but we want to ensure, if you live in Vanderhoof, McBride or Vancouver, that there are supports for seniors provided through the Better at Home program. Perhaps the minister can speak specifically to resources related to Better at Home.

Hon. A. Dix: I apologize to the member. I was captured a little bit; I gave too long an answer there. People in my office are going to give me a hard time about giving these long answers.

We’re seeing, I think, a significant increase in services delivered year unto year in Better at Home. That’s good news. We were part of it, and the member was part of that. She knows that. The program, by the way, was started under the previous government and has been expanded, since I’ve been Minister of Health, to include more communities — including, I think, four more this year. I’m looking at it coming to Peachland, Golden, Princeton, Nicola Valley — no, more than that — Houston, Cortes Island, Quadra Island, expanding both in terms of its scope….

Just to take a look at Better at Home data year unto year, for seniors in 2019-20 — Better at Home data: 11,935 seniors served, 191,147 services delivered. In 2020-21 reported data, which includes Better at Home services and new programs that we’ve added together on the safe seniors, strong communities initiative, the integrated community-based programs for older adults and the work done by many other agencies as well, including those involved in Better at Home, it’s 816,457 services — which shows, I think, the effectiveness of the model.

I would put this caution, and I think the member would agree with this: sometimes we ask Better at Home to do things that it’s not equipped to do. It’s not a home support agency. It’s not able to provide community-based professional services. I think we can continue to expand it. I’d ask all members of the House — because members of the House know the programs in their community — where we’re succeeding and where we’re not.

My principal goal, when we moved from $10 million in annual funding to $11 million and now to more, was of course to expand the reach of the program and the number of communities where it’s received. But that’s not the only measure, nor is the only measure the number of services, although that has clearly increased, in this model, quite a bit. Now we’ve got to work together, and the member will have suggestions on how we go through this post-pandemic period and maintain the momentum in services — I don’t think, as we go through the pandemic, that the needs of seniors are going to change; there may be less pandemic-related services, less isolation services required — and on how we can make it better.

That’s the general thrust of the program — which has, as we’ve seen, significantly increased over time. That reflects the very significant increases in funding from year unto year. There is an advisory committee involving many community organizations, an advisory committee to Better at Home, which is composed of the United Way, the ministry and other community-based agencies, to provide information about the program.

I’d encourage the member and members of the opposition to feed in their views on this as we develop the program, because this program is again going to change. It has seen an increase in resources. That sometimes can be a good thing for programs, but sometimes it doesn’t work entirely well. I think we’re going to have to take another look at it next year. I’d suggest to the member that that’s something we could do as the Legislature, together.

[4:25 p.m.]

S. Bond: During last year’s estimates there was an interesting discussion. As I was reading it…. It was about other options, in terms of supporting or allowing seniors to essentially use their means more effectively, the minister had said — to support not just care but living. I thought it was an interesting concept. He referenced a number of proposals from the seniors advocate, from care providers and others, and that they were being considered as we move forward.

I’m wondering if the minister could just give me an update on those proposals. Did anything actually move ahead? What was considered over the last year? I’d be very interested in knowing whether progress was made on that particular concept he discussed in estimates last year.

Hon. A. Dix: I think probably less progress than I would like. Obviously, it’s been a year. I’ll just say that. It’s been a year where we’ve shifted our focus. There’s a huge focus on supporting home support in a time of pandemic, which has been a real challenge, and a huge focus on Better At Home. That’s where we’ve seen the effort, including, obviously, all the efforts around the COVID-19 pandemic.

I think the issues remain the same — the issues of a growing number of seniors who are finding it more challenging to live well in community, when we’re asking them to live well in community. You don’t want to create, in a system…. I think it would be hard to do this, because it’s hard to get into long-term care, actually. You have to have very significant conditions to get into long-term care. Even with respect to assisted living, you see a lot of it. If you wanted publicly funded assisted-living beds, that’s a challenge as well. I don’t think we’ve gone as far about it…. I think the issues are still there, and they’re ones that we can think about as a society.

A very long time ago I worked in the Minister of Finance’s office. I remember arguing with a senior at a particular time that they could use land tax deferment — something that the senior, I think, would rather have eaten glass than do. They didn’t like that idea. I do think that that model is interesting and one that we should explore: how we can find ways to allow people to use the means that they have, understanding that the demands on long-term care are going to grow.

The demands of that portion of the population, which is going to grow in parallel to the overall growth of the seniors population and assisted living and all the other demands…. How do we allow seniors to use their own resources to live well and to avoid the condition that many people have in Metro Vancouver, where they’re living in their very expensive places but are not able to live well?

S. Bond: I certainly understand that there are priorities. My point is simply to raise it so that we have an ongoing discussion about that. I think it does make a difference to the quality of life for seniors, not just now but in the future. I look forward to having further discussions with the minister about that as we emerge, we hope, from the pandemic. There are so many things that we will look forward to working on, hopefully together, in this area in particular.

I would also like to ask the minister if he could outline for me…. There is a $12 million investment in the home health monitoring initiative each year. I’m wondering. Is it $4 million per year? How many seniors will receive expanded or new services as a result of that investment in home health monitoring?

Hon. A. Dix: What I’ll do is…. When the other answer comes in — I know the member may have follow-up questions — we can get that specific answer to her.

S. Bond: I appreciate that. We’re probably not going to have enough time, either, so we’ll just submit questions. The minister is very good, I know, at getting back.

I wanted to reference the consultations for Budget 2021. The Select Standing Committee on Finance and Government Services made a recommendation that government increase investments in home support, including revising the regulated co-payment for the home support program, to enable seniors to stay at home.

[4:30 p.m.]

Can the minister provide us an update on whether or not the ministry is looking at revising the regulated co-payment for the home support program?

Hon. A. Dix: I think that the select standing committee dealt with that issue, as did, I think, the seniors advocate in her 2019 report, which was talking about the thresholds for those programs. That’s been, as the member will know, a focus of mine in the PharmaCare program, where we used the basis of Fair PharmaCare and dramatically reduced the size of deductibles for many people in that case.

Some of the thresholds were quite similar. Someone earning $29,000 a year was paying a $750 deductible for PharmaCare at that time, which, if you are making $29,000 a year, is a huge, pretty significant deductible. For someone in that category, we eliminated the deductible so they were getting the immediate benefit, which was a partial payment in that case.

We haven’t decided to do that. We’ve made, as the member will know, some significant improvements in terms of home support hours over time. I think that in 2020-2021, they went down slightly. What I’ll do is I’ll forward to the member, at the end of the session — I have a note here which sort of summarizes all those questions — those facts around home support hours, and so on, year to year.

We’ve seen a significant increase, and we’ll expect to see a significant increase in home support hours next year. I think there was a slight reduction, probably because of COVID-19, this year in the number of hours. The funding has increased. That’s partly the investment of the provincial government — we’ve increased home support funding — and partly the investment of the federal government, which provided us, under an agreement that we have with the federal government, additional dollars for home support.

The number of hours has increased. We’ve increased respite care. We’ve made the other changes we’ve made. We haven’t made that change yet, although it’s a change that would be under active consideration. It affects…. It’s an expensive change, potentially. One has to judge it against other expenditures, but it is one way of providing more access to publicly funded home support in the province to a group of people who most people would describe as lower income. I’m trying to remember exactly what the threshold is, but a couple of thousand dollars change in the threshold would make a significant difference in that regard.

It is something we’re actively looking at, but it’s not part of Budget 2021.

S. Bond: I think the issue of revising how regulated co-payments work is important, because it can act as an impediment. I think that was advice, again, that the seniors advocate provided.

When you revise the co-payment for the home support program, it means that community supports available for seniors and families allow them to stay at home longer. I think all of us have that mutual interest. An example was…. Investing in home support costs the public system less compared to public funding for long-term-care space. We know that. Not only that, it is a quality of life issue.

I wanted to be sure that that, again, hasn’t been completely forgotten or lost on the minister’s radar screen. I understand there have been a lot of other priorities, but I did want to raise that issue and hope that there will be an ongoing commitment to considering that and looking at a specific plan that looks at the potential for revising that regulated co-payment.

Moving on, I’m wondering if the minister could provide me with an update on adult day programs in British Columbia. Are they fully operational? What is the ministry’s target for the number of adult day service hours it expects to provide in 2021 and 2022?

[4:35 p.m.]

Hon. A. Dix: We have debated this in past estimates. This is one of the things, as the member will know, that I’m proudest of, the very significant increase in adult day programs that occurred — adult day services and cumulative days that occurred — in my time as Minister of Health. It had been recommended by the seniors advocate. It was something I really believed in, that and respite care services.

In ’18-19, it was 255,000 hours. In 2019-20, it was up to 292,000 hours, which was a huge increase. I was very proud of it, obviously. That was 292,000, not counting March of 2020, when those programs were essentially shut down during the first provincial restrictions that were put in place by the provincial health officer and by ourselves in order to keep people safe and to stop the virus from spreading in communities, especially to vulnerable people.

The number of hours is specifically very small this year. We went from massive increases to essentially the suspension of those programs during the course of the year. Some of the programs, on a very selective basis, were relaunched in August of 2020. At least in the Vancouver Coastal, Fraser and Interior Health Authorities…. Even in those cases, those programs were shut down again in November, as we entered into the second wave.

The result of that is that as of February, Vancouver Coastal and Northern Health are each operating one stand-alone adult day program. Vancouver Island Health, which has seen less COVID, is operating at seven sites. This is something we’re going to have to relaunch partially this year, with continued restrictions and controls, and then really relaunch.

The budget is still there, and the supports are still there. A lot of the money that went to adult day programs was sent to develop mitigation strategies, including virtual programs across the province. If there’s one thing that I’m proudest of as Minister of Health, it’s those programs, those baseline services that are provided.

I think that different health authorities have come up and offered different programs. Interior Health, Northern Health and Vancouver Island Health have relaunched some of their programs. What other health authorities did was develop alternatives, which was to connect with seniors at home and use the resources for outreach visits and for check-ins and to address the client base for adult day programs.

I think if you look at the losses of the COVID pandemic for people, it is those enormous…. When you think of that, 292,000 days in 2019-20 to in the tens of thousands of days in the 2020-2021 fiscal year, this is a place we have to come back to.

Of course, we’ve used it to reach out and to do all kinds of other mitigating things, but I think everyone participating in those programs and supporting them says that that’s not the same. That’s a significant diminishment for adults in the community that was made necessary by COVID-19.

That’s what happened to the program. It’s different from home support and community-based services, which continued on, basically, as is, with new restrictions in what people could do. In the case of adult day programs, essentially those programs have been suspended for much of the year.

S. Bond: Thank you to the minister for that response. I want to quickly ask the minister…. I had a number of questions on this. It’s actually something I care a great deal about but knowing how limited our time is…. I’m wondering if the minister can give me an update on the First Link program in British Columbia.

Dementia is an enormously challenging situation for many families who have loved ones that are impacted. I admit that I was concerned when I…. First of all, I have visited the minister before to speak about First Link. I wanted to just point out that in…. First Link dementia support served 18 percent more clients. In 2019-2020, there were over 6,000 new clients, an increase in the number of referrals via health care providers and a number of other contacts.

The minister can provide me with more information later, if that’s more helpful, but I want to ensure that there is sustainable permanent funding and that there is a recognition that those numbers and the services provided are increasing. We need the resources to follow that. We need to make sure that there is adequate and appropriate support.

[4:40 p.m.]

I’ll just raise the issue of First Link, making sure that the minister is aware of the increase in the number of referrals and the number of clients that are being served. I want to make sure that we have resources to deal with that as we move into the future.

Hon. A. Dix: If the member would do me this favour to not publicize this beyond the provincewide TV that we’re on here.

The member will know that First Link has typically, over a very long period of time, received what’s sometimes called year-end funding. It’s really $2.7 million a year, which is what they consistently ask for, it should be said. That’s their funding request, which is approved. I suspect that if they asked for incremental funding, they would receive it.

As an organization, in principle, they ask for what they need for the program. They want to maintain some own-source investment in the program, I believe. That’s the case of the Alzheimer Society, which is admirable.

If the member won’t tell anybody, we provided year-end funding this year of $5.4 million. That means for this current fiscal year that we’re in, 2020-21 and ’21-22. We’ll, obviously, be making the public announcement of that later. I’m just counting on the low ratings of the Birch Room so that won’t get out too much. But it’s no surprise to anyone.

What we’ve tried to do, in the absence of base funding, is give two years in advance. Two years ago we gave $5.4 million as well. So it’s clear. If anybody in British Columbia thinks that any government is not going to provide funding for the First Link program or deal with growth in the program…. I suspect that that’s not the case. In any event, they’ve received two more years of funding, and we’ll be making a public announcement of that soon.

May was Alzheimer’s Month. Many of us went for a walk for Alzheimer’s. I don’t know if the member did as well.

What the Alzheimer Society does with First Link is extraordinary. The member is quite right that the work of First Link…. Nobody should confuse the $2.7 million in annual funding for First Link as a replacement for all the supports that are going to be required for people with Alzheimer’s and other dementias in our society, which is a growing number as well. It’s reflected in long-term care but in a lot of other places.

The impact of Alzheimer’s on families is profound as well. That’s what makes First Link so effective. It’s not, as the member will know, a government program, although it’s a government-supported program. Because of the credibility of the Alzheimer Society, it’s a place people feel free to go, and they’re going in increasing numbers.

S. Bond: I think the minister knew that he would receive some sort of question about that issue.

I want to move on to talk about a report that the Ministry of Health commissioned. It was a report on the government’s COVID response in long-term care. The minister would know that it was done by Ernst and Young. It was commissioned on July 30, and it was submitted to the ministry on October 22, 2020. Yet the minister knows — we’ve had this discussion in other venues — that that report was released publicly on January 25, 2021.

Maybe the minister could just walk through the timeline for me. When did the minister become aware the report was commissioned? When did he review the report? Again, remind all of us why the report wasn’t released earlier. When people are anxious, when they’ve participated in a process…. We’re not certain what the outcomes are. It’s important that we know those details.

Perhaps he can walk through the timeline of when the report was commissioned, when it was received and why it wasn’t released earlier. Then the next question, obviously, from that will be if the minister can outline any steps that have been taken to address the findings of the Ernst and Young report.

Hon. A. Dix: I’m happy to take the member through the timeline. I think some of the details of this have come out through a freedom-of-information request. So all of that information has been made available.

[4:45 p.m.]

The report was not commissioned by me as the Minister of Health, but it was commissioned in the Ministry of Health. It was commissioned at the ADM level with the approval of the Deputy Minister of Health.

The discussions around it started in June, I believe, of 2020. The intent of the report was to do something that the division would ordinarily do itself but was extremely busy. They wanted an external partner to do the review, which was to reach out to partners in the seniors care system and to ask how we’ve been doing through the first wave of the pandemic.

The decision was made by the ministry to contract Ernst and Young rather than do a report or review internally and reach out internally, for reasons of the fact that that part of the ministry, as you can imagine, was extremely busy. Really, their focus was service-outward. The issues that they weren’t going to ask were how infection control was in long-term-care homes, because that’s not the expertise of Ernst and Young, and, of course, we have a public health team that is doing that on a systematic basis.

That’s what happened. They commissioned a review by Ernst and Young. In the summer of 2020, Ernst and Young went out and spoke to people in the ministry but also people in the sector. That would have included, initially, organizations like the B.C. Care Providers and others. It might have included other representatives in seniors care. The idea was to say: “How are you receiving both the direction of provincial health, and also, how are we doing in terms of coordinating on issues such as PPE and other issues?”

The folks at Ernst and Young, who had done a very good report for us about the Nanaimo Regional General Hospital…. The hon. member, the Leader of the Opposition will remember John Bethel, who often works on these things and works with Ernst and Young, and others who’ve got a lot of experience in health care. Mr. Bethel had served the previous government as an associate deputy minister and assistant deputy minister.

They prepared a report to the Ministry of Health, which was submitted. It was received, as the member says, on Oct. 22. It was shared with the Deputy Minister of Health towards the end of November, I believe, and shared with me in January. In that period, most of its recommendations…. Perhaps I’ll give the member a chance to ask another question around intervention before I go through, because we have recommendation and action that I can take the member through.

Was I happy to discover that a report had been conducted when I’ve been working on seniors care a lot and I only received it in January? I wasn’t happy, I don’t think. That wasn’t a happy day for me. But it’s what happened.

What the Ministry of Health did was take the report, work to implement its recommendations. Those recommendations were reflected in recommendations to me and to Dr. Henry and to others, about the actions we should take. But the report should have been released publicly sooner. It just should have been, because as the member said, they consulted a lot of people. When you’re consulted on a report, you want to see the work product.

I think there is an argument that I’m sure the ministry can make legitimately, that they were extremely busy, and they just wanted to move on and act. But I think the report should have been released sooner. I’m the first to say that, including to me but to everyone. Of course, it was released, I believe, on January 25, the day the member suggests.

I think the report, on balance, is relatively complimentary of the government, but that’s neither here nor there. The recommendations should have been put out and put out sooner.

S. Bond: I appreciate the minister’s candor. I can imagine that at a time when people are already anxious about information and how things are working…. One of the things we’re all going to have to face, as we emerge from the pandemic, is there is going to be a looking-back portion here that says: “What did we do right, and what do we need to be aware of?” I hope to goodness we aren’t facing something of this magnitude, but it is about lessons learned.

I think that there has…. As hard as it is to answer those questions, I actually think it is far more productive to accept the report, look at the recommendations and deal with them. British Columbians expect that of us. There are a lot of positive things to be said about how British Columbia has managed, but there are also areas where questions are important.

[4:50 p.m.]

I can understand that the minister isn’t happy. I have a job to do too, and that is to ask the tough questions that are sometimes uncomfortable.

I appreciate that answer, and I think that it did cause a lot of unnecessary distress. Hopefully, we have that situation sorted out so that it doesn’t happen again. But I do want to speak about another report. The B.C. Care Providers Association released a report on November 10, 2020, and it was on the first-wave impact on long-term care. It was vetted — as I understand it, at least — prior to its release by a six-person academic panel that was led by Dr. Carole Estabrooks of the University of Alberta.

I’m wondering. Did the minister review that report and the recommendations contained within that report?

Hon. A. Dix: Yes.

S. Bond: There’s a succinct answer.

The follow-up that the minister would expect is: having answered the question about Ernst and Young and looking at the recommendations, did the ministry choose to act upon the recommendations in the BCCPA report?

Hon. A. Dix: I think maybe I’ll start, because on some issues, anyway, the reports overlap…. I’ll just take the member through. I won’t spend too long on this. I’ll try and go quickly. What I’ll do is just share the document with the member as well, which is one of those recommendation action documents, so the member can see that and use that, as she will, to inform her comments and her policy development.

What we did was make changes. The Ernst and Young report had a number of recommendations. The first was to update the structure to allow for quick decision-making. The COVID response and health emergency management division was created within the ministry to centrally manage the response from the ministry. Also, health authorities made specific actions based not just on that recommendation but to more effectively enhance coordination, collaboration and data sharing — not just between the ministry and health authorities but with partners.

To establish policies for financial support to operators was a second thing, as the member will know. We can go through the financial support that was offered, including some that was offered today to operators. But financial support has been provided based on identified need. The key question in all those questions, though, is: how do you account for that in a way that isn’t burdensome but is effective and ensures that government’s fiduciary role is maintained? That has happened.

To continue, we put in place new data-reporting structures. This was recommendation 3, implemented to assist in the collection of health human resources and financial data. The long-term-care monitoring tool was started in the fall of 2020. That follows through on that recommendation.

The pandemic response communication should formally consider contracted and private providers and be clear about messaging and policy. That was a recommendation. The report was focused on the ministry, and a process was established for regular operator communications through health authorities with industry associations.

What I would say in defence of the ministry and the staff is…. And there are more coming. But I think what they wanted to do was get an outside look at how they were doing, so they went out and contracted Ernst and Young to give them that, and then they responded to it.

What I tried to do — and this has been challenging to me; Dr. Brown and Dr. Henry can both testify to this — a little bit is to allow people, without my usual intense observation of events, to have the freedom to act, because we needed to act. In this case, the ministry acted without my knowing, in terms of commissioning the report. But I’m very supportive of their wish to seek outside advice and to try to do better. I think they should have that authority, especially during these times, and they do have the authority to commission reports to support themselves in this way.

There is a series of other recommendations around clear guidelines around PPE policy, for example, that were also put into place. There’s actually a number of recommendations, and I think it’s going to take me about ten minutes to read them all into the record. So what I’ll do is provide them to the member. But on each item recommended by Ernst and Young, action was taken in advance of the report being made public.

[4:55 p.m.]

From my perspective, I suppose, it would have been just as well to do that. Showing action — the action that followed the recommendations, showing that they were fully engaged — is a positive thing that should build confidence. I think the fact that there was a debate about the report had people lose sight of that. But I do agree with staff taking initiative. I do agree with them having someone else look at their work and say, “Is it the best work?” and make recommendations and then act on that recommendation.

I think that’s what our team in the Ministry of Health, who have worked with great dedication from the beginning of this on seniors issues…. From Steve Brown to Peter Pokorny to Teri Collins on down, people have worked with commitment and dedication on this issue. Their commitment to this process, notwithstanding the public debate — for which I am ultimately responsible, the decision in failing to release the report publicly….

The things that they’ve done based on this report, the fact that they asked for the report from an external person…. This is always a risk when you’re working in government — to have someone assess your work. I think all of that is something that deserves credit, and I will share all of the recommendations and action items with the member, the Leader of the Opposition, that I have in my briefing book.

S. Bond: Thank you to the minister. I would very much appreciate having information about the specific actions.

I want to turn for a moment…. I’m certainly assuming that the issue of personal protective equipment is going to continue to be part of the world that we live in, particularly in long-term care, so I want to talk a little bit about that. It seems, at least…. And certainly, Ernst and Young did talk about some discrepancies in PPE access. We know that that was a challenge between health authority facilities and contracted facilities. But again, the minister is going to provide some feedback to me on the specific actions that were taken.

I guess I want to just ask specifically about management of PPE, going forward, and the fact that at the beginning — and, obviously, everybody was trying to manage through this situation — there were concerns about gaps in British Columbia, and also in other jurisdictions, managing what was considered a PPE stockpile. There was criticism that some products were going to expire and others had been provided to other countries.

Maybe the minister can just walk through for me…. You know, we hope we don’t face similar circumstances, but it would be good to know that we learned from that situation. Does the minister have a plan, going forward, so that we have a robust, obviously date-appropriate supply of PPE so that we don’t face that concern about gaps and stockpiles and those kinds of things? Could he just outline for me some of the steps that we will be taking as a result of that issue that we faced early on?

Hon. A. Dix: Certainly, this issue of PPE, especially at the beginning of the pandemic, was a central issue of concern that happened in February and March and April. This has been documented in a report I did in August, I think, of 2020 at one of our briefings. We’ll talk a little bit about the standards, the guidelines, the resources and the directions from provincial health, perhaps, in subsequent questions as well.

But in February and March and April, we saw an exponential increase in utilization of PPE in our system, such that our stockpiles of certain types of PPE — especially a particular type of mask called N95-S, a N95-small because of the way it fits — were under great pressure. I can tell the member — and I suspect we’ll have some discussion of this when we discuss the Provincial Health Services Authority next week — that that period of April 2020 was a period where we were more focused on PPE than on virtually any other issue in parts of the ministry and the health authority.

[5:00 p.m.]

I particularly want to recognize the remarkable role — I mean, really remarkable role — played by Associate Deputy Minister Peter Pokorny in this time, who essentially became, in some ways, for the whole health system, along with the Provincial Health Services Authority, the leader in procuring PPE. He now knows more about it than I think just about anyone on earth.

What we’ve done in the past year is procured an extraordinary amount of PPE. We are not just building for now but building a stockpile for the future that is going to be significantly beyond any previous stockpile created, because we need to do that.

The expenditures on PPE. I think I shared those last time. I’ll get these numbers. I know that Peter will be sending them to Deputy Minister Stephen Brown now, to compare the amount we spent on PPE in the 2019-20 fiscal year, which would have been in the neighbourhood of $70 million, I think…. I don’t know exactly. That was increased seven- or eightfold.

Two things happened. One, there was a limited supply, and we needed more when the utilization was up. Two, the price went up — on some items, per-unit cost, by 500 percent. It wasn’t an issue about whether we should pay the price. We were going to pay the price, because we weren’t going to have people working in health care without appropriate PPE, so we did. We spent an extraordinary amount on PPE in that time. During that period, as well….

That centralized approach, where the Ministry of Health plays a central role, is the new approach, and it will continue to be the new approach, I believe, for governments in the future, regardless of whether they’re NDP or Liberal or whatever, because I think it’s the right approach. We have produced the numbers, which I report on occasionally over time, units of PPE that are very significant across the province, as you would expect with the hundreds of millions of dollars that we spent. Millions of pairs of gloves and wipes and masks and N95 respirators, and so on. All of that information I’ll share with the member.

I think the centralized approach we’ve taken is the right approach. Our job now is to build not just for now or the next six months or the next nine months but well into the future, so that there’s no question in future. The cost of that in this fiscal year will be high, because prices are still too high. This is a separate question for Canadians, I think. That is: why aren’t we making PPE in Canada?

What happened in February and March is that the United States of America, where we received most of our PPE, stopped our shipments at the border. They just did. We were left to procure PPE in other countries in the world. They did that because they needed the PPE. That’s why they did that.

But that’s not a surprise. This is an essential commodity, and I think in Canada, part of our plan, our jobs plan in B.C. and the rest of Canada, has to be to produce a domestic supply of PPE, just like we need a domestic producer of vaccine in this country. These are the lessons of this. The lesson is we need Canadians to be making products that are essential to the lives of Canadians if a crisis happens.

We need to build out our PPE inventory so that in the next crisis, we’ll be more than prepared for that, yes. But we also need domestic supply, because domestic supply has been proven to be absolutely necessary in these times, and we must continue to have that.

In addition to that, of course, there were very significant guidelines on the use of PPE, and we shared, on part of that plan on March 26, PPE with our contracted providers. What happened for our contracted providers was they had their own supplies of PPE, but they were faced by the same thing, and they weren’t as big as us, and they’re not able to procure or get around or find other countries, and so on. So we made our supplies available, I think in the neighbourhood of $30 million for contracted providers, of PPE. They were provided, we say, for free, but they were provided because they were needed.

That situation, the centralized management that’s come out of it, the massive effort — which I’m happy to report on in detail and send the member a note in detail — to increase our supplies into the future so we meet future demands…. That’s been one of the experiences. If we are a year from now and there is no domestic provider of vaccine and there’s no domestic provider of PPE, then we, as leaders in our country — I think I say this not just in British Columbia but in Canada; we’re limited in the size of our market and effectiveness — then we have not learned a major lesson of the pandemic.

The Chair: Members, we will now take a five-minute recess while we undertake cleaning and safety protocols in preparation for a new committee Chair.

The committee recessed from 5:04 p.m. to 5:09 p.m.

[D. Coulter in the chair.]

Hon. A. Dix: Just for the Leader of the Opposition, I’m informed that a comfort care aide is not a role that’s generally used or a title that’s generally used in B.C. It’s a term and role that’s used generally in Alberta. The closest role we have in B.C. is health care worker 1, which provides non-direct care to patients.

[5:10 p.m.]

With respect to HCW-1s, they are eligible for the HCAP program, which we may talk about in a little bit, either by applying directly through the provincial portal or by working with an employer to be hired directly by the operator. The only caveats would be the operator has a need and the person meets the minimum employment criteria. That’s the issue on comfort care aides.

What I will do is I’ve got a document which is up to date on the remarkable numbers of PPE we produce and our current inventory, so it’s actually a very interesting document. I’ll share that with the member through the Chair, or maybe I’ll just send a copy to her office at the end.

S. Bond: I would like to just pursue the concept of PPE and its utilization. One of the things we learned, certainly as we’ve seen science evolve around airborne transmission…. We know that as we look at airborne versus aerosol transmission, I understand that the BCCDC website was only updated recently to actually reflect the evolving understanding of the science.

Can the minister perhaps describe for us whether there will be a change or some sort of assistance related to protection for front-line workers in seniors care homes as a result of the fact that there is now emerging science on airborne transmission? For example, would long-term-care home workers require an N95 mask? Is that something the minister is considering in terms of support to workers in long-term care?

Hon. A. Dix: I think I speak for everybody watching us when I wish that Dr. Henry was providing this answer and not me. I think what’s important is that there is specific guidance that’s provided by the experts at the BCCDC and others about the use of respirators in certain conditions and particularly, for example, in circumstances such as the ICU, which are aerosol-generating places. We do use N95 respirators often in acute care. They’re significantly utilized in specific circumstances.

[5:15 p.m.]

In terms of long-term care in a general sense, I don’t think you’re going to see a change in that guidance. That good infection prevention and control using goggles, masks and other existing techniques is both sufficient and the best response to dealing with COVID-19 and other respiratory illnesses in those circumstances. The majority of what the change in the guidance reflects is more understanding of COVID-19 as we’ve gone through the pandemic and the appropriate use of PPE. That’s the key — the appropriate use of PPE, which is a very challenging thing.

I am very compassionate. If you watch me during this thing and replay the mask coming on and off, there would be some criticism. If you’re in health care, with all of the stakes involved in dealing with long-term care, it is extremely challenging, but the appropriate use of PPE and that guidance, which is constantly reviewed by the BCCDC, is unlikely to change, although our understanding of COVID-19 continues to evolve.

S. Bond: Thank you for that response. I think all of us recognize that as the days unfold and as the science has become more clear, it does cause moments of anxious…. People feel anxious. All of us know how incredibly hard front-line workers, particularly in long-term care, have worked throughout this last number of…. Well, over a year now.

Let’s move on, perhaps, to something that is…. I would be the first to admit that I recognize that it’s been difficult for Dr. Henry, for the minister and for others, but I think we need to have a discussion about the impacts of visitation on long-term care and assisted living.

When we look back, I think, over the last 14 months, at the impact on long-term-care residents in particular, have we started to give thought to…? I know we’re still dealing with some restrictions. I’m going to talk about those in a moment. Have we started to reflect on the impacts of the lack of connection for people in long-term care? Maybe it’s too soon to start to contemplate that, but has the minister thought about whether there are things that we would do differently if we were looking at the same circumstance as we move ahead?

I think all of us know, and I’ve heard countless stories — I am completely certain that we don’t need to repeat them here — of the devastating impact on families, both to the person in long-term care and to the people who care for and love that person. I know you’ve heard them over and over, so I’m certainly not suggesting that it’s not known to you. Have we learned lessons already at this stage about what we might do differently?

Obviously, as the pandemic emerged, there were a lot of considerations — the first, of course, being the health and well-being of people. I feel deeply concerned about the impacts of that lack of connection and, in many ways, the lack of familial connection in particular. Certainly, the minister knows that I experienced that myself. It was in a different setting and for a different reason, but I will never, ever forget the painful circumstances in my family’s life when we lost my husband and were not able to be there. That is something you will never forget.

In terms of long-term care, have we learned lessons? Are there things we would do differently? Then I would like to, as we move forward, talk a little bit about what’s happening in long-term care as we speak.

Hon. A. Dix: The member will know that I certainly appreciate her own experience and what it means for people not just in long-term care but in acute care as well, where there have been significant visitor restrictions for some time.

[5:20 p.m.]

What would we do differently? We have to step back and say: “What did we do?”

In March of 2020, we put in significant restrictions on visits.

In May of 2020, we made some changes, particularly with respect to acute care, as a result of very significant advocacy and the number of cases involving people with disabilities, allowing them to have access, for example, to advocates within the health care system, which was necessary. There was a particular case that symbolized this, but there were a number of cases that people felt…. So we made changes then.

On June 30, we announced the return of social visits. So in March, we had limited visits, but there were essential visitors. For 30,000 people in long-term care, roughly, 6,500 essential visitors. Those visits were restored on a limited basis at that time.

Then, obviously, in February, as a result of the intervention of the Ombudsman, we codified those in provincial health orders. They’d previously been directions from the Ministry of Health, myself, Dr. Henry and Deputy Minister Brown. They were codified, because we felt that that would allow more equity across the system.

We’re still in the position where we have…. Obviously, it feels, compared to what it was, massively open now. But there are significant restrictions now which we are reflecting on and which we’ll have more to say about soon. So that’s the process.

What would we have done better? I think that we would have made the adjustments sooner for people with disabilities, I’d say.

I think probably, in retrospect, we would have…. I’m not speaking for Dr. Henry, just for myself here. We would have codified it earlier. I think the differences between how people were treated in one care home and another were a source of concern. It wasn’t because the care homes were uncaring. Everybody was concerned.

There had been…. I don’t think we would have made the changes. There were significant proposals made by the seniors advocate at the beginning part of November, as it turned out, to open up visitations. That, I think, would have been…. Given what we learned about the second wave and what was to come almost immediately thereafter, that was probably the right decision. I’m not critical of people for advocating for visits, because we know their impact.

All I can say is that I think the issue of what we’d do better…. This doesn’t change the fundamental question of these issues of consistency amongst care homes. The way we responded later on to deal with those consistencies…. The opportunities we gave to people to appeal could have been there at the beginning. There are reasons why they weren’t, but that could have been there at the beginning.

All of those would have made what I would call, for some people, a significant improvement but, overall, marginal improvements to the system. They were things we could have done a little bit better, fundamentally.

We’ve experienced this in my family. We have experienced outbreaks — three of them. I’ve experienced a positive test for COVID-19 in one of them.

What happens when an outbreak comes, and has come and came through the second wave, is that no one got access in an outbreak. There’s a lot of discussion about enhanced surveillance, and we’ll probably have that discussion.

What medical health officers know is the profound impact of a lack of visitation on people in long-term care. They have consistently tried to balance those things. The balance has been against visitation. It has been. People haven’t been able to visit, not only as much as they should but as much as people need.

There are lessons to be learned and, I think, lessons to be learned going forward, as well, in how we deal with this next period. We’ve gone from, on January 15, 49 care home, assisted-living, independent living outbreaks. We went from there, within a month, to five.

The third wave took place in very different conditions in long-term care. The second wave was hugely about long-term care and about the losses, particularly, in care homes that had the extensive outbreaks. The third wave less so because of vaccination. We’re at a better place in the care sector.

[5:25 p.m.]

What we have to make in our next set of decisions is decisions that ensure that those residents in long-term care…. Sometimes we talk about seniors in long-term care. It’s not just seniors in long-term care but all residents in long-term care that get access to more visitation and that we do it in the safest possible manner.

People have made suggestions and recommendations about how we deal with the issue of vaccination, including for essential visitors or visitors in a long-term-care home. If you’re in a care home, such as in our family’s case, and you’re sharing a room with other people, the requirement for that, and for a visitor who comes into that room, to be safe is significant — and because the vaccine, while these are maybe the best vaccines we’ve seen ever, are not 100 percent safe.

We’ve got to take the same approach in the next few weeks. The decisions we’re going to make I hope are the right ones but ones that will allow more visitation.

The short answer is yes. In retrospect, there are things we could have done better. I think the decisions were ultimately the right decisions, but the consequences of those decisions, and the choices that were made by medical health officers between safety and living life, are decisions that will be with us for a long time.

S. Bond: Thank you to the minister for that response. I think all of us know that there will have been a significant impact when you would think about not just physically but obviously deterioration from a mental wellness perspective. There are lessons to be learned, and I appreciate that this is a discussion we’ll have not just today but as we look at the model of long-term care in the future and the potential impact of future health care crises like this.

I guess we now know that there has been a profound impact. We’ve all heard the stories. Could the minister tell us what is being done today to assess the impacts of residents in long-term care, particularly from a mental wellness perspective? Will there be resources and supports and additional ways to provide support not only for the resident but for families, who have been profoundly impacted by that separation? There are many, far too many, that have lost a loved one, but there’s still hope and a chance to assess what happened and to look at how we find a way to create a better period of time, moving forward.

Is there a systematic approach to looking at what the impacts are, how those assessments are done and what kinds of resources that families and residents could both take advantage of to deal with what we know will have been a significant impact?

The Chair: Minister.

Hon. A. Dix: Thank you, hon. Chair. It’s good to see you there. Members of the public may not know that we don’t see each other very much, even if we’re members of the same caucus, only by Zoom. So it’s especially good to see the member for Chilliwack.

What I’d say is that I think there’s a myriad of things we have to do — I think I tried to reflect this in a previous answer — in this next period to improve life in long-term care. The focus has to be on living better. There are lots of things we can do.

One thing I’d suggest to the member that we can work on together is to change some of the dynamic of, for want of a better term — trying to think of a better term — politics, the balance of forces in long-term care.

We have, and we should have, employer organizations that are effective and, in some respects, powerful to represent the views of employers. We have health authorities that are large and impressive. We have lots of people working in the area. We have unions that are very committed to their members and to the life in long-term care. One of the things that I think we need to work together on….

[5:30 p.m.]

There were recommendations — the member will know this — in 2015 that neither her government nor my government has yet implemented with respect to the roles of family councils. One of the really practical things we can do in this next period is to start to give, in regulation but also in fact, more of a greater role for family councils within the lives of long-term-care homes, a greater voice for residents and their families in the running of long-term-care homes. I think that’s something we can do. We can propose, we can come to agreement with, and we can move ahead on, in this period, as an expression of how we want to see the next period in long-term care.

The individual assessments are significant. The need for improving policies is…. Investment and resources are important. The recruitment of people is important. But I think many family members, in the period leading into the pandemic…. This period of the pandemic has exacerbated or put a megaphone to that sense of distance from control in what is, after all, the home of residents. It’s their home.

Giving family councils a more institutional role in both regulation and institutional support is something I think we could do, at least to indicate, not a major initiative but a small initiative to make things better. It’s something I think we could come together as a Legislature on and work on together.

S. Bond: I think it is something that all of us are going to have to think carefully about as we think about not just what happened in the past but what we need to do, moving forward. I think all of us will have etched in our memories the handprints on the windows. It’s hard to contemplate that period of isolation, the impact of that, particularly on frail elderly British Columbians. I think we owe it, as a group of people, to do our best to figure out how we make improvements in the short term but also think about that model over the longer time.

I absolutely respect that it is a balance. I am not for a moment suggesting…. The health care risks are obviously very, very important. They’re the priority. But there are the consequences of that process that are playing out as we speak now. I just want to be sure that there is effort being made to look at what we can do to provide the kinds of support that families and their loved ones need.

The current visitation restrictions were announced on March 25. As I understand it, some care homes are still restricting visits to one hour. Again, I think equity really matters. I think that when families in one part of the province or in one home versus another one hear about inconsistency, that adds to their frustration and their distress.

Could the minister speak to what is being done to ensure there is an equitable application of visitation guidelines across all long-term-care homes, and what resources are in place to make sure that care homes are able to fully support loved ones by allowing visits, as outlined in the updated restrictions?

Hon. A. Dix: Thanks to the member, both for her question and her previous comments. Firstly, we decided in the hardest-working time of the pandemic…. At least for many in the Ministry of Health, that was July and August of last year, because we were preparing for what we expected in the fall. We decided, at that time, to hire a lot of people in long-term care.

It was needed. It was needed because there were needs into the future. It was needed, and there was an opportunity because, of course, many potential workers were looking for work. So we had a new group of people we hoped would be the next generation of health care workers. We created a series of programs that are intended to add up to about 7,000 workers.

About 5,000 have been hired under the auspices of that program, which is pretty good. It’s a three-year program. We’re going to get there. So 1,600 of those people, I believe, were hired to support visitation, because in each long-term-care home, when you set up, essentially, a system to support visitation, that requires human beings.

[5:35 p.m.]

Each care home was given access to positions. That was a good place to start, where we added, I think, 1,600 or 1,700 people that care homes accessed under the auspices of that program, which was a good place to start and was an important place to start, in terms of what we’re doing. I think that was important, especially for care homes in this time. We’ve, of course, provided significant resources to care homes in the contracted sector to support them in this.

We have put in place a system of appeals for people that they can go through. That is part of the provincial health officer’s approach, her guidelines and her orders in this regard. Of course, the challenge the member rightly raises is some inconsistency in that. We put in a minimum standard of visits where, at minimum, it can be 60 minutes. We thought it was important. It was actually a suggestion that had been made in our discussions around this by the seniors advocate, if I’m not mistaken, or at least was something that had been proposed by Dr. Henry. We discussed, and we thought the decision to be unequivocal of that 60 minutes as a minimum standard was important for us, and we put that in place.

Obviously, some care homes, and some people, in managing those systems…. Sometimes the minimum becomes a maximum when you’re applying those rules. But it’s intended to be a minimum.

We are hopeful, in the coming weeks, to make further changes. We may talk about vaccinations in a little bit, but our goal of fully two-dose-vaccinating through care homes is close to fruition. The significant majority of care home residents have received their second dose. A majority of care home workers have received their second dose.

Since most of those groups of people got their doses in January and February, they’re amongst the first people to get their second doses now. In fact, a majority of care home residents received their second doses before the change in the policy around second doses. So 72 percent of care home residents received their second doses in advance of the March decision to extend the gap between first and second doses, and a very significant share of health care workers as well. I think it was a majority, but it wasn’t as large a majority.

We’re going to get everyone vaccinated. That’s going to involve, if there are unvaccinated people in care homes as well, a renewed effort to make sure that number gets as close to 100 percent as we can reasonably get. In some cases, especially in the case of, sometimes, residents of care homes who are in circumstances where they’re essentially palliative, they may be reluctant. But that, I don’t think, is a big issue. That’s actually a reasonable consideration for someone living in a care home, and for their family, making decisions around vaccination. But overwhelmingly, residents and staff in long-term care have gotten vaccinated.

Once that happens, through second doses — and that’s going to happen fairly soon — we have to develop those measures and put those measures in place that are going to be durable. Some of those measures — I’d just say this; this hasn’t been decided — may be ones that we consider doing on a time-sensitive basis. There are some changes where we’d like to open up now, but we may consider putting in, again, some restrictions on visitations during respiratory illness season because we haven’t gone through a second year of COVID-19.

In any event, that’s a serious season. Influenza outbreaks in long-term-care homes — which, thankfully, we did not see this year, not one; if one wants to pray, that’s something to pray for — were important. That’s a consideration. Are there times in the year when we may want to, have to, for example, have everyone don masks again, and so on, in their experiences? That’s a consideration.

What we’re going to see, once we are fully vaccinated through dose 2, is, again, another step forward in opening up visitation in long-term care, and especially trying to ensure that the kinds of visits that support the health of residents are encouraged and supported. That will involve, as well, addressing and engaging with family members.

[5:40 p.m.]

I would say that the decision sometimes made by families to have people go to long-term care is one fraught with difficulty for them, for the issues. There’s already a feeling of intense guilt, sometimes, around the whole experience. There just is, right? I think all of that has to be reflected.

Once vaccination is completed, the plans are in the works. We’ll be consulting the hon. member and her colleagues. We’ll be consulting widely on this question so that we…. As I think we got it right in March when we further expanded visitations in a way that was managed and controlled and thoughtful — with some problems in some places; we’ll acknowledge that — we need to make that, in the next round, important so that we keep people safe but also we contribute to a return to normalcy in long-term care.

S. Bond: I think that the minister has segued into my next question, but I just want to walk through it a bit more specifically. When the announcement was made on the 25th of March, the minister did commit to reviewing and looking at visitor restrictions moving forward. It sounds like a lot of thinking is going on about that, and I am very grateful to hear that. I’m sure that families across the province will be as well.

The minister commented that there would be a review and reconsideration. Is that an informal process? Is there a formal review? Is there a report? Is there going to be some public reporting back about where we’re at with restrictions?

I think the other thing that…. I thought this was an interesting perspective that, you know, the restart 2.0 is appreciated. I think people were happy to know that there is a plan, and it’s been laid out. Looking at things like long-term care, for example, those are not included. You know, long-term care is not included. I understand the point about vaccination and all of those things and the balance, but it leads to that ongoing uncertainty and concern.

Maybe just a two-part question then. The minister has reflected on thinking that’s being done as we speak and that we’ll be hearing more about in the weeks ahead. But is there a formal review? Is work being done more informally? Will there be any sort of public notification, public discussion about that?

We are seeing increased vaccinations, so I’m wondering if the minister has received further advice from Dr. Henry about: is it possible that the restrictions could be lifted more expeditiously? Where are we at with a commitment to say that perhaps before June 30 there may be some further adjustment? Could the minister just, sort of, address that grouping of questions about what kind of review? Is it formal? Is it public? Not included in the restart plan, leaving some room for people to be concerned, what is the next step, and is there any consideration for restrictions being eased prior to June 30?

Hon. A. Dix: I won’t put a time on it, but I would say this. The opening up of visitations occurred on March 25. The member will recall that the circuit breaker came in on March 29. So in that case, we seemed to be going in two different directions.

We’d seen the impact of vaccination in long-term care and the profound effect of those limits on visitations on people in long-term care. We felt confident — and I think the evidence has suggested that Dr. Henry, in her advice, was right in that regard to make the changes — about the very significant changes in visitations occurring March 25, even though, at the time, case counts in the broader community were going up.

We had two different periods. We had put in more restrictions, and there were a lot of outbreaks in the months of November, December, January and February, ending in February. Before, really, the end of January, we’d stopped seeing a lot of outbreaks. It was evident — the impact of vaccination. Dr. Henry presented, I know, to all the caucuses but also to the whole province the impact in long-term care as part of an argument, frankly, in favour of vaccination.

It was just profound, in fact, what had occurred in long-term care, which is the essential elimination, for the most part, of outbreaks, although there were still some. I know that people who had family members and who live in those care homes understand how serious those are.

[5:45 p.m.]

The decisions in long-term care and the decisions in health care are a little bit aside from the restart plan, which is for the broader society and the broader economy. So we won’t be making…. When we’re ready to make more changes in visitations in long-term care, we’re going to collect the evidence, get the recommendation — there will be changes in the provincial health order, changes in Ministry of Health policy — and we’re going to proceed equally there.

We’re doing the same changes and the same consideration around changes in visitation in acute care, which is a whole different issue but which is, as the member will know, a very significant issue. People tend to — not all; there are people who stay a long time in acute care — have shorter stays in acute care. So the impact of limits on visitations is different but nonetheless significant. So we are looking at that question as well.

Our intention is to proceed — when we’re ready and we get the advice to proceed — to make those changes. The process for long-term care wasn’t in the restart plan because it’s a different process of consideration. Clearly, we want to see an increase in visitation in long-term care. It’s linked to different standards of immunization, because the risk is so different in long-term care, right?

You know, to go from step 1 to step 2 required 65 percent of all those over 18 to be vaccinated. We’re currently at 74 percent, so we’re there on that. In long-term care, it’s clearly higher than that and different than that. So I’m not sure whether it’ll be June 30 or what date it will be, but we’re doing that work now, and we would proceed. That’s separate from any kind of review of the visitation policies. We’re proceeding with changes, as we did on March 25. We’ll proceed with changes in the visitation policy when those tests and considerations are met.

S. Bond: I think that that response leads to what would be a natural next question, in that while the minister was going to consider when restrictions might be eased in the short term, we have discussed here today and British Columbians are talking about, the impacts on the mental health and wellness of seniors in long-term care, as a result of isolation.

Will the minister consider a more formal review of visitation policies as we look to the future? We know that one of the considerations should be: what was the impact? Physical health was obviously a priority, but the deep concern is: what were the impacts from a mental health and wellness perspective? Is the minister considering a more thorough and formal review of visitation policies?

I almost shudder to ask, but I think it’s the responsible thing to do. We are hopeful. Vaccination is obviously critical in making sure that residents in long-term care and staff and others have had both of their shots. In the event of a fourth wave or some other form of pandemic, will the ministry be looking at the whole issue of visitor restrictions to say: could we make some changes to allow the maximum possible visitation, understanding the need for balance and the priority on physical health? There have been lessons, I think, that we can learn.

Is the minister prepared to consider that formal review, looking at visitation policies? What can we learn? Then how would those be applied in a potential future situation where those types of restrictions might need to be considered?

Hon. A. Dix: I think there are a number of sets of considerations. The impact on the mental health of residents and the impact of those policies on the mental health of workers have been very challenging. While we’ve hired all of those people to assist in visitation, the challenge of mediating those concerns for workers has been really challenging, just on visitation — never mind all the other stresses of being involved in care homes that have outbreaks, and so on.

[5:50 p.m.]

So there are those considerations as well. The mental health of families is affected by that. I’ll take that as a recommendation or a suggestion by the hon. member.

What I’d like to do in the immediate period is to continue with vaccination and make changes to visitor policies in the near future that allow for more visits and to establish what I hope will be a more permanent situation. But I think those issues, and others, will be something worthy of review in the future, and I’ll take the recommendation that…. I think, if I hear the member correctly, she’s saying that visitation…. She may think other things should be reviewed as well, but visitation is certainly…. Its impact on residents, its impact on the system, is something that I think is worthy of consideration in the future.

I’d like to get through this next stage, as the member will understand, first, then make those changes. I think we’re at the point where actions are required. We need to engage with care providers, we need to engage with workers, we need to engage with families, and so on. But right now I think we’re in a position…. We’ll be in a position soon to take action. I’d like to see us take action. But I absolutely don’t rule out any review of it in the future.

S. Bond: I appreciate the minister’s response. I’m wondering if we could just speak for a couple of minutes about the Staying Apart to Stay Safe recommendations that came from the seniors advocate. I know that when the report was released, the ministry said that all of the recommendations from the seniors advocate would be considered in future planning.

There were three key actions, and I’m wondering if the minister could outline for me any steps that have been taken. Are there plans in place? Are there dates? What are the timelines, additional budgetary consideration, those kinds of things to make sure that those recommendations in the report that was provided are actually followed through on?

Hon. A. Dix: I think three sets of things. As the member will know, the report, which I found, of course, very useful and, as you would expect, would have read cover to cover and was interested in very much…. I think at the time, which was November 3, it was our view that we couldn’t proceed with those changes, for the reasons that became evident during the second wave of the COVID-19 pandemic and its impact on long-term care. They were reflected — longer visits, multiple visitors and so on — in the changes we brought in March 25, and those recommendations will be, and are, strongly considered in the coming changes we hope to make to improve visitation in long-term care.

[5:55 p.m.]

S. Bond: I will ask this last question, and I am hopeful that the Leader of the Third Party…. Is she appearing virtually? I wanted to make sure that they had adequate time to do their questions. I think the Clerk is nodding.

There’s the Leader of the Third Party. I know that she will have some questions to wrap up our day today. I wanted to be sure she had as much time as she needed.

Let me just finish this section, then, with this question. Considering the conversations that we’ve been having about the impact not just on residents but on their families, one of the recommendations that was critical is the suggestion that there be a long-term-care and assisted-living residents and family council association. Unless I missed that response in the minister’s….

I’m wondering if that is being seriously contemplated. I think now more than ever, that would provide a place for that voice that is so essential at this point in time. I’ll make that my last question for this afternoon, wait for the minister’s answer and then turn the floor over to the Leader of the Third Party.

Hon. A. Dix: Yes, I think that’s a little bit what I was indicating to the Leader of the Opposition earlier. There are proposals dating back to, I think, 2015 about an expanded formal role for family councils. Some of that has come out of Vancouver Island. That will require, I think, regulatory changes and will require, also, some supports for family councils.

As I said to her, I think one of the things that we need to reflect on is the need to ensure that families and residents have a greater voice and a greater say. That only happens, inevitably, without being critical of somebody or somebody else, when these circumstances are formalized.

I think it’s the point I made earlier. There’s no right or wrong here. The recommendations were made in ’15. They weren’t implemented by the previous government or recommended by our government yet. But what I’d suggest to the Leader of the Opposition is that we do have proposals before us, and we’re actively considering those proposals.

I would be happy to share those proposals and that information, both with the Leader of the Opposition and the leader of the Green Party, in their respective roles as Health critics and seniors critics — and that we’d have a discussion about what that would look like. We would do that in the next little while. We are proceeding. Those recommendations are before me.

I got a briefing note not long ago. Occasionally this happens, I say to the Leader of the Opposition, when I’m not entirely satisfied with a briefing note. It happens one out of every 273 briefing notes that I receive. But it’s not for any reason….

The teams are working on it, so we wanted to engage in some other options. Why don’t we engage in them together, with the leader of the Green Party’s interest in those very issues, and see if we can’t…? I say that because I think it’s important coming out of this period. We’re still going to be in it for a while. COVID-19 is going to continue to be with us. We’ll talk probably later in estimates about what that means.

But this would be a message coming out of it, of an expanded institutional role for families. It’d be something that I think, as we’ve done before with the opposition and the Green Party, we could recommend and move forward unanimously.

S. Furstenau: Glad to have a few moments here to ask some questions. I’ve been listening. We were going to canvass very similar questions on the seniors advocate report, so I’ll just jump down to the other questions that we had around long-term care. These are questions that we submitted last year in writing. We didn’t get a response, but I recognize it has been a year unlike any other, so I’m coming back to ask some of these same questions again around funding for long-term-care homes and, in particular, for-profit care homes.

My first question is: can the minister confirm that for-profit homes have the ability to use public funds to pay their mortgages, and whether these homes are required to disclose this information in their annual expense reports?

[6:00 p.m.]

Hon. A. Dix: Yes and yes.

S. Furstenau: I did ask the minister yesterday if he was going to be as speedy as last year, and apparently, that is his intention.

Can the minister just provide some explanation of how the ministryoversees the use of public funds across the care home sector?

Hon. A. Dix: What we’re doing, I think, at this time in the pandemic — but it’s work that has been taking place over the last six to eight months — is we’re working to take action committed to developing what I call a standardized provincewide funding model for long-term care. More transparency is required, more equity, more consistency and sustainability with respect to funding. What we hope to do is to align that funding model with a provincial quality and accountability framework to support the delivery of quality care.

One of the advantages, I think, of the single-site order that was put in place by the provincial health officer — and effectively by health authorities and by a very significant government investment — was that it puts back the lens not on competition between care homes on the issue of wages but rather on quality.

What we’re going to work with, working with the sector…. The seniors advocate has had a word in her report. We’ve had advice and will continue to have advice from the sector but also from others who are interested in long-term care.

My goal — our goal — is to ensure that money is well spent. My goal and our goal is to ensure that there’s fairness across the sector. I think we’ve gone a considerable way to doing that by raising care standards — the 3.36, which has been achieved in every health authority now, average staffing per resident day, of direct care per resident day, which is a significant change. The move to the single-site order is a second key element of that change. And a change in the accountability and ensuring a provincewide model that makes sense, that people can understand between care homes, is a third part of it.

So those three things are happening, because I agree with the member that some changes are required. We look forward to working with the sector, but also, some excellent work has been done within the Ministry of Health on this subject.

S. Furstenau: Just further to that, I appreciate the minister’s response, to talk about an accountability and quality framework and to ensure that there is that transparency and accountability.

Can the minister square the answers to the first and second questions? Is it, in the minister’s opinion or view, an appropriate use of public funds to pay for mortgages as opposed to ensuring that those public funds go specifically into the care of people? I’m really just interested in the minister’s take on this and how that would fit into the quality and accountability framework.

Hon. A. Dix: I think that one way of looking at it is when we build public acute care hospitals — and we’re building quite a few of them across British Columbia right now — and with major hospital projects, ultimately we pay for our capital in that process. Similarly, over the last number of years, there have been a number of care homes added where we contract to private providers to build and then to operate care homes. It would be normal in that process for some of the….

Essentially, the benefit to the province is not taking on the direct debt, but there’s a substantial obligation over time to pay for that and to pay the provider to provide publicly funded long-term-care beds, either in a not-for-profit or for-profit situation.

[6:05 p.m.]

I think all of that is what one expects in that kind of system. But I think what is reasonable to know and to be accountable for is the expenditure of money within that. That’s what my mandate letter asked me to do. That’s what we’ve been working to do.

Because of the changes that have been made, I think the expectation of changes around quality is going to be there. We have to work in such a way as to ensure that people who are in public beds, whether they’re in a contracted provider or health-authority-owned-and-operated provider, receive very significant…. That they see an equal level of care. That’s why a lot of the money, in terms of the raising of care standards, has gone to those living in those contracted providers. They were lower at that time.

I think the key here is transparency and accountability and ensuring care standards are high. That’s what we intend to do. I don’t know if that squares it for the hon. member.

I would say that if we were to pay…. And we will be. We have a very ambitious plan to build out and to replace existing long-term-care homes that are health-authority-owned-and-operated. That’s an expenditure on capital by the province. That means the incurring of debt and the paying of, effectively, mortgages, albeit by the public system.

S. Furstenau: I appreciate that information and explanation from the minister.

I just wondered. The mandate letter, as the minister spoke to, is about reviewing this and looking at this and increasing the accountability and transparency in this sector. Does the minister anticipate any kind of significant change to the vision for the future of long-term care based on, again, what he has seen over the last year and a half but also from any kind of preliminary work that he’s been doing on building this framework and looking at the sector as a whole?

Hon. A. Dix: I feel like I could give a speech, but I’ll be very respectful of the member’s time.

What do we want to do? We want to improve care standards and the quality of care with a focus, I think, on quality of life. In other words, provide supports to improve the quality of life in care homes, not just to make people safe, not just to keep them alive and healthy but also to allow a better quality of life in long-term care. That’s a key priority for me.

Secondly, it’s to replace multi-bed rooms in long-term care, most of which are in the public system. Most of the investment, over the last 20 years, in new capital infrastructure has been in the contracted sector. So we need to replace….

For example, in Kamloops, there’s a care home — which has not had an outbreak, I don’t believe, in this pandemic — called Ponderosa, which the member opposite probably has visited, and I’ve visited. It’s on the Royal Inland site. It is of a certain age and multi-bed rooms. It was built at a time…. It served the people of Kamloops unbelievably well, as for the people who work there, as for the people who are living there, but it’s not a 21st-century care home. So we’ve got to replace those.

We have to rebuild and improve the capital stock of the health-authority-owned-and-operated sector. We’ve done an enormous investment in hospitals, which you’re going to see over the next number of years. If you’re talking about capital priorities in the Ministry of Health beyond those existing projects, the main capital priorities are going to be in long-term care. You’re going to see that in the next little while. So improving that capital stock is very important.

Training, developing a new workforce, promoting a new workforce, ensuring that workers are treated fairly, ensuring that workers have stable, family-supporting jobs in the sector, which means they can commit to the seniors they’re serving for years to come, are key priorities. That’s why we got rid of Bill 29 and Bill 94 and have made the changes around the single-site order that have made it the only place in Canada where the single-site order has been truly effective. Those are all significant changes. Then, with the contracted sector, working through this issue of accountability around our contracts, issues that have been raised by the seniors advocate and by many people for a long time.

[6:10 p.m.]

That’s, already, quite a bit. Also, I feel — and, hopefully, people in B.C. feel — a sense of profound obligation to everybody in long-term care for what they’ve experienced in this pandemic. B.C.’s results have been better than all the other jurisdictions in Canada, but surely, that matters not one whit to people who haven’t had a visitor, people who have suffered outbreaks at their care homes. While we acknowledge that, I also consider that a debt to the future to improve the quality of long-term care.

S. Furstenau: Actually, I appreciate the speech, short as it was, from the minister. I think it is really important for us and for the public to be able to hear and have a sense of the minister and the government’s vision for the future of long-term care. I think it’s important to have that clarity around what the work is and what’s coming and where the minister hopes that work will lead. I think it is important.

Just coming from the minister’s comments, COVID-19 certainly has highlighted a lot that we, as a society, have had to come to terms with around seniors care and around long-term-care homes. In light of this, I think a lot of people are wondering about the possibility and the options of seniors staying home, being supported by families, more than going into long-term-care homes.

Can the minister speak a little bit to any changes that have come in or been introduced or will be coming around being able to better support seniors in their homes or in families who want to keep them in their homes?

The Chair: Minister.

Hon. A. Dix: Thank you very much, hon. Chair. It’s still really good to see you there, I have to say. I can’t get over that. I’ve known the hon. member for a long time and to see him as an MLA here in the Legislature is just an amazing thing.

I would say, in terms of what we need to do in the community…. We’ve spoken about this a little bit in the estimates, in terms of how we need to deal with things. I think it’s important to recognize…. I was telling the Leader of the Opposition that we’ve immunized 985,000 seniors. There are only 30,000 seniors in long-term care. There’s a natural focus on long-term care. But at the age of 65….

When we started public health care, life expectancy was about 69 or 70 years. Life expectancy now has increased to about 80 years, a little above 80 years. In general, life expectancy at 65, when you become a senior, is actually quite significant. It can be 23, 24, 25 years. You go through significant numbers and period around that.

What do we need to do? We need to, of course, continue to build out home support. We’ve invested significantly in that. The federal government, to their credit, has invested significantly in that. We’re just going to see and continue to see an increase in ours.

Community-based professional health care services. We saw remarkable one-year increases in both 2018-19 and ’19-20, and we’re seeing significant ones this year, although there are some changes in the model, including making some aspects of it virtual. You’re going to see those continue to rise. That’s been a significant focus.

The seniors advocate worked with us to recommend significant increases in respite care, which are critical for families to support people to stay in community. That’s a third set of things.

We saw the largest increase in adult day programs in ’18-19 and ’19-20. In ’20-21, because of the orders that we’ve had to put in place, those programs have gone back and, in fact, have been, for a good part of that time, suspended. They need to be significantly increased in community.

We have to find ways in terms of developing seniors housing, especially in our cities but in other parts of B.C. where housing is extremely expensive, to allow seniors to remain in community, to never make it a better deal to go into long-term care. Not that it’s easy to get into long-term care — you have to be assessed — but to never make it that way.

There are significant efforts that are beyond the Ministry of Health that we need to work on, including with cities, to make all of our cities more senior-friendly in a time when we’re going to see a dramatic increase in the number of seniors in our province.

[6:15 p.m.]

All of those are elements of the health care things we need to do, but I think there are some societal questions that we have to ask about adjusting to a society where we’re going to have more and more seniors and ensuring that seniors can continue to play a valuable role in all aspects of our society.

I move that the committee rise, report resolution and completion of the estimates of the Ministry of Agriculture, Food and Fisheries and report progress on the Ministry of Health and ask leave to sit again.

Motion approved.

The committee rose at 6:16 p.m.