PROCEEDINGS IN THE
BIRCH ROOM

Committee of Supply

ESTIMATES: MINISTRY OF HEALTH

(continued)

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

The committee met at 2:57 p.m.

On Vote 32: ministry operations, $25,308,645,000 (continued).

The Chair: Good afternoon, everyone. We’re meeting today to continue consideration of the estimates of the Ministry of Health.

S. Bond: Good afternoon, everyone. I’m going to begin this afternoon with having my colleague ask a specific capital question, and then we’ll move on from there.

I cede the floor to my colleague.

J. Rustad: Back a couple of months ago I asked the minister — we happened to run into each other in the hall — for an update in terms of the capital project in Fort St. James, what the status of that was. But also, most importantly around it, is the plan for staffing of that hospital. The current hospital in Fort St. James is often on diversion because of a shortage of nurses and doctors within the community.

The hospital, of course, is much looked forward to by the people in the community. Of course, a facility is one thing. It’s the people that make a facility work, and it’s very important to be able to understand how we’re going to meet those staffing shortages that we already have as well as for the capital plan. So I’ve asked the minister if he could provide an update for the plan for the hospital as well as — and most especially — for the staffing.

Hon. A. Dix: The member was there the day, I think, we announced the concept plan approval at Stuart Lake — along with many other communities around it. It had been, and it is, a project that had been long overdue. People watching and listening will know that the current Stuart Lake Hospital, which is essentially a temporary mobile hospital, was put in place in 1972 with an expected lifetime of ten years, and we’re still there.

[3:00 p.m.]

Part of the reason — in spite of the fact that the facilities, I don’t think, meet the standard that we should expect — that services have continued to be maintained there is the outstanding teams that work, particularly out of that hospital and out of Fort St. James and through surrounding communities, supported by Northern Health and First Nations Health Authority with respect to primary care. Some of the most innovative work in public health care in Canada has been done out of Fort St. James, and we’re going to continue that commitment.

I think the decision to proceed with the hospital, then approve the business plan…. As the member will know, the design-build agreement was executed on April 14, 2022. That we’re expecting the start of construction this month is extraordinarily good news. While there is a….

We’ve just had a lengthy discussion in another place about capital and operating, so we’ll get back into that. Capital means something, in the case for recruitment. It shows our commitment and I think the commitment that the member certainly has, as well, to Fort St. James and to the region that we’re building a hospital there that demonstrates the commitment to public health there in the community for a long time into the future.

So it’s happening. When you’re seeking to recruit, whether it’s doctors or nurses or health sciences professions or health care workers or workers supporting long-term care, having a new facility will make an enormous difference in being able to attract people to Fort St. James and other communities in the neighbourhood.

What’s required across the health care system, it seems to me, is a continuing commitment to build health human resources. We’ve seen some progress of that, for example with nurses in the last four years. We’ve increased the rate of growth of the RN population in British Columbia. We’re No. 1 in Canada.

We have a long way to go, and we have to continue to do that work. What have we done? So 602 new nursing positions, training positions, including a significant number in different regions of the province, which I think is critical to reaching the health care demands in communities such as Fort St. James.

Equally, with health sciences professionals and Allied Health — the focus on that, which is a key part of the measures we’re taking to build the health human resources over the next ten years.

Obviously, the continued effort…. We have the largest, now, family practice residency program in Canada because of the 60 additional places that we put in place in the last few years, which makes us now the biggest. And the HCAP program has added, across the health care system, the long-term-care system, thousands of new employees. In fact, out of the 7,000 promised, over 6,600 positions have been created.

These are the measures we need to take to build the supply of nurses — and in addition to nurses, health sciences professionals, doctors, health care workers and people across the system to support all of our health care facilities. We need to focus, as I say, on training people within regions.

I think, significantly, as we go forward, we have to ensure that health care workers are treated with respect in every way. That’s what we continue to try and do.

I think what’s also important in the member’s region…. He’s right to be concerned. We have a declining under-65 population in the member’s region, the member’s constituency in the Fort St. James region. And we have a dramatically increasing population over 65, meaning the demand for health care services is going to increase like this. The capacity with the existing population to meet that demand is going to be challenged by a declining working-age population.

That’s what the projections have shown us, really. These are 2016 projections. I suspect they haven’t changed very much over that period of time. That means we have to find better ways, as well, to bring people into health care who previously haven’t been employed in health care in sufficient numbers.

One of the messages and the lessons of the In Plain Sight report was the need to recruit at all levels, including leadership levels but at every level, more Indigenous people in our health care system as workers, as professionals, as leaders. That’s, in particular, needed in communities where a growing number of the working-age population are Indigenous. Those opportunities have, in the past, for a whole series of reasons which I’d be happy to discuss at length, been denied.

All of those things are part of the health human resources response. We need to make sure that that hospital — which we’ve committed to, which we’ve invested in the hundreds of millions of dollars to, which we’re delivering on, which we said we’d do and we’re forward on the plan to do — will be a great success in Fort St. James.

[3:05 p.m.]

S. Bond: I’m sure that my colleague would appreciate an opportunity to sit down and speak more directly with the minister.

I’m going to take a slight detour here for a moment. Obviously, our time is truncated, and there are significant questions around long-term care and seniors — incredibly important. Prior to that, I am going to ask the minister if he could get me an update by the end of the day, if at all possible.

I have been receiving calls this morning from seniors in Prince George and other communities around ours who are incredibly concerned. They have been given an invitation to have their second booster shot, their fourth shot in total. I am being told there is no vaccine in Prince George. So if there is none…. I would like to know if that is accurate. The minister has been very helpful, tweeting out things about vaccination clinics, but there is significant concern.

One senior told me that she was told to, potentially, drive to Quesnel and get her shot. That is a significant drive. Not that the minister will want to hear this, but she said: “First, I’m not comfortable doing that.” They have tried a number of other locations in Prince George. Apparently, vaccine may not be available in Quesnel and other locations as well. You can imagine the concern that raises for seniors who have been given the invitation to book an appointment.

I’ll leave that with the minister. Hopefully…. As soon as he or his staff can get an answer to that question, I would really appreciate it.

As we transition to looking at the estimates for seniors in long-term care, I want to begin by recognizing the work of the seniors advocate in British Columbia. She is incredibly dedicated to B.C.’s seniors. I know she is travelling now, again, around the province, meeting with people across British Columbia. I know the important work that she has done. Also, the staff in long-term-care homes and the issues that their families and others have faced throughout the pandemic — very important topics for us to cover.

There isn’t a lot of time. So I would really hope the minister would be as efficient in his answers as possible.

Let’s start with the office of the seniors advocate. Perhaps the minister can tell me what the base funding for the office of the seniors advocate is for ’22-23.

Hon. A. Dix: The base budget for the office of the seniors advocate is $2.5 million.

S. Bond: The seniors advocate had a significant role to play during the pandemic. In fact, some of the work that she did we did together as part of a joint committee which the minister put together. That, by the way, worked extremely well. It was a real pleasure to work with other members in the Legislature on that committee.

When we look at the allocation of the funding for the B.C. seniors advocate, did the allocation take into account any of the extra work that was necessary during the pandemic?

My second question. I’ll give you the second part so that you can contemplate the answer at the same time. Did the seniors advocate request any funding for special projects this year? If yes, was funding approved?

The Chair: Minister.

Hon. A. Dix: Thank you, hon. Chair. It’s so good to see you in the chair.

The answer is that there have been no requests for funding for special projects. I think there has been a request for some additional base funding. It came in after it went through the budget process. Those kinds of divisional questions we’ll be looking at now. So with respect to requests for special projects, the answer is no.

S. Bond: Thank you to the minister. Well, I certainly hope that despite the arrival of the request…. It was not during the regular budget process. I’m certainly hoping that the minister is going to contemplate what it takes for the seniors advocate to efficiently and effectively do her work. It’s incredibly important.

[3:10 p.m.]

I know that British Columbia is highly regarded across the country. I’ve been on calls, for example, where the advocate has spoken. Her work is certainly leading the way.

Let’s look back, then. If there’s no funding for special projects, moving forward, in this fiscal, what projects or reports, completed by the seniors advocate in the past fiscal year, were funded through special project funding rather than the office’s base funding?

Hon. A. Dix: The seniors advocate’s base funding pays for all of her projects — for example, the work of the committee that the member was on and the member for Burnaby North and other members of the House in 2020. That obviously is a separate fund. The seniors advocate is essentially influencing, or giving direction, to the expenditure of that money. But that wasn’t from her base budget, either.

Essentially, the money for her initiatives comes out of her base budget. I understand that she’s asked for some increase in that base budget. That’s something we’re looking at in the year. I think, in a general sense, I would say to the opposition Health critic — there, I get to say it for the first time — that in general, I think, in comparison to other, similar agencies, the seniors advocate has an efficient organization. We get excellent value for money. Any requests she would make would be considered in that light.

S. Bond: I do want to be clear, though, that should the seniors advocate look at money for a special project…. When I look back at our transcript from last year in estimates, obviously there is “base funding, which goes up, as base funding does.” That is a quote of the minister. “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.”

It does look like, in the event that the seniors advocate requires additional funding for a special project, that request is made directly to the ministry.

Could the minister just briefly describe for me how that decision is then made? Does the project have to align with ministry priorities? What is the decision-making process for a special project that might be a request from the seniors advocate?

Hon. A. Dix: I think it’s probably why the seniors advocate hasn’t gone that route. I’ll just say that what you would want in a general sense, because of both the independence of the office and the approach of it, is to ensure that the base funding is sufficient and that the seniors advocate isn’t essentially, as the member suggests, asking for permission in that sense. I think that’s important.

That’s what’s actually occurred this year. There hasn’t been a request for just that kind of funding for that reason. There has been a request that’s come in, that’s before the ministry for consideration. Essentially, that request…. I don’t want to summarize it too much. It’s obviously an internal request. The seniors advocate hasn’t been doing any kind of public campaign. I don’t suggest she has. It’s a request for three additional FTEs. That would enable, essentially, the seniors advocate to make such decisions.

If there was a special project outside of that, it would be submitted and held against the fiscal requirements of the Ministry of Health, through the Deputy Minister of Health. But I don’t think that…. In my view, anyway, the best way to deal with that for an agency such as that is to ensure that the agency has sufficient resources to do its task.

If a special thing comes up — for example, what did come up during the COVID-19 pandemic and the work we did together on that…. We created the fiscal room there, which was in the tens of millions of dollars, that the seniors advocate essentially directed, with the advice of members of the opposition, obviously; the advice of members on the government side; and the advice of the staff of the Ministry of Health.

[3:15 p.m.]

The short answer to the question is that’s the process forward. There would always be the occasion for a special project, and that would come through the Deputy Minister of Health. Probably the best way is the way that the seniors advocate, I think, has generally chosen to do that: to request a budget increase so that she can achieve goals, within her independent mandate, that work for her and for the people of B.C.

S. Bond: I want to move our discussion to home health and home support. Obviously, home health is the broader term for community-based professional services, including home support, adult day programs, respite, at-home end-of-life care. The 2021 Monitoring Seniors’ Services report — it’s based on 2021 data — showed that home support clients and hours decreased 3 percent from 2020, while the population of seniors over 80 grew by 3 percent.

The average hours per client remained consistent but varied regionally. We saw that professional home care services and clients increased, but there were significant decreases in ADPs. They actually had…. We saw a significant decrease.

I’m wondering if the minister can speak to how the home support system is currently operating. My biggest concern is the number of unfulfilled appointments there have been over the last year. How many hours of home support were provided over the last year in comparison to 2020 and 2019?

[3:20 p.m.]

Hon. A. Dix: I’ll go through some of the numbers for the member. There are different baselines that we look at. Some of this may not be exactly what she asked for, but it’ll give the sense. Obviously, there’s a series of programs that we are talking about. One is home health services. The second is adult day programs. The third is community-based services, essentially. Those are home visits, which have been expanding substantially. Then there are, finally, other community programs.

Overall, the trajectory, just to talk about adult day programs, for a moment…. That was one of the key areas, as well as community-based services. When we announced our seniors plan in 2018, in the community, it was one of our highest priorities. We saw, in fact, the largest increases ever in those programs, leading into the end of the 2019-20 fiscal year. Then, obviously, adult day programs largely shut down. We saw the dramatic change, and we discussed that in last year’s estimates.

That has reversed. We’re moving forward and responding to that now. You see that a majority of those programs are now back in place, but we’ve still got some work to do. There are two sets of work to do. There’s still some reluctance, on the part of seniors, as one would expect, after this period of COVID-19, to return to adult day programs. We need to encourage them to do so.

As of March 31, 2022, 94 out of the 125 adult day program sites were open across the province, providing 21,413 of the 33,945 spaces that were available at pre-pandemic operating capacity. There’s information about that, which I’m happy to share with the member, for each health authority, to give that as sent. That was certainly my leading priority. It was the leading priority of others, like the seniors advocate, to increase the level of community services, both at the home and in adult day programs. That was succeeding.

Then, of course, COVID-19 radically changed the how and the nature of those services and forced many of those services to close. Despite workforce shortages — it has been a challenging time in home support; that’s for sure — a steady increase has been achieved because of continuing investment.

In 2021, which is the last full year we have, approximately 1.719 million community-based service visits were provided by health authorities across the province, which was an increase of 24 percent over 2016-17. That means services were provided, on that basis, from that base, to approximately 132,000 British Columbians, which is an 11 percent increase.

Further, on home support, 11.134 million hours of home support were provided by health authorities across the province in 2020-21, which had been an increase of 3 percent over the same period. Services were provided to approximately 51,000 British Columbians in that period.

In addition, and we talked about the health career access program, about 259 health care support workers were hired to work in home support directly through that program, which is a useful thing to do. We’re also expecting a report, on a home support client and caregiver survey, soon from the seniors advocate. That’s coming forward.

We’ve had, obviously, significant investments in those areas, but that gives the member a sense. What I’ll also do is…. I’ve got detailed information, by health authority, which I’ll share with the hon. member.

S. Bond: Thank you to the minister. I would appreciate that information. If he could provide that, that would be helpful to me as I look to better understand those numbers.

I’m wondering if the minister can provide me with how many people are on the wait-list, waiting to receive home support, in each of the health authorities across the province.

[3:25 p.m.]

Hon. A. Dix: Just one other thing, just because I gave a different baseline there. There’s a 4.2 percent increase in hours over the ’21-22 year against ’20-21. So it’s a significant increase in hours and under the circumstances, I think a really remarkable achievement for those providing home support.

There isn’t a wait-list, per se, for home support services. People are assessed for home support, and then they start to receive the visits. If there’s a delay or there’s a request for assessment, there may be a wait at that point. But there’s not a wait-list for those services in the same way as there is a wait-list for a particular surgery.

S. Bond: Thank you for that answer. Does that mean there’s a wait-list for assessment or to begin to get into the process? What the minister has just said is that if someone is assessed for home support, they receive it immediately. Is that accurate?

Hon. A. Dix: You seek a referral. There are different people with, obviously, different levels of need. For example, there will be a group of people who will need home support after discharge from an acute care hospital. There are other groups of people who require home support for, say, palliative care and the supports they get in palliative care, and so on.

People are calling home and community care, getting a referral and, based on that assessment of need, getting access to home support services. That’s the way it goes. Now, as the member will know, I gave the wrong numbers in the number of people who get home support. The assessment of services is based on, obviously, the judgment of public health professionals. But that’s the process you go through.

There’s a seeking of home support services or the need for home support services. They can come from people who need those services to remain at home and not go into long-term care or need them for other reasons. These are not just seniors, as the opposition Health critic will know. It’s many others, as well, who require such services. There are post-acute services, etc.

That’s the process. It goes through the health authorities, and then the request goes out to provide hours of support.

S. Bond: Thank you very much to the minister. That does not align with my experience in my constituency office. We get phone calls all the time from people who are waiting for home support. Is the delay, then, from when a person is referred to the time they actually get assessed and then get the services?

I don’t think the minister is saying here today — at least, that wouldn’t line up with my experience — that you phone in, you need an assessment, you get the assessment, and immediately you get home support. We have people who wait for a period of time, so perhaps the term “wait-list” isn’t the correct use of a description.

Are there seniors who wait from the time they get a referral for an assessment until the time they get home support?

[3:30 p.m.]

Hon. A. Dix: I do this casework too, so I know what the member is talking about. I’d say, for example, that if you get a referral from a doctor, from a hospital, that says, “We’re discharging,” and a client, or a patient in this case, needs home support right away, needs it tomorrow, then that would be almost a prerequisite to discharge.

Part of the challenge sometimes, of course, both in home support and in long-term care, is if for whatever reason that wasn’t available, then the discharge wouldn’t occur. That would mean that the client, or the patient in this case, would still continue to get care, but they’d probably be given that care in either the rehab unit or in their hospital.

If the home support referral is for someone who — and this is absolutely legitimate — say, has a caregiver and they’re overwhelmed and need some additional help…. If that’s the nature of the referral, that might take longer. So that may be what the…. These things are judged on need and urgency, always, in the health care system, so that’s what you might see.

But with respect to immediate home support needs, that’s the way the system functions. It responds based on need, based on the nature of the referral and the assessment by a health professional.

S. Bond: Does the minister agree that there are seniors living currently in long-term care who could actually be accommodated in community if they had adequate support?

Hon. A. Dix: I think it’s fair to say that it’s for this reason that we made such an effort to invest, leading into the pandemic, in home support and community-based services. It’s my belief that if there’s an option for people to be able to stay at home, that option should be pursued.

That said, what we’re also seeing — and I don’t think there’s any doubt about this — is increasing acuity of those living in long-term care across the board. I think the seniors advocate has talked about 10 percent of long-term-care residents possibly being able to continue to live in the community. We do see also, though, on all kinds of measures, increasing acuity. Of course, we’ve gone through the two years of the pandemic as well, which has had its own impact.

I wouldn’t want to hesitate to say what that number is. There are undoubtedly some people in those circumstances. That’s why we’ve made so many significant investments in those areas, based in part on the recommendations in seniors advocate reports.

The short answer is yes, but it’s an increasingly challenging situation, I would say, in long-term care, because we’re building out and adding long-term-care capacity in the province and rebuilding some of our existing long-term-care capacity, which has too many multi-bed rooms in it.

We also see a very dramatic increase in the population over 75, over 80 and over 85, so the demands on that long-term-care system are going to continue to grow. It would be my guess that the number of people who are underassessed or assessed as long-term care who might be able to stay in the community is going to continue to decline for those reasons.

That said, there are some, and that’s why we need to invest more in home support. Outcomes are better, and just about everybody, if you ask them — and I know this from personal experience — would rather be, obviously, in their home they’ve lived in all their lives rather than in a care home, no matter how good that care home.

[3:35 p.m.]

S. Bond: I don’t think either of us…. I don’t think I would disagree with the minister’s assessment that seniors, if able, would rather live in community — the vast majority of them.

The other aspect of this…. Obviously, I don’t want to minimize the quality-of-life aspect, because it is very important. But when we look from a fiscal perspective, we know that home support is very cost-effective, and it also provides quality-of-life for those particular seniors who choose to stay in community. I know that the seniors advocate has made a number of recommendations around home support. I am very interested in seeing those — a look at what those might mean in terms of improving the system.

I’m going to go back to two things, and then I have another question. I want to go back to the wait-lists. Perhaps it was that I was inarticulate in asking the question. There are wait-lists in adult day programs, and there are wait-lists in respite. I know there’s been commentary that it’s been difficult to track those wait-lists, as a result of the pandemic. Obviously, most in-person programs were shut down. So can the minister provide me with the latest wait-lists in adult day programs and respite?

Hon. A. Dix: The whole question of adult day services has obviously been in flux over the last couple of years. We saw, really, in the first couple of years after I became Minister of Health, a 26 percent increase in adult day spaces — which was an earthquake in the positive direction — and a dramatic increase in respite spaces as well.

Then obviously, in 2020-21, we had the pandemic and the shutting down of those spaces. So in terms of wait-lists, I think we’ll have to assess, as we regain and put the system fully back into place. In its majority, it’s back in place now. The adult day service will have to assess the demand for those spaces.

What I would say on respite is that any wait time has decreased dramatically because, of course, there has been very little demand in the province for in-facility respite from home to, say, a long-term-care home for a period of respite care, because of the pandemic itself. That’s changed that system.

I will give the member the year-over-year numbers that show what we’ve seen, which is dramatic increase because of the direct investment in adult day programs, in community-based services and in respite programs leading into the end of fiscal year 2019-20, and then, obviously, the decline in the numbers in those programs because many of those programs were shut down.

At this point, I would not say that wait-lists are really an issue for adult day programs. Respite care is a slightly different proposition, but as we build back up to normal, we’re going to look at the demand for those services. I believe that they’re critical, that we need to give more and more opportunity in these areas, not just to have seniors stay out of long-term care and all the other public health goals that one might have but also to live better and to live well. Those programs are a key part of that, and that’s why I support them.

[3:40 p.m.]

S. Bond: I’m wondering, while the minister is going to provide me with some data, if he could please add to that list an update on the number of home support hours and clients in 2021-22. If he could provide me with that information, that would be most helpful.

As we look at the issue of seniors being cared for in community, as I noted, there were a number of recommendations made in the 2019 home support review. One of those recommendations which the minister said, last year, in estimates, that he was looking at…. It would not be part of Budget 2021, but it is a significant barrier. That is the issue of the home support co-payment. That is an important thing for, I think, the minister to consider.

There was a series of other recommendations, and perhaps, at some point — not today — the minister can give me an update or a response to the recommendations that were provided. But today, could he just update me on progress that’s been made in terms of considering eliminating the co-payment?

Hon. A. Dix: I think in the most recent look we had at the data, about 64 percent of those accessing home support services paid zero, and that’s because of the testing that’s in place now. Now, some would argue that the reason that number is so high is because the co-payment itself is a deterrent to the receiving of the services. So that’s an argument that’s being made. But we’re looking at it.

Obviously, all of this is going to be critical: how we provide a broader range of home support services; how we give people — who often, of course, are not inside the health care system but will, outside of the system, seek supports of various kinds — home care or home support and enable them to use the means that they have to do that; and all considerations in the report provided by the seniors advocate.

We haven’t proposed changes to the co-payment. Our focus, obviously, in home support has been on maintenance of services and making sure — especially for the many people who want to stay home, especially now, because they didn’t want to go into long-term care during the pandemic, for all the reasons the member will know — that the access to those services was there.

We haven’t made any progress on that set of recommendations from the seniors advocate, except to say that the very significant number of people using the system — the majority, in fact, of the public home support system — are not paying a co-payment at all.

S. Bond: Certainly, that is correct. But when we look at the work that was done in 2019, it showed us that a senior that had an income of $27,800 would pay $8,800 a year to receive daily home support. They don’t have their co-payment waived.

I think the minister…. I would urge him to look at the impact of that frail, elderly person paying $8,800 a year. The Select Standing Committee on Finance recommended both in 2021 and 2022 that the minister increase access to home support and adjust the co-payment.

[3:45 p.m.]

I’ll leave it at that for now, but it remains a concern. I certainly agree with the perspective the seniors advocate has provided that that is a significant barrier for the seniors who do not have their co-payment waived.

I take it, then, that the other questions I have, related to the seniors advocate’s recommendations, related to things like client-direct funding for home support clients…. Again, that was a recommendation of the 2019 home support review as well as the office’s submission in Budget 2022. The minister referenced the fact that they had not made significant progress on those recommendations. Is that the case for looking at client-direct funding?

Hon. A. Dix: I think the direct action was taken in the years leading into the pandemic — increasing home support hours; increasing adult day programs; increasing respite care; increasing community-based services, which are very important, the services by health care professionals which are essentially home services that are not home support. All of those saw dramatic increases in both funding and hours. That’s been the key part of the program and the progress we’ve made.

The area of self-directed programs such as CSIL, Look at This and others — there hasn’t been a change in that in the last couple of years. But these are areas, obviously, under review as we seek to take steps to enable families and seniors, in particular, but also others who might be in long-term care. Anyone who has ever visited long-term care knows there is always a very significant number of people in long-term-care homes who are not seniors, many of whom have benefited, could benefit, from community-based services.

How best to do that, other than the very significant investments we’ve made and are going to be back to making with the restoration of these programs, in some cases, is something that we’re assessing.

Our belief was that addressing an increase in community-based services was the right approach initially, and it was supported. In fact, the specific announcements on community-based services — adult day programs, respite and community-based services — were strongly supported, for example, by the seniors advocate. So we haven’t made a change on self-directed programs in the last year, although those things are still in front of us.

S. Bond: I’m relieved to hear they have not been…. Let me think of the word. I think it’s important that we consider those recommendations as we look at how best to care for seniors in our province.

[3:50 p.m.]

When it comes to CSIL, for example, and looking at the ability for clients to be able to direct their funding, it looks at…. Frankly, it’s more cost-effective to government as well. So there are a bunch of advantages to looking at the recommendations that have been presented. I’m glad to hear, although I wish…. I understand that a global pandemic got in the way, but we do need to pick up that work and continue to look at how we improve the system.

I know another area that the ministry had been working on was service redesign in specific areas across the province, including a neighbourhood model of care, looking at fixed shift scheduling. Can the minister describe whether there’s been progress made in those particular areas of neighbourhood models of care, fixed shift scheduling — basically, the service redesign — or again, has the pace of that slowed because of COVID as well?

Hon. A. Dix: I would say that a significant change was made a couple of years ago when home support contracts were repatriated.

This is not a criticism of anybody. I like to say that right off the top these days. It’s not a criticism of anybody to say that the decision to repatriate those contracts and not have multiple contracts in health authority areas in Fraser Health and Vancouver Island and Vancouver Coastal Health was incredibly beneficial in the pandemic and allowed us to better organize by neighbourhood and address the various service redesigns that the opposition health critic is talking about. It enabled us to do it more effectively.

That’s something that we’re really, now, going to pursue, now that we’re…. We’re not through the pandemic, but we’re dealing with this latest phase of the pandemic and getting back to that organization because we have, now, the capacity, in many places, to organize and continue to organize the system more effectively by neighbourhood.

Yes, that redesign in a number of health authorities — particularly the larger ones, which are organized more by neighbourhood and not by whole communities — has been going on. I would expect us to continue to pursue that. The very fact of repatriation of those services, especially in Metro Vancouver — where we had, I think, eight separate contracts in a time when there were significant disruptions in the labour market — was an incredibly valuable decision to have made and, obviously, not one we made with that in mind.

I think the capacity to do that and the way we’re doing it has improved, but there’s a ways to go. This is certainly going to be the year when we’re going to be focused on that with respect to home support clients.

S. Bond: What I’d appreciate is if the minister could provide me with an update, not at this moment in time, in writing. What has been accomplished to date specifically in regards to the concept of neighbourhood models of care and fixed shift scheduling?

An additional recommendation of the 2019 seniors advocate report was also about increasing the stability of this home support workforce. The minister would know that many of them work part time. They work irregular shifts. Certainly, I know that during the pandemic, the minister pursued a single-site initiative in long-term care. That was obviously done related to COVID.

The question is: how do we take what we learned during COVID when it comes to creating that stability for the workforce and implement that now? What specific steps is the minister considering or taking to improve the working conditions of community health workers?

[3:55 p.m.]

Hon. A. Dix: A couple of things. First of all, we need to increase our home support and home care staff. Giving home support workers, health care assistants working in home support and health authorities access to the HCAP program has been making a real difference in the hundreds of new workers, which is really positive.

Secondly, the repatriation of contracts I referred to obviously brought all home support workers up to HEABC standards. It made a difference for many of them who were getting paid under that through both contracts and subcontracts. While the contracts were generally in parallel across health authorities and across the contracted areas, there would have been many home support workers who were being paid under that rate. Obviously, in a time when there is demand for health care workers, we have to ensure stability and equality in the way that we organize that care.

Finally, the repatriation of the contracts themselves gives workers more flexibility and options, because they’re obviously bigger employers, covering a wider service area. This has all been positive news for home support workers.

Now, I suspect that if you talk to the people representing home support workers, they’ll have a series of things that they’d like to see. As the member will know, we’re in the midst of a round of collective bargaining. That will occur, inevitably, at the bargaining table. But I think the decision to give access to HCAP, the decision to repatriate and the broader decision in health care to lift up the wages of the people who were being paid well below the HEABC standard, in the broadest sense, has been positive for ensuring stability in the sector.

We’ve got to keep working at it. We’ve added a lot of new health care workers: 30,000 across the board, 6,600 in the various programs in support of HCAP and other programs that dealt with infection control in long-term care, but we’ve got, obviously, significantly more recruitment to do. We’re going to have to do that by following the policies that we have been following, which is treating workers fairly and giving priority to community care.

S. Bond: If the minister could provide me, I want to just ask for an update, in writing, on the adult day programs. We talked about that earlier, and the minister mentioned that we were transitioning back to, well, where they’re actually operating. If he could provide that, that would help me with that.

I’d like to just ask a question specifically about respite care. If we look at the report that was written by the seniors advocate, the number of respite beds decreased in Fraser Health by 3 percent and in Northern Health by 17 percent. I’m wondering if the minister can provide me with some perspective about that.

If ever, now…. Caregivers always are challenged with fatigue and all of the things that they are trying to manage. They are desperate for increased respite care, and I would ask the minister today: what new funding will be attached to increased respite care?

[4:00 p.m.]

We do know that there are wait-lists. I know that he will provide me with that information. We also have a regional imbalance, depending upon where people live in B.C., in terms of the access they have to respite care. Could the minister address that concern?

Hon. A. Dix: A couple of things. Prior to the pandemic, again — this is just the reality of things — we saw the increasing availability of in-facility respite across the board, with a 9 percent increase from, basically, 2017 to 2019-20. Obviously, we’ve seen a very significant decline in that in the last couple of years. In fact, it’s been reduced more than half as in-facility respite became less in the system. What’s clear as well is that that’s differently felt in different communities. What I’ll do is endeavour to share the regional breakdowns of that with the opposition Health critic.

I think the priority…. In-facility respite and in-home respite, where possible, are both critical aspects of how we support families in difficult times. Sometimes it’s literally a week of support or two weeks of support that makes all the difference for families. So we consider both in-facility respite and in-home respite. I suspect, as we have achieved some greater degree of normalcy in long-term care — I don’t want to overstate that; it’s still very challenging in long-term care — that we’re going to be able to continue to do that.

I’ll simply provide the details and the numbers by health authority. Proportionally, I think the member is right. Northern Health, in this area and others, is underrepresented in our system. It has been for a long time. It’s not a matter of argument. How we address those issues in community…. I think even within Northern Health, there would be significant differences between communities. Prince George might well be much more like other larger communities in B.C. — and then the rest of Northern Health not doing as well.

We’ll provide that information to the member, but those are the basic numbers around the availability of in-facility respite.

[4:05 p.m.]

S. Bond: I’m sure the minister would not disagree that we need to make sure that there is a more equitable approach to that provision of respite across our province.

I’d like to circle back, just very quickly, for basically a yes-or-no answer. I was thinking during these intervening questions about the ask of the seniors advocate for additional funding. If the ministry agrees that that is a reasonable request, will that funding be able to be allocated in this fiscal?

Hon. A. Dix: Yes.

S. Bond: Thank you. That is my favourite answer: yes. That wasn’t my favourite answer of the whole time. Usually getting to yes is an important thing.

I’d like to spend a few minutes talking about the national standards that are being developed for long-term care. The minister is well aware of the two new national standards. There are various working groups that are working on those. One standard will address the delivery of safe, reliable and high-quality long-term-care services, while, of course, the CSA standard is focused on operations and infection prevention and control practices.

There are two national standards being developed. I’m wondering if the minister can outline briefly what participation B.C. has had in that process. What specific points of engagement have there been with committees of the federal government? Have there been written submissions? What policy points did the minister or the ministry advocate for during this process?

Hon. A. Dix: I should say, just in a general sense, that the standards are in alignment with B.C.’s legislation and regulations, guidelines and standards.

It’s one of the significant issues that we are going to be engaging with the federal government on. They’ve published their draft standards, and we’ll be responding to those in their process. We intend to provide feedback on those standards with any material concerns.

We’re not overly concerned, to one extent, with a federal imposition in this area. Our efforts, our long-term-care projects, our investment in long-term care are being done with those standards in mind. So it doesn’t become an issue of dispute in any way.

They’re largely in alignment now, and our future activities are going to be done with the new draft standards in mind so that there won’t be an issue in B.C. I’m the provincial chair right now of the Health Ministers. It’s one of the areas that Minister Duclos and then, as well, the minister responsible for seniors at the national level are working on with us and with provincial ministers right now.

I don’t know if we’re going to have our usual, shall we say, get-together, which we haven’t had for some time. We get together on Zoom all the time, but we haven’t had the full-on meeting. Minister Duclos and I are in regular contact. Certainly, this area of long-term care as well as, obviously, the Canada health transfer are key issues that we’re working to pursue on behalf of British Columbia and on behalf of the provinces.

S. Bond: If the minister has any particular documents, information, policy suggestions or direction that the ministry provided during the process…. If he’s prepared to share them, that would be helpful.

Can the minister tell me: will accreditation become mandatory for long-term-care homes in B.C., and if it does, will there be additional funding provided to operators to actually achieve that accreditation?

[4:10 p.m.]

Hon. A. Dix: In terms of funding, I haven’t considered that. I would say this to the opposition Health critic — that more than 82 percent of contracted long-term-care homes are accredited, and 100 percent of health authority–owned and –operated sites are accredited at the moment. So the vast majority…. If you take those together, that would get us closer to 90 percent than 80 percent of all care homes that are currently accredited, based on the existing funding, and so on.

It might be interesting to look at the small proportion that are not. While I wouldn’t reject funding for that, I would note that it’s a positive reflection on the sector that people have gotten accredited here.

S. Bond: Does the minister have the ability to compel long-term-care facilities to demonstrate that they have sufficient staffing?

Hon. A. Dix: As the former Leader of the Opposition, the opposition Health critic, will know, we’ve substantially increased staffing funding. That money has disproportionately gone to public beds in private, either for-profit or not-for-profit, facilities.

There is not just the expectation but there is the requirement that that money be spent on staffing and that the staffing levels that are funded be put in place. If, for some reason, they were not, then, obviously, the money would come back to the province. That’s absolutely a necessity. That’s the contract requirement. In addition, of course, there are standards, which are put in place and supported by licensing, about their overall standards of the quality of care in different care homes.

In recent times, a number of care homes have been essentially taken over or put under administration by health authorities on the recommendation of medical health officers. That’s happened in a number of cases on Vancouver Island and in one case in the Interior Health Authority. We are always reluctant to do that.

Those standards are enforced by licensing. Those are not, strictly speaking, staffing standards, but they are quality-of-care standards, as you’d expect. The one means, from the ministry, is contracts. The other is, obviously, licensing, which has a care standard requirement on all care homes.

S. Bond: Can the minister tell me if the seniors advocate will have a role in ensuring B.C.’s compliance with the national standards once they’re implemented?

Hon. A. Dix: I think that she will, no doubt, have a role to play. I think that the role of the seniors advocate is to oversee. There was an exception to that in the committee that I set up in the early days of COVID, where there was a direct kind of administrative responsibility. But her job is to independently review the system and make recommendations about that system and hold people accountable. You can’t do that if you’re running the system as well.

No doubt her comments…. She will have comments. There are significant issues around…. There will be issues around the draft standards, which, while they’re largely in line with what we do…. Really, it depends on whether there’s a new set of standards that the federal government might want to impose that are, in some fashion, mandatory, which would be an interesting situation. Currently those standards are voluntary.

I think the seniors advocate plays a role in the system, but her role wouldn’t be to directly administer that system. That would be the responsibility of the ministry and the health authorities. I think it would be a change and a transformation of her role to have the seniors advocate and the seniors office to do that — effectively take over a role as sort of an ADM of seniors services.

[4:15 p.m.]

I don’t think that’s what she’d necessarily want, but her voice will definitely be heard and her advice absolutely sought as we work through this process that the federal government has undertaken and communicate our views as a province. I would expect to see the seniors advocate in response, in advance of, for example, us putting forward our position on any changes we might like to see or our assessment of the new standards.

S. Bond: The federal government promised in their 2021 election $9 billion to long-term care, and a third of that was going to be earmarked for standards implementation. Has the minister or the ministry had conversations with the federal government to ensure that British Columbia has access to that funding so that we have the ability to implement the national standards?

Hon. A. Dix: With respect to that funding, obviously we’re going to get our 13.4 percent of that funding. What I think the opposition Health critic is referring to is a political promise made during the election campaign. So we would expect to see our full 13.4 percent — or is it 13.6 now? I think it’s 13.6 now — as we have with the announcement around surgical funding that Mr. Duclos made just recently.

That money hasn’t been forwarded yet, and the $9 billion is still — let’s just call it — notional on their part. But it’d be our expectation that, yes, we would get our full share of the money and use it, should that happen, for those services. But it’s our position and our priority not to go down those routes but to see a significant lift in the Canada health transfer that would allow our health system to respond and improve services for the public and support the public health care system in this very challenging time of the post-pandemic period.

That 22 percent from the federal government is inadequate, and they need to address that issue first. That’s been the Premier’s position. That’s been my position. Obviously, when funding comes forward, it gets allocated to everyone, and we have a number of funding agreements with the federal government. But that said, our priority is the Canada health transfer.

What might be of interest, though, in terms of the federal funding for long-term care — because there was some additional federal funding for long-term care in the last two years — is $134 million in federal funding was provided. More than half of that has been spent, and the rest is on track to be spent in the coming months.

So that money has gone forward, and it has gone forward for a number of purposes, including infection control but also very significant new equipment, HVAC equipment, etc., in long-term-care homes around B.C. But the focus of that was improving infection controls in long-term-care homes.

The Chair: Members, we’re going to take a ten-minute recess, and we’ll return at 4:30 p.m. sharp, please.

The committee recessed from 4:19 p.m. to 4:31 p.m.

[M. Dykeman in the chair.]

S. Bond: One of the concerns that I had when the head of the technical committee, looking at the standards that are going to be implemented…. When they looked at the infection prevention and control standard, they noted and acknowledged that not all long-term-care homes may have funding to implement the standards and said that the committee will help them “pick and choose, where necessary.”

I’m sure the minister doesn’t think that’s acceptable in British Columbia. Can the minister describe to me what he will do to ensure that standards are implemented across the sector?

Hon. A. Dix: Essentially, the HSO standards, as noted, are based on the Accreditation Canada LTC services standards, and we’re overwhelmingly meeting that test. They largely align with policy.

A little different are the CSA standards, which is as the member says. That’s why the federal government has talked about spending money in this area as well, presumably. There are some differences, so we’re working hard on that, because of course, we don’t have two standards of care in B.C. We need to have one standard of care. These are areas where we’re working with the federal government. They’ve produced draft standards, and we’re going to communicate to them our views on those standards and how they should apply.

In B.C., one positive thing, I would say, on some of these areas, especially in infection and control, is the degree to which the province and, indeed, the federal government have invested in these areas in the last two years during the pandemic as well.

That said, there is more incongruence on the CSA than on the accreditation standards, and that’s why we’ll be having those discussions with the federal government. I think it might be premature to say this is a problem, because we’re not quite at that point in the process, but I take the point of the hon. member.

S. Bond: Thank you to the minister for that. I think we would all agree that we want to make sure there’s consistency in our province. We’re not going to pick and choose long-term-care homes for infection prevention.

I’d just like to ask the minister — I want to be, perhaps, more clear about my request — if the minister or the ministry provided input or data points or policy points on either of the two standard development processes. If he is prepared to share any of that, that would be most helpful.

I do want to speak, just for a moment, about the capital side of things, the draft infection prevention and control standard that is designed to improve ventilation and medical gas systems. Did the ministry provide any feedback, input into that process? Does the minister know, at this point, what funding will be required to implement that requirement?

[4:35 p.m.]

Hon. A. Dix: The standards are out for public comments. We, obviously, on draft standards, haven’t provided or aren’t preparing detailed costing on those questions. We are doing some, obviously, intense looks at them, particularly on the infection control side.

I think it’s fair to say that in new builds — there will be a significant number of new builds, and we can talk about this — we’d be meeting those standards in any event. That’s something that we’ve reviewed, not so much in terms of costing but in terms of how we might conceivably implement it.

We haven’t communicated that, either, to the federal government yet — our position on it. They’ve just arrived. We will be providing them our view in due course, but we have not yet.

Our folks are doing the work, as you’d expect them to do. We don’t have sort of a rough: “Well, it’s going to cost this much.” We do know that there’s going to have to be very significant investment in long-term-care infrastructure, not just in new builds to create new beds but also to provide improvements in existing, especially health authority–owned and –operated beds, many of which have multi-bed rooms.

S. Bond: I certainly did understand that the government is going to respond to the draft. My questions were on the front end. There was a process that garnered the draft recommendations and the draft standard. If there was any information or work that was done and provided to help create those standards — so in the earlier phases — that’s the information I’m talking about.

I want to go to HVAC systems for a moment. Then I’m going to…. I want to talk about single-bed rooms. It’s an important element in the infection prevention and control standard, and the minister and the government have already talked about single-bed rooms in the province. So we’ll combine those groups of questions.

However, I’m wondering. We know that many stakeholders have cited the need for HVAC systems that provide appropriate heating, cooling and microbial filtration. Does the ministry have information on whether HVAC systems in our long-term-care homes are up to date? Do we have that? Do we have an inventory of what the status of HVAC is in each of our long-term-care homes? Does the ministry monitor any improvements or need for upgrades?

[4:40 p.m.]

Hon. A. Dix: I shared a little bit of this, so I won’t go over it in detail, because I shared the briefing note I had about our investment in HVAC systems with federal funding since ’21-22, when the federal funding was provided. A very significant portion of that funding — which is $134.74 million — 39 percent, is going to HVAC systems.

That money is shared out between health authority–owned and –operated and public beds in non-profit and for-profit-owned facilities. What I’d suggest we might do is lay out in detail, and provide in detail, how that money has gone out into those different sectors by health authority. I think that might be useful. We’re also doing a full review, with all care homes in B.C., of their circumstances in that regard, including in places where it’s not convenient or not immediately possible to put in HVAC systems to improve, for example, air conditioning — portable air conditioning — in rooms.

This was a question related to heat domes, where we responded quite quickly, in care homes, to some of those needs and are doing that in a sort of systematic way — also with respect to smoke in other communities, where it’s a significant factor as well. Part of the challenge with HVAC systems has been — we’re working hard with municipalities to try and get this done across the board — making sure we get permits in place, because we have money allocated here, to get those systems in. We’re doing a lot of work on that.

I’ve shared with the member the note as to where that investment is. We’re doing a systematic review to see where everybody is. So it’s partly the HVAC systems, and in some cases where that’s not possible, we’re using more room-by-room systems. The goal is to improve both the quality of health in care and also, obviously, the safety of everybody living in long-term care.

S. Bond: Thanks to the minister for that answer. I can imagine that that is obviously…. We can’t fix what we don’t know, if there’s an issue there. We need to be identifying, monitoring and looking at what needs to be upgraded wherever that is possible.

I want to link what the consultation report said about the development of the infection prevention and control standard with the recommendation that residents be provided with single rooms. They looked at the…. Stakeholders certainly recommended that residents have single rooms and bathrooms to limit the spread of infectious disease and promote dignity and privacy. I don’t think the minister and I would disagree on that for one moment.

I can remember the days during COVID where my own community was impacted. It has four-bed units. COVID was virtually…. You simply couldn’t stop it. We have to do something about that. Not only has the ministry and the government made a commitment to look at that, but the development of the standard recommended it as well, at least in that process.

Can the minister tell me how many residents in public long-term care in B.C. have single rooms? When I look at the minister’s commitment, the government’s commitment…. The government has committed to investing $1.4 billion to replace multi-bed rooms in owned and operated care homes. How many residents in public long-term care are in single rooms? The $1.4 billion — is that work contained in the Treasury Board three-year capital plan?

[4:45 p.m.]

Hon. A. Dix: We have fairly detailed information, as provided before, on single-occupancy rooms and beds. To put it in context, I’m going to treat the whole health care system, all of the public beds, together. Disproportionately, those beds are in health authority–owned and –operated, because we haven’t really built…. We went, largely, through, in the post-2000 years…. We’ve largely gone to contracted services.

The health authority–owned and –operated services are older, have more multi-bed rooms and haven’t had a lot of investment, or didn’t have a lot of investment for a long time. The newer beds are more public beds in private for-profit facilities, in general.

Single-occupancy rooms — 90 percent are single-occupancy rooms, of our public beds; 7 percent are double-occupancy rooms; and 3 percent are multi-person rooms. Remember, that’s rooms, not beds.

In terms of beds, 77 percent of beds are in single-occupancy rooms, 12 percent in double-occupancy rooms and 11 in multi-person-occupancy rooms.

If you look at that by different health authorities, and then by public and overall, all facility types…. As I say, 90.1 percent of rooms are single-occupancy rooms. But in health authority–owned and –operated, that number is 80.9 percent. Obviously, that shows what I was saying earlier — that the disproportionate number of multi-bed rooms are in health authority owned and operated now.

A couple of things. It is absolutely true that multi-bed rooms are not best for infection control. It’s also true that if you actually take the long-term-care facilities with multi-bed rooms, there was less serious infection during most of the waves of the pandemic than there were in other care homes, because of the quality of care often provided in those care homes.

I would say that multi-bed rooms are an infection-control risk, and we need to get rid of them anyway because of the quality of life of the people living in those rooms. But it doesn’t necessarily follow that they saw the worst of COVID in those facilities, because of course those were the public facilities, and they had the lowest rates of COVID deaths and infections — the health authority–owned and –operated ones — of all types of facilities in B.C.

I don’t draw any conclusion about that. I just note that in passing. I agree with the assertion that we need to get rid of them. So we’ve just got to move towards that.

In terms of the $1.3 billion, yes, it’s in the capital base. For individual projects, you go through business plan approvals. One project that will be of interest — we’ll have more to say to this shortly, but people know what’s going on — is the New Vista project. What that project is…. You’ll recall that there was lots of support when the New Vista Care Home was built in Burnaby. There’s lots of…. It was an incredibly positive thing, and some really innovative culturally based, culturally sensitive care is being provided there.

The old New Vista facility then became available, and we’ve spent — with our partners, the federal government — quite a bit refurbishing that facility. The purpose of that refurbishment will be to reduce the number of multi-bed rooms.

[4:50 p.m.]

In other words, we’re going to use that space not to increase incremental capacity but to decant a number of people from facilities which have multi-bed rooms today. We’ll be making announcements about that shortly — about who will be eligible to go and get a single-bed room.

What we’re doing in that case is making a practical difference. The $1.3 billion is in the base, and we’re going forward with business plans for those different projects. You’ll see that in the next little while, but it is very much in the capital budget of the province.

The details by health authorities are of interest. I’m going to choose another occasion to share those with the hon. member. But she will note, because this is often not the case in our discussions and in my reflections on different health authorities, that the health authority with the largest percentage of single-bed rooms in B.C. is the Northern Health Authority.

S. Bond: I will look forward to seeing the projects move through the capital process — hopefully, expeditiously.

I am obviously concerned about what happens to residents when they are decanted during the new construction. What type of planning is being done by the minister, by the ministry, to look at the process of moving residents, when we are looking at altering a facility to that magnitude? Is that part of the planning process, in terms of what happens to people who are in those existing facilities?

Hon. A. Dix: Basically, we’re talking about care homes that are moving to the end of their active life. If you were to build…. There are couple of care homes on the North Shore that are in this category — and around the province, where you have a care home where most of the facilities don’t really meet modern standards or they’ve only been retrofitted, I guess, to somewhat meet modern standards.

In general, what will happen is that people won’t be moved out during the process because we’ll be doing a new build, and then they’ll be moved at the time of the opening of the new facility. It’s a little more like the Terrace hospital than, say, the Williams Lake one. We’re building an entirely new Terrace hospital, whereas in Williams Lake, we’re doing a massive project, but it’s in the building. Most of these will be like the Terrace hospital, so the moving will happen at the end.

In the case of the New Vista development, which is new, those are new beds. We will be offering to people to be able to get their own rooms and to move from existing facilities. That decanting would be a permanent change for those people, though. It wouldn’t be like you’re going there until the new build is done somewhere else. These are significant. Many of these facilities….

If you think of how long, for example, the St. Vincent’s facility has been in place in B.C., or the needs for the people of Quesnel, for example…. I don’t know why I’m raising that. But at Dunrovin Park, which is obviously in need of similar investment, the change would happen not in a way that would have an impact where people would be moved or moved temporarily. It would happen when the new facility is open.

S. Bond: That’s fantastic. I will look forward to having those discussions about the new University Hospital of Northern B.C. and how it’s accommodated, when we work on the next phase of that project.

[4:55 p.m.]

In addition to replacing the older health authority–​operated beds — I think the commitment was 2,850 — there was also a commitment to adding 1,500 additional long-term-care beds. Can the minister confirm whether or not this is in the three-year capital plan and what the timeline is for meeting that commitment?

Hon. A. Dix: To meet those commitments, we have new contracted beds. You’ve seen that in different places — for example, the 495 beds that are being created in Interior Health through RFP processes. We just made an announcement with respect to Vernon. The Parliamentary Secretary for Seniors, the member for Vancouver-Kensington, made that announcement. She has been very committed to this work in particular, as well as her leadership on foreign credentials work, which has been a key part of what we’ve been doing. She’s been very much involved in this.

So how are we going to get there? By, when we’re replacing facilities, adding capacity, because we need to do that. It’s not just a question of moving from four-bed rooms to one-bed rooms and having more rooms but also having more capacity in facilities. You wouldn’t build all these new facilities without increasing capacity.

That is in the $1.3 billion, which is a combination, then, of incremental net new beds, the replacement of existing beds, the replacement of multi-bed rooms. The priority of that is in order — multi-bed rooms before two-bed rooms, as you’d expect, then net new beds that are public beds as well.

We’re maintaining that balance, I would say. But the goal of the $1.3 billion is to increase the number of beds and to reduce the number of single-bed rooms and, obviously, bring many of our facilities up to 21st century standards.

S. Bond: That leads nicely into my next question, because we do need to add capacity. Obviously, a commitment to move to single-bed units is critically important for quality of life and infection control and a variety of other things, but we have to add capacity.

On that question, have the government or health authorities individually done an analysis on the number of long-term-care beds which will be required over the next ten years, say? When we look at our aging demographic, we know that we certainly do not have enough now, much less in the future. Is there an analysis that the health authorities have looked at, and if so, what are the numbers telling us?

Hon. A. Dix: I mean, if you did straight-line analysis, we’d just use the population numbers, and you’d see very dramatic increases in populations and seniors populations everywhere. Obviously, we need to bend that curve for the sake of seniors as much as everybody else.

[5:00 p.m.]

That means addressing assisted-living capacity and the assisted-living changes. Changes in assisted-living legislation passed under the previous government and implemented under this government will have a positive effect. I believe that we have to continue to invest more and more to support seniors living at home and bend the curve to do that.

What we are doing is making significant investments — the $1.3 billion, the new contracts for new beds in the Interior Heath Authority, in Surrey, for example, and more culturally safe care across the province. That’s what we’re doing. One can do straight-line analysis that would show a lot of demand. We don’t want to just build out to meet that potential demand. We want to do some building out but support all of those services that would keep people out of long-term care as much as possible.

That’s the reason we have a plan that’s founded on more support in the community and, obviously, increasing standards in long-term care, which we’ve implemented, to a significant degree, and then doing what we are doing, which is investing in building out, replacing our current bed stocks which are becoming unsustainable. You’re going to see significant announcements made for new numbers of beds across B.C.

There is a significant priority, I should say, in the Interior Health Authority, which is why we’ve gone ahead with the 495 beds. That process is well underway, and you’ll see all of those contracts rolling out. That’s new bed capacity that’s absolutely needed in Interior Health.

S. Bond: Well, we certainly do need to look at the overall supports for seniors, those who choose to — the vast majority — and want to live in communities. So we need to make sure that we’re accelerating our investments in home support and home health so that people can stay there. That’s where they want to be, and the outcomes are certainly very positive when that happens.

There are wait-lists to get into long-term care today. So, yes, the minister speaks of all of the supports we need. Frankly, we need a lot more long-term-care beds. In fact, it is estimated, in work that has been done…. The Conference Board of Canada, for example, said that B.C. will need up to 30,000 net new long-term-care beds by 2035.

Certainly, we need to be picking up the pace here in terms of making sure that we have the spaces that individuals who need to be in long-term care need. We certainly understand that as many as possible want to be in community, and we want to support them there. But we are thousands of beds short today, and we have to look at projections of the need as we move ahead.

One of the reasons for the challenges that people are facing — and the minister and I have had this conversation over the course of the last four days — is that all of the pieces of the health care puzzle need to fit properly together. When we stop and look at the number of alternative level of care patients who are in hospitals across British Columbia — it’d be interesting to know whether the minister has those numbers — nurses will tell you that it is, first of all, very difficult for them as they try to care as best they can for ALC patients.

We know that there are hospitals where a very high percentage of the acute care beds are being…. We need to care for ALC patients. Again, it’s that whole system that has to work well together. So we have staff that are overwhelmed. We have patients who are in hospital who shouldn’t be, because the kind of care they would better receive would be either in rehabilitation or in a long-term-care home.

Can the minister provide me with some degree of comfort that there is an understanding about the ongoing wait-lists but also the need for expedited expansion of long-term-care beds? We have ALC patients. It’d be interesting to hear the minister on whether he has the numbers of ALC patients currently in hospital settings that should be in long-term-care facilities across the province.

[5:05 p.m.]

Hon. A. Dix: Yes, I think it requires a multi-pronged approach, and that’s what we’ve provided. It had been decades of non-investment in the health authority–owned and –operated long-term-care beds, except in some places, including in the member’s own constituency or in her own home town, with Gateway, where there were new health authority–owned and –operated long-term-care beds. But in general, there’s been no investment in them.

That problem of multi-bed rooms is a lingering problem of decades that we’re addressing now. Obviously, if we were to maintain them and just build new, we’d have more beds, but I think everyone would agree that that’s a priority.

Secondly, we need to invest in the community, and we have, very significantly. I’ve described that at some length. We need to build more long-term-care beds, and we have to improve supports in the system.

The other thing we have to do right now, to deal with the current situation with ALC beds, is to get all of our long-term-care homes back to capacity. This is particularly a challenge, I would say, in Interior Health right now, getting those care homes back to capacity. There are another, I’d say, 500 beds available to us. Considering the sum total of what might be described as alternate-level-of-care beds in the acute care system is about 445 right now, that would obviously make a significant difference.

One concern was expressed about the policy change that the government made under my direction a couple of years ago to get rid of the previous government’s first-available-bed policy. There was a thought that this would increase alternative level of care or would create delays in terms of people moving out of the system.

That has not been the case. There’s been relative stability in terms of discharges in that period, which shows that the change to give people and residents more choice in selecting their long-term-care homes has not negatively impacted the system. In fact, it’s just been very positive. It’s one of the things that I get when people talk to me at Save-On-Foods or at Safeway. I don’t want to take sides in that important debate. They regularly talk to me about how meaningful it is to have done that.

Those are the things we need to do to address ALC, and in the short run, the immediate run, it’s to get some of our long-term-care homes back to capacity. I’ll just give the member one example, in Summerland, at Summerland Seniors Village. This is a care home that was under, for a time, Interior Health administration.

[5:10 p.m.]

I think we’re contracted for 75 beds, but only 31 are currently operating. We need to get that back up so that we can, again, ensure that we get the appropriate level of care to people.

S. Bond: No one in this room is going to argue that we don’t all want seniors to be well taken care of in our communities. But if you summarize the conversation we’ve had over the last hour or so…. We have people in multi-bed rooms, seniors in multi-bed rooms.

I will preface my comments by saying that the staff in the health care system, the staff in the long-term-care system are incredible. It has been one of the legacies, I think, of COVID that, hopefully, we all have a deeper sense of appreciation for the people who work in those systems. None of us can imagine the difficulties and the challenges that they’ve faced. But they continue to face them.

Let’s look at a summary of what we’ve just talked about. We have seniors in multi-bed rooms. The minister has described a process that will work on that. We have ALC patients in acute care beds in hospitals, and frankly, they need to be in a more appropriate place for their level of care. We have wait-lists in long-term care. In fact, when you look at the seniors advocate’s report, the wait-list went up by 9 percent. We have new standards that will have implications for our system. We also have needs in home health and home support, whether it’s adult day program capacity or whether it’s respite.

I would suggest to the minister that we need to…. It should be all hands on deck here, trying to figure out how we are going to add capacity and how we’re going to ensure that seniors in British Columbia, whether they choose to live in community and are able to or they are in long-term care, have the absolute best-quality care they can get with options. Being on a wait-list or spending time in an acute-care hospital when you should be in long-term care is not good enough for the seniors of British Columbia.

I simply wanted to lay out for the minister…. I know he’s aware of it. We need to make this a significant priority, and we need to expedite these processes. Our seniors deserve the absolute best — a number of options and, certainly, the best-quality care, in whatever form that looks like.

That is not, at all, a commentary on the staff. I am utterly amazed and grateful for the work that they do and, like the minister, have had very personal experiences with aging parents in a variety of those circumstances.

I’ll, perhaps, ask the minister this question. How many beds are projected to be added to the system over the next five years?

[5:15 p.m.]

Hon. A. Dix: First, to respond to the opposition Health critic’s summary, I would say this about the progress we’ve made. Eighty-five percent of care homes didn’t meet staffing standards. We eliminated that problem by applying resources to it. That was a $110 million lift to the base. The majority of those were in private and contracted care homes with public beds. We’ve gone from a system that was dramatically below standard to one that’s met the standards that we’ve set. That’s an achievement, and thankfully, we did that in advance of the pandemic.

In the pandemic, we added the HCAP program and other programs, and 6,600 people have been hired. Multi-bed rooms. It’s true we hadn’t made any progress in decades on existing multi-bed rooms. We’re taking action, and we have a plan, and we’re addressing that with a massive investment. We described the $1.3 billion.

We got rid of the first-available-bed policy, which is a significant step. We’ve invested and worked with our partners and the care providers in Denominational Health by continuing to invest in the Equip program. We’ve substantially increased adult day programs in advance of the pandemic — and we’ve described what’s happened since then — respite programs and investments in home support. This is a comprehensive response to what we faced, which was a system that wasn’t meeting standards when I became Minister of Health, so we’ve made those changes.

With respect to new investments, we’ll be describing and laying out the announcements. I can’t remember the exact number of beds involved in our announcements around the $1.3 billion, but it’s obviously a significant number of beds, the majority of which will be incremental.

In addition, of course, we’ve got programs such as the Progressive Intercultural Community Society diversity village program, which is 125 new beds in Surrey; the 495 in Interior Health; 106 at New Vista; the other contracted services in Fraser South; and, of course, Dogwood Lodge, which is 150 replacement beds which will be coming into place in the spring of 2023.

So a very significant number of beds and projects, and I’d be happy to provide the member with a list of those projects and then the growing number as we go through business plans and make announcements in the coming days and weeks. So more beds, higher care standards, more staff, more support for staff and, I think, collectively, a very strong response under unbelievably difficult circumstances to the COVID-19 pandemic.

S. Bond: Thank you to the minister. While I appreciate that, wait-lists still exist. Families still struggle every single day in this province to try to figure out what they are going to do to make sure that their loved one is cared for. ALC patients are in hospitals. I can name the hospitals and nurses that have reached out to me with deep concerns about that, so there is a lot more work that needs to be done.

I’m going to move to the long-term-care funding model. We know that the Ministry of Health committed to reforming the funding model for the province’s long-term-care sector and, in fact, went as far as to retain consultants Ernst and Young for the purpose of reviewing the existing model. The report was finished in late 2020.

I think the minister would agree that the work of updating the funding model is pretty important when you’re delivering services, if we want them to be delivered efficiently and sustainably. I’m sure the minister knows that many long-term-care operators are experiencing very significant fiscal pressures. That situation has been enhanced during COVID-19.

The sector called for a new funding model, and the key principles are that it be timely, sustainable, equitable and transparent. I think we recognize that there is no consistency between health authorities or, in fact, even within health authorities as to how long-term-care homes are funded, whether they are government operated or contracted.

We know that last year the minister said: “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, sustainability with respect to funding. What we hope to do is align that funding model with the provincial quality and accountability framework to support the delivery of quality care.”

[5:20 p.m.]

Can the minister update us on that work and when the funding model will be presented? Key, from my perspective, is: will there be consultation with the sector prior to the funding model being adjusted?

Hon. A. Dix: The short answer is yes. When those determinations are made, there will be consultation with the sector. The Ernst and Young report, as a seniors advocate report, did a baseline on where we’re at, so we’re working through that process. It’s an important discussion, and part of the challenge has been not to make those substantial changes in the midst of the COVID-19 pandemic when people are dealing with all kinds of other issues.

With respect to the financial issues of long-term care — $156 million in direct funding for long-term-care homes in 2021 and ’21-22, which is a staggering amount of money and reflects the very real challenges operators faced in that period. In addition to that, the support for the Equip program and others…. And that’s over and above, essentially, what they get on their contracted rates, and so on.

So those are significant supports which reflect our support for the sector in extremely difficult times. I think they were the right decisions, to take those actions. We provided them across care homes.

Those supports also went to private care homes that didn’t have public beds in them. That money also was distributed in those places. That would have been a request by Denominational Health and by the B.C. Care Providers to do that, and we agreed to that. So that is a massive, short-term support for those care homes, in addition to all of the actions we’re taking.

The wage levelling, which, on top of that, went mostly to those working in private homes…. There’s about $165 million annually. That raised up the level of salaries, without which, frankly, many private and for-profit care homes would not have been able to hire people. That was, I think, an important and necessary act of social justice for our hard-working health care workers. It got us away from some of the worst aspects of the Bill 29 system that had so undermined long-term care for so long.

In addition, I just note that the office of the seniors advocate’s A Billion Reasons to Care, which also significantly informs this discussion…. Now, there isn’t, on this issue, as much alignment, I think, between the sector and the office of the seniors advocate, but it’s those issues that we’re working on as we develop the new contract model. We’re obviously going to ensure consultation with the sector, and of course we’ll be asking the seniors advocate to inform on that as well.

[5:25 p.m.]

By “inform on it,” I don’t mean to inform on it; I mean to provide information and input. Sometimes I get that wrong. The subtlety of that is wrong, and just for the people watching on TV, I think we should be clear about that.

S. Bond: One thing we’ve certainly learned: people are watching on TV, which is a very good thing.

Is there a timeline for the development of the draft formula?

Hon. A. Dix: Well, you know things are getting closer when they arrive on my desk. This has not arrived on my desk yet, but a lot of work has gone into it. It’s a very significant decision. Post the development and their presentation, we will have a consultation. It would be our hope that we’d be looking at the fall — I think that’s what we’re looking at — in terms of the development of that.

This has been a period of significant instability as measured by the fact that we provided $156 million, straight up to the sector; $165 million to support wage levelling and the single-site order; another significant amount of money for the Equip program; plus the creation of whole new labour programs that have led to the hiring of 6,600 people. All of that has been a remarkable period of work by the team — some of the people sitting behind me and the people who are in the ministry that work on these issues — and the health authorities and private and public care providers.

S. Bond: Thank you to the minister. I’m going to ask one other question, and then I’m going to turn the floor over for a question from my colleague from West Vancouver–Capilano.

Let me ask this question related to funding. Funding letters that have been coming from the regional health authorities have offered increases, for non-staffing costs, that actually fall short of inflation. We know that inflationary pressures are significant. Think about the cost of food, as a really good example.

When we think about a new funding model, will we be proactively thinking about the rate of inflation as a factor when it comes to the funding changes? We want to make sure that seniors receive healthy food. The costs are going through the roof. As the minister can imagine, all of these costs chip away at the ability of the long-term-care system to actually do their work and provide the kinds of care that they want to.

A pretty straightforward question — as inflation is making a difference, and it’s a negative impact: will the new formula contemplate looking at the role that inflation plays in the funding of long-term care?

[5:30 p.m.]

Hon. A. Dix: I’d say, first of all, that we have increased over the last couple of years, seeing the impact of inflation on what we call non-wage spending in long-term care. We made an increase in ’21-22 to deal with circumstances in that year. We made another increase, in addition, in the beginning of ’22-23. It doesn’t necessarily meet all of the tests of inflation, depending on one’s view on it, but it showed our response to it.

Not only do we look at those things in terms of developing a new system; we have taken steps. For example, the non-wage inflation payment has gone up 3 percent this year — which is more, certainly, than in previous years, and it reflects that commitment.

When it comes to the circumstances in providing care for seniors, we have massively increased funding to long-term care in two years during the pandemic and, in the three years before that, also massively increased it, to address fundamental questions of staffing, of supports, of infection control, of underpayment to staff. We’ve responded to the massive short-term difficulties with $154 million in direct funding to the sector.

Yes, as we look at the model and changes we make to the model, those things will of course be considered. They’re not just a question of the model itself. Obviously, the contract model also has questions of accountability involved in it. Any member of the hon. member’s caucus or mine will frequently see issues around accountability and wish for more accountability from care providers. You see that reflected in the seniors advocate’s A Billion Reasons to Care report.

That’s a big part of the process as well. It’s not just a question of deciding what the formula will be or the amount of money it is, but how we ensure accountability in the long-term-care system — which some people feel lacks such accountability.

K. Kirkpatrick: Thank you to my colleague for the time. Last week, in estimates with the Minister of State for Child Care, some questions that I had asked, I was told, were more appropriately asked in the Ministry of Health because of that dual responsibility with respect to health care and oversight.

A question to the minister is: how many child care spaces are there in British Columbia? How many of those spaces are licensed spaces?

S. Bond: While the minister is contemplating those numbers and how he would like to share that information with my colleague, perhaps she could ask her second question, in case there needs to be a scurrying to look for the answer.

I’m going to turn it back to my colleague.

K. Kirkpatrick: Two questions, then. How many child care spaces have closed, or child care spaces have been lost to closures, this past year? How many new inspectors are being hired? There was money in the budget this year for that. How many new inspectors will there be?

Those are my final questions.

[5:35 p.m.]

The Chair: Members, if we could just get it read into the record.

Minister.

Hon. A. Dix: Thank you. I was just suggesting to the critic that there’s also a whole bunch of detail that she didn’t ask for that I’m happy to provide as well. It’s in the note, you know? It just feels like someone worked hard on the note and that we should have the information. It’s child care by different categories.

What I’ll do is make all that information available to the critic, and we’ll have it to her before the start of the session tomorrow, before ten o’clock tomorrow. So we’ll continue on with the debate, and I’ll just provide the detailed notes that we’ve received to her questions.

S. Bond: I appreciate that opportunity. Thank you for arranging to provide that information.

I am now going to turn the floor over to my colleague the leader of the Green Party. I want to make sure that she has adequate time. And should she finish a little bit ahead, I had one other colleague who may have a question. We’ll see if we can fit that in, but I would like to give the floor to the leader of the Green Party.

S. Furstenau: Thank you to my colleague. I’m glad to have a few more minutes to ask some maybe a bit more specific questions.

I’m going to start with Our Cowichan Communities Health Network. I’m sure the minister is very familiar with some of the incredible work that they do. Cindy Lise is their executive director. I can attest to the extraordinary things that they accomplish with very limited funds.

But they are struggling to survive, and Cindy has asked about a $40,000-per-year budget to be able to ensure that that work continues. I’m just wondering if the minister can speak to committing to financial support for community health networks generally, but also specifically the Cowichan community health network.

Hon. A. Dix: The member knows this, but just speaking to the broader audience…. We’re working hard on it. The community health network system in Island Health is unique. What I would say is that I would be interested in the proposals by Island community health networks.

[5:40 p.m.]

Of course, you wouldn’t make a decision for the Cowichan Valley regional community health network alone. You’d have to look regionwide. We do provide funding across the province through the B.C. Healthy Communities Society. In addition, there is funding, by region, provided by Island Health within Island Health.

I think what I would suggest is that the Cowichan organization…. I don’t believe I’ve seen such a request. If they have a specific request for funding, at least one way to look at that is through the flexibility we might have on one-time funding.

What I’d suggest…. I’ll work with the hon. member on this on how the process works and how it might be made effective with some tangible results. We’ll get together and talk about how such a proposal might be made to be brought to my direct attention. I can do that work through Island Health. That might be the best way to do it.

I know she asked about this last year. We did provide the funding more broadly. We also…. In terms of the kinds of amounts of money the member is talking about, I think there may be some possibility for a direct request to be made. I’ll work with her to see the kind of information that we’d like to see in such a request.

S. Furstenau: Thanks to the minister for that. I will absolutely follow up on that post-haste.

Another really pressing concern in the Cowichan Valley is the lack of mental health supports — psychiatrists and, specifically, child psychiatrists. We hear often from families trying to access these resources that are really struggling to get those needs met. Some constituents have even described it as a humanitarian crisis.

If I can ask the minister general questions about this, recognizing the real urgency we feel in Cowichan: how do psychiatrists fit into the shifting model of care in B.C.? How are we increasing access to mental health supports but, specifically, to psychiatrists in communities?

Hon. A. Dix: First of all, one of the key ways that we’re doing it in B.C. is by advancing the primary care agenda of the province, providing better primary care for people and better access to primary care through the development of primary care networks. Primary care networks are developed by local regions. For example, in the Kelowna primary care network, there are 51 additional FTEs applied to improve team-based care in that area.

If you look…. I described this yesterday, I think, when we were having a little bit of an exchange in the House. It was one of those days last week. I think it was Thursday. About 170 of the new positions added to primary care networks, which are incremental, funded positions, with hundreds of millions of dollars of support, that support family practice doctors and nurse practitioners and others in providing primary care, have been….

Proposals have, in fact, been created by family practice doctors. Never before has such respect and ownership for a major public health proposal in primary care been provided to family practice doctors. They’ve done, I think, a remarkable job.

What they’ve recommended, in lots of places, is that in some cases, this might be psychiatrists, but it’s counsellors and other mental health supports. You see that throughout primary care networks such that, as I say, about 19 percent of all the new positions have been in support of mental health in communities as part of primary care networks.

Primary care mental health is so important, for example, for primary care doctors, for family practice doctors. A lot of what, when they talk to me about challenges they have…. Someone presents. They have an issue. They need some form of chronic support, not regular doctor visits but chronic support, and to be able to provide that. That’s why we’ve added those services. It hasn’t been something that we’ve announced or celebrated, but it’s something that’s happening in communities and will continue to happen.

I think, in terms of providing, in a primary care setting, more support for mental health, there are all of the actions being taken by my colleague. I’m sure the member has already had questions for my colleague the Minister of Mental Health and Addictions. In addition to that, the transformation of primary care has given an emphasis to mental health and addiction supports that I don’t think has ever been seen in any primary care initiative before in the province.

[5:45 p.m.]

S. Furstenau: I appreciate the role, absolutely, of primary care and having positions like psychologists and counsellors involved in that. I think what we are experiencing in Cowichan is that as that system is, ideally and hopefully, being built, there is a lot of urgent need. Where people are ending up is in hospital, in need of psychiatric care, and we have a real problem and a real lack of psychiatrists — and in particular, psychiatrists for youth — in Cowichan.

I won’t ask the question again, but just to really bring this to the attention of the minister that this is a crisis in Cowichan, and that lack of access for youth and children to psychiatry is really significant.

I’m just going to move — then I’ll pass it back over to my colleagues, because I know everybody feels urgent about getting their last questions in — to long-term care and the role of oversight of delivery of services. I know that…. I’ve heard the minister talk about the recognition for the need of there being a consistency of care and service across long-term care, whether it’s for-profit or not-for-profit, or publicly run or privately run.

One of the things that has been brought to my attention is quality of food. I have an image. I can share it with the minister, but this was a meal from last week for one of our staff’s grandparents who is in a long-term-care home.

What role does the ministry have in ensuring that the food being provided in long-term-care homes is meeting a standard that promotes the health and well-being of the residents?

Hon. A. Dix: Well, I think the issue of food is one of the most important issues in long-term care, and we touch on it in many respects.

First, overall issues of quality and what it means for people who have often cooked their own meals all their lives and now are receiving what is effectively institutional food. It’s already, for many people, a challenge and shock with the lack of choice. So it’s a key question.

Secondly, there is the increasing need to address cultural sensitivity in food. For example, people have eaten a certain type of food all their lives, and suddenly, they’re receiving food that’s not anything like that — and its impact on their health, their willingness to eat often.

There’s also the myriad of health demands in terms of swallowing, in terms of being able to consume food, needing support to consume food. These are very visceral and emotive questions. You speak to any number of family members of people in long-term care, and they’ll tell you that.

As I’ve mentioned to the hon. member, I talked to one who receives the food every day, and I get daily reviews of that as well. It’s sometimes very challenging, I would say.

This is one of the reasons why we’ve addressed, in a preliminary way, inflation on the non-wage side in long-term care, why we’ve provided significant funding to long-term care and why the provision of food is a significant part as we review the contracting process in long-term care and the quality of that food. One of our important benchmarks in improving care will be improving the quality of food.

[5:50 p.m.]

In addition to that, I would say that there is obviously all of the minimum standards that the member would know about as a member of the House, in terms of licensing and quality of food. We touch on it in many ways, and I think we address it in many ways.

The very fundamental changes that have been made in terms of staffing — improvements in the amount and quality of staffing that we’ve made — and the supports have run up against the very difficult challenges of the last two years of COVID-19, which has affected people’s lives profoundly. For a number of people in long-term care…. There wasn’t really a long period where people couldn’t deliver food, but a lot of people depend on external sources of food — people bring food to them, as you’d expect they would — and there’s been less of that as well.

That issue is right at the centre of the quality debate in long-term care. With the massive investment that we’ve made to raise standards in long-term care, investment that was necessary, and to improve the working conditions of those working in long-term care, which was necessary and a fundamental issue of social justice, this issue of food is a key issue in long-term care. I appreciate the member raising it.

M. Lee: I appreciate the opportunity from the member for Prince George–Valemount to ask a question relating to George Pearson Centre.

This is something that, in terms of a care facility, the minister knows well. We’ve had an ongoing dialogue for the last number of years in terms of the state of care, including food quality; cleanliness; and infection control at this facility. I had the opportunity, certainly, to address — with the deputy minister and Dr. Bonnie Henry, during the course of the pandemic — some of the arrangements that were being made necessary at that facility.

I’d just like to touch on another example of a resident that the minister may be well aware of, Dave von Holtum, who passed in July of 2021. Mr. von Holtum was someone who was a patient at St. Paul’s Hospital for over four years, wanting to have the necessary B.C. home parenteral nutrition, HPN, program available to himself. There was lots of back-and-forth between the hospital and the ministry, as well as the Vancouver Coastal Health Authority. I certainly wrote letters of support in support of his condition. The minister did respond in terms of the nature of Mr. von Holtum’s situation.

Eventually, Mr. von Holtum did get the clearance to go home and to have the right equipment, which his mother would assist him with, in terms of his care. He had a stay at George Pearson Centre, which was quite unfortunate for Mr. von Holtum. This was where I met with him on the streets. This was in the media. But Mr. von Holtum did pass just as he was having the ability to go home.

He never made it home, but in speaking to his mother at his memorial service and speaking at the service, I committed to his mother that I would raise this with the minister, in effect, to continue to talk about the level of care at George Pearson Centre.

The minister will recall back in August of 2020, when we were going through a different estimates process, the minister had agreed to meet with the families online, which is what we did — four other families, including for Eric Regal as well as Bill Sahanie. Glenn Teague, regrettably, passed. His sister, who participated on the Zoom call, was in the hospital with Glenn when he was, unfortunately, near the end of his life.

In any event, what I’d like to come back to is…. I meet occasionally with the family and patient council at George Pearson Centre. The level of care continues to be a concern. The situation with David von Holtum was another example of this. What is the current focus that the minister can bring to the level of care, the quality of care at George Pearson Centre?

I continue to hear, as the local MLA, from the residents and their families, concerns about the quality of care, the struggles they are having with the care, the infection control, cleanliness, the food quality and many other issues that we’ve addressed previously with the minister at the George Pearson Centre.

[5:55 p.m.]

I certainly would encourage and ask the minister to consider again the situation there and consider further interaction with myself, as a local MLA, to consider what is happening at that centre as we continue to address the concerns that I hear on a fairly regular basis from those families.

Hon. A. Dix: First of all, I, of course, recall very well the meeting that we had and the concerns raised by different members and different family members.

There are two ways I’d like to answer. First, absolutely, any time. We’ll arrange to do that. It may be, in the present circumstances, we can do it in person. It’s in his riding. It’s not 100 miles from my riding. I think I can get there. If he were driving, it might be 15 minutes. It would probably take me 22 or 23. I’m sure he’s a much faster driver. I’m a very slow driver, I was going to say to the member.

I’d be happy to meet with him and engage with families again. I think we’ll have occasion to do that once the Legislature adjourns, which is relatively soon. I’d be happy to do that.

On the broader question. I strongly believe…. Something the opposition Health critic raised last year and something I hope we would be working on together is that broadly speaking, family councils need a bigger and more formal role in long-term care, whether it’s in a care facility that’s health authority–run, such as that one where there are much higher care standards overall, in terms of staffing, but also very high acuity, in many cases, of patients and diversity of patients, which can be a problem. We know that at George Pearson, there are a lot of investments going on, as well, in the overall redevelopment project and all that’s going on, on the site. But also in private care homes.

Coming out of the pandemic and the very challenging period that the pandemic created for families, we have to create a stronger institutional role. It’s important that MLAs and ministers engage, and so on. It’s also important to have families having the sense that they can have their voices heard and engaged with at care homes across B.C. every day and not just when issues are raised or a serious issue comes forward.

I think there are two ways of looking at it.

I’d be delighted to meet with the member. We’ll arrange that, probably for the month of June, if that works for him.

M. Lee: Just to say thank you to the minister for that response. I appreciate the opportunity. I think that would be a great follow-on with the minister. We’ll look to schedule that with your office in June. Even at a slow drive, it’s still close to the minister’s Vancouver-Kingsway office.

I will say that the family council…. There are tensions, of course, in these facilities, in the way that staff have to deal with family members who are very concerned, at times, with the treatment of their loved ones. I know that with some of the members of the families that I’ve mentioned, it’s been a long-standing challenge.

I agree with the minister that the family councils play a very important role. I’ve been supportive of those family councils, that level of dialogue. As the minister knows well, patient quality review processes are lengthy. The degree to which staff members have to manage the tensions with family members as to quality-of-care questions in a facility of this nature…. I would agree with the minister that that’s going to be a very important role.

I certainly would want to support the minister in strengthening the role of family councils, particularly at the George Pearson Centre. So I look forward to that visit and that discussion to come.

S. Bond: I’m going to move on to a new section. Before I do, I’m wondering if the minister could provide me…. I did get some indication about the situation with vaccines in Prince George and the North. Would the minister have an update on what is happening there that he could provide to us?

[6:00 p.m.]

Hon. A. Dix: One of the changes in the way we’ve done vaccines is…. We’re distributing them through pharmacies, and this has been, ultimately, I think, a very positive process.

It means there is more flexibility. There are more appointments available. But it tends to be smaller amounts of vaccines and, in some cases, small numbers of appointments in recent periods now because of what’s happened in the last two weeks. That is that a significant number of those over 70 have reached 182 days since their third dose. There are more eligible.

For example, in the week we’re in, there will be 75,000 invitations sent out across B.C. for the week. Then that number will grow in coming weeks. That means that there is, actually, significantly more demand.

There have been some distribution issues between the warehouses and the pharmacies. We’re told that those problems will be worked out in the next couple of days.

S. Bond: I would just urge the minister to try to share that information. As he can imagine, when people are being encouraged to get their booster and they’re anxious about that…. I know I’m receiving calls. I’m sure that my colleagues who live in that part of the province…. If they haven’t been, they will be. So it would be most helpful if you could keep us updated.

I want to have a bit of a discussion about single-site orders and health human resources in long-term care. I’m wondering if the minister could explain for us, fairly specifically, the rationale for continuing single-site orders in long-term care and assisted living and, perhaps, include in that explanation whether or not he can confirm that an individual can work in both an acute care hospital and a long-term-care home at the same time or simultaneously in another place of employment.

I think it warrants a specific explanation as to the single-site order in long-term care and assisted living, if all of those other possibilities exist for staff.

Hon. A. Dix: First of all, some of the questions the opposition Health critic asked….

[6:05 p.m.]

In acute care, it is different. There’s no question. You have, sometimes, medical staff who are, say — I don’t know — conceivably a doctor in acute care and who also work in a long-term-care home. You wouldn’t want that limitation in place. The issue was really workers going across care homes. That’s where we were seeing levels of infection. That’s why the single-site order came in, in the way it did.

We’ve made adjustments to the single-site order that have provided more flexibility since then, and we’re going to continue to do that. Just like anything else, you untie something too quickly and it does have unintended consequences. So we’re going to work closely with the sector to continue to make changes to make it easier for people to staff while at the same time maintaining the benefits of the single-site order.

Of course, a key part of the single-site order decision was the decision around wage levelling and raising…. I just say in passing that the $165 million cost was the amount…. Every year workers in long-term care were getting under — were giving back or not getting — the HEABC standard because of the labour situation in long-term care. That was a fundamental act of justice but a necessity that has greatly strengthened the ability, particularly, of the contracted sector to be able to hire people and also, obviously, to allow people who work in long-term care, who contribute a lot, to earn a living wage.

The member is right. We are looking at more flexibility on the single-site order, but we’ve got to do that in such a way as to not cause disruption. So that’s what we’re doing.

S. Bond: I think the critical part is the evolution of the steps related to the single-site order and consultation with the sector so that there’s a sense of better understanding about what that looks like.

There are also concerns about the ability for staff to take a much-needed break this summer. As the minister can imagine… Both of us, today, have talked about the incredible work done by staff in long-term care, particularly impacted during COVID. So there is a concern that with summer coming and people taking time off, which is badly needed by many of them…. What is the minister going to do to ensure that there are casual labour pools available to be able to fill the staffing gaps that may well exist?

Hon. A. Dix: Just on several aspects of that. We’ve released more seats in the HCAP program. That will be available to health authorities and to contracted providers. That helps the overall staffing situation. As I just described, there are what are called the clustering amendments to the single-site order, which allow for vaccinated temporary staff — and they’re all vaccinated, of course, in the sector — to move between facilities that are clustered together.

[6:10 p.m.]

There’s a number of other steps that health authorities are taking. We work with contracted providers in their areas, and the providers can connect with health authorities on those that involve a whole bunch of proactive planning things for this summer as well as the future periods.

A very significant impact in staffing has been made, both in terms of the remuneration for staff and, on top of that, the provision of new staff through HCAP and other programs. In addition to that, there’s the continuing exploration of float teams potentially being established to support where shortages exist. We also, obviously, have had, at different times in the pandemic, close to 100 staff from health authorities come in and support particular care homes that had difficulty.

There may be a summer issue, but the ongoing issue and the reason why we’re taking so many steps to make sure people are vaccinated in long-term care and support them in long-term care is that the main interruption in care has been related to the COVID-19 pandemic, which is not over, and which is going to continue to affect long-term care through the fall.

The steps that we’re looking at and that we continue to take in periods such as this summer are going to continue to be necessary well into the fall, as we deal with the onset of respiratory illness season. We’ve had relatively good years, for example, in the last couple of years with respect to the flu. But there are no guarantees, as we all know, about that as well, which is an additional cause of concern in both long-term care and in acute care.

S. Bond: Thank you to the minister for that answer.

We know that when we look at the census from 2021 — and all of us would be aware of the fact — our aging population is growing rapidly in our province. The minister and I have had a number of discussions about the soon-to-be-released — no, I think that it was to be released; then it is going to be released — health human resources strategy. I’m wondering: will the strategy address the issues in health care for health care professionals to make sure that seniors and the elders in our province receive the care they need?

When you think about that — whether it’s home care, community care, long-term care, assisted-living staff — will that be part of the overarching health human resources strategy?

Hon. A. Dix: I think the answer is: yes, of course. It reflects demand, which is — and we see this across areas of health care — an increasing seniors population, increasing life expectancy after 65, which is a positive reflection on society and on the health care system. All of these are going to significantly increase demand on health care and the need for health human resources.

In the pandemic, in September of 2020, we promised to hire 7,000 workers in long-term care over three years, and 6,600 have been hired. It’s an extraordinary public success, and it’s involved training, new positions, adding new positions, adding new programs, adding access and supports and scholarships and bursaries to allow us to have the health care workers that we need. Clearly, part of that health human resources plan that we are putting together will be an assessment of that.

It’s not just a question of long-term care or seniors services. It’s in issues with cancer care. We heard from the B.C. Cancer Foundation today of an increase of 40 percent of the number of people with cancer, they estimated, between now and…. I think 2033 was the date they used. We sometimes use 50 percent by 2035. Those numbers are largely related to age-related cancers, which are increasing.

Increasing survival rates mean increasing supports for chronic disease. Across health categories, the human resource demands are going to become more and more significant, which means we have to be more efficient in our use of resources and technology. That’s important. But also, we need more people. That’s why, on nurses, on doctors, on health sciences professionals, on health care workers, on ambulance paramedics, we are adding workers to the system — 30,000 in the last three years net, which is pretty extraordinary. We’ve got to continue to do more of that.

Hon. Chair, I move that the committee rise, report progress and ask leave to sit again.

Motion approved.

The committee rose at 6:15 p.m.