PROCEEDINGS IN THE
DOUGLAS FIR ROOM

Committee of Supply

ESTIMATES: MINISTRY OF SOCIAL
DEVELOPMENT AND POVERTY REDUCTION

(continued)

The House in Committee of Supply (Section A); R. Leonard in the chair.

The committee met at 3:06 p.m.

The Chair: Good afternoon, everyone. I call Committee of Supply, Section A, to order.

We’re meeting today to consider the estimates of the Ministry of Social Development and Poverty Reduction.

I now recognize the minister to move the vote.

On Vote 43: ministry operations, $4,745,331,000 (continued).

D. Davies: I welcome back the minister and her staff. Again, thanks for the time today. As I’ve mentioned to the minister, no more than a few hours and we should be wrapped up here and call it good. I’m just joking. We won’t be too, too long.

Just a really quick question. Can the minister discuss the caseload and some updates from income and disability assistance?

Hon. S. Malcolmson: For disability assistance, an average of 143,953 people received assistance each month in 2022-23, to December. That included 19,322 dependent children.

For income assistance, an average of 79,389 people received income assistance monthly in the year 2022-23, to December, including 25,981 dependent children across 51,321 cases. That’s singles and families.

D. Davies: Thank you to the minister for the answer. Can the minister describe what is accounted for in the growth of spending around PWD and income assistance?

[3:10 p.m.]

Hon. S. Malcolmson: Disability assistance caseload growth is assumed to be 3½ percent. Then, also, remember that the $125 increase in the shelter rate is also part of that increased budget.

D. Davies: In the minister’s transition binder, on the bottom of 126, top of page 127, it talks about this, which is the “expected to work, medical condition” category. It has increased by 196 percent since August 2021. It is believed that many of these clients will be designated as expected to work, medical condition until their applications for disability assistance are adjudicated.

Can the minister explain why those who apply for disability would have to be reclassified in order just to receive the benefits that they do need?

Hon. S. Malcolmson: I’m told that probably the most important thing is that as an individual transitions, maybe, through different types of support…. It’s simply a coding change if they move from one kind of support to another. So that’s not costly to the system.

We do have front-line workers that identify if they think a person is going to be best suited and best supported on disability assistance, but recognizing that sometimes that application process takes longer because of the medical designation that is necessary. Then they will sometimes be on expected-to-work income assistance while the disability application is working its way through. So the individual is supported.

D. Davies: I’m going to follow up a little bit on that, because it does connect to a couple of other things here, in just a moment.

[3:15 p.m.]

Also, in the same note out of the binder, it’s quoted as saying: “It is believed that a delay in completing disability assistance applications, PWD designation, is causing the slow growth.” Can the minister discuss what barriers people are facing to access disability?

Hon. S. Malcolmson: Our ministry’s service standard for adjudicating applications for PWD is 45 business days — that’s once we have received the full application — at least 80 percent of the time. That’s our service standard. In this most recent fiscal year, April 1, 2022, to December 31, 2022, the ministry took an average of 17 business days to process an application for PWD.

I’ll also just give, for the member’s knowledge…. We talked a bit about the pandemic impact. We discussed this a little bit in some detail on Thursday. In 2019-20, we were receiving 1,105 applications for PWD a month; ’20-21, 826 a month; ’21-22, 975 a month. We did describe that during the pandemic, the number of applications for PWD seemed to flatten out a little bit. It might be because people were having some challenges connecting with a doctor, for example, but that’s not my ministry.

But this fiscal year, 2022-23, applications seem to be climbing back up again. So 1,117 per month is the most recent information we have about PWD applications received.

D. Davies: Just to maybe reclarify as well, 45 days…. It’s just that in the note itself, there are a number of times it captures that there are delays in adjudicating the process and such.

[3:20 p.m.]

I know the minister says 45 days is the time frame, but most recently, I think she said 17 days. So it kind of doesn’t balance with what’s in the transition note, unless that’s recently changed since these numbers.

I guess part of that first question I asked, or the last question I asked, was about: what are the barriers in place that are holding people back in regards to getting their disability claims done expeditiously?

Secondly, is it expected that the 17-day approximate…? Is that expected to continue on?

Hon. S. Malcolmson: As I think I said before, the application processing time for our ministry is based on when we receive the application. How long it takes to complete the application is in the hands of the individual filling out the application. We recognize that there may certainly be external delays like somebody being able to access a doctor or medical practitioner, because they’re the ones that make the assessment and give a diagnosis on which the PWD designation is based.

The times I referenced are our ministry’s processing times, and that, back to the member’s first question, is why our SDPR staff will often recommend that an individual go onto a different form of assistance so they are supported during the process of completing the PWD application.

D. Davies: Tied in with that process, one of the questions we heard over and over again, and I know the minister has also heard these questions, is around advocates. In fact, they were recently out on the front lawn, and I know the minister had a conversation with them. It’s the paperwork and challenges around people facing challenges completing the paperwork, getting the supports needed.

I’m just wondering if the minister or the ministry has any plans to simplify the process, making it easier for persons with disabilities to get through the paperwork.

[3:25 p.m.]

Hon. S. Malcolmson: A couple of examples of help that’s happening right now, that’s in this year’s budget.

We’ve expanded the number of community integration specialists, as we’ve discussed before, the member and I. Community integration specialists are kind of filling the gap for what used to be caseworkers for people that were on assistance decades ago. That was a support that was cut by the previous government.

We’ve brought in someone that can help navigate, particularly people that have particularly complex needs and are at risk of homelessness or are already unhoused, onto assistance, onto PWD and help connect them with the medical staff that can help make the assessment and the diagnosis that they need, the middle part of the paperwork, which we discussed on Thursday.

For example, community integration specialists have been doing a lot of work on East Hastings for the last ten days or so. There has been action around street encampments, making sure that those folks are connected with supports and helping them get onto assistance. That’s one example of a way that, right now, we’re helping people navigate the system.

We also have a number of community organizations that we provide funds to for them to help people with the paperwork and navigate the supports. I’m very grateful to a lot of these very talented organizations who, in many cases, have very close relationships with the clients that they serve and act as a bit of a bridge between government institutions, from which some individuals and people have felt alienated.

I’ll say that the bigger picture…. Certainly, it’s one of my directions from the Premier to make sure that people can access the support that they need. We want, in all kinds of ways, to remove barriers to people being able to get onto support.

This is an active conversation that we’re hearing in our review of the poverty reduction strategy and also our legislative review, where we’re looking at our underlying foundational legislation, which is dated from 2002 — so certainly born in a different time. That input opportunity is open until April 30. I certainly encourage the member to let his constituents know. I think he might have been doing this already.

We’ve had 8,000-plus inputs already and more to come. People are certainly letting us know that they’ve got some ideas about how we could remove barriers to people getting on assistance. That’s some of the work that we have ahead of us — to implement those recommendations.

D. Davies: I’ll certainly echo the minister’s thanks to the many not-for-profit organizations. I know they do step up, in every community across British Columbia, and help folks with paperwork, just like in my community.

I definitely thank the minister for that.

A minute ago the minister was talking about the processing of PWD paperwork. There has been an improvement on that. Again, going through the transition binder, it was stated that 9 percent of reconsiderations in the B.C. Employment and Assistance program were not conducted within the legislative timelines. Can the minister tell us what the legislative timelines are for those?

[3:30 p.m.]

Hon. S. Malcolmson: So if a client is dissatisfied with the decision made under the Employment and Assistance Act or the Employment and Assistance for Persons with Disabilities Act, they may request a reconsideration. The client must submit their request for reconsideration within 20 business days of the date that they were notified of the original decision. Upon receipt of a client’s request, the ministry, my ministry, must render a reconsideration decision within ten business days — or within 20 business days when deemed necessary and with the consent of the client.

D. Davies: Great. Thanks, Minister.

So with the 9 percent of the cases that aren’t meeting that requirement, what is being done to ensure that these cases are handled, going forward, in a timely manner?

Hon. S. Malcolmson: My staff team are reminding me that often the SDPR staff — while processing, while looking at these requests for reconsideration — rather than rejecting the application based on the information that they have, take the extra time to be able to talk with the client about making sure that we understand what it is that they need and maybe getting more of the paperwork that’s necessary to make the decision.

In this case, my understanding is that it’s an effort to get the most complete information, to get the best decision for the client, rather than just to say: “We’re just going to rush to the deadline, and if we don’t have the information, then we’ll close the case.”

So that is some of the work that’s happening and how we can recognize that the straight target is not always met for really very humane reasons. That said, staff will track applications that look like they’re starting to become late. They’ll watch it carefully and take carriage of that particular case, personally if necessary, in order to have the very best outcome for the individual as quickly as possible.

D. Davies: Great. Thank you for that. Just a little around staffing — I believe there was a little bit of canvassing around staffing last week — more specifically, though, within the PWD and income assistance area.

[3:35 p.m.]

There’s a note here in the transition binder on page 162 that there was a decline in number of staff since April 22, 2022, due to a higher-than-expected attrition rate. Numbers did start to climb a little bit in July.

I’m wondering if the minister can give a bit of an update on staffing levels within those areas. Have they increased? Have they stabilized? Are they the same?

It also talks a little bit about a comprehensive hiring strategy and centralized recruitment team. If the minister could give us a little bit of an update on what that looks like.

Hon. S. Malcolmson: My deputy gets updates on this really important issue every two weeks. It is true that within the whole caring economy, not-for-profit and all throughout government, there have been challenges with staffing. We’ve all felt that, and we’re working on that across government.

Right now we are very pleased. Thanks to the impact of our centralized recruitment team that works very closely with PSA, we are really up at a full complement in the service delivery division as of December 31, 2022, 1,610 people.

D. Davies: Great. Thanks very much for that. It’s good to hear that they’re at a full complement of staff.

Just in regards to some of the other notes and discussions, and understanding that you’re at a full complement, are there any plans to grow SDPR staff to help deal with some of the other issues, deal with some of the backlog that we’ve just canvassed here, just to have more feet on the ground to improve service deliveries?

[3:40 p.m.]

Hon. S. Malcolmson: I’ll just first say that I don’t believe that I used the word backlog in any case, so that’s the member’s word. We are meeting our service standards on applications that we receive once we receive them.

On the staffing side, one example of a place that SDPR staff will still grow is in the community integration specialist position. We started from 73 community integration specialists. In last year’s budget, we were budgeted to grow to 190 community integration specialists. Right now we have 126 of those positions filled. It has grown, and then we’ve had some attrition as these very talented people move, in some cases, to other parts of government or other parts of the front-line service delivery. That is a place that you will see us bring more staff into place in the field.

D. Davies: I believe the Leader of the Third Party might have canvassed this a little bit, but I can’t recall. One of the areas, one of the things that we hear about…. Everybody is talking about the inflationary costs, the rising groceries, the cost of transportation. The cost of everything has gone up substantially, but there’s no group, probably, that’s been hit worse than our vulnerable population — those that are on PWD, certainly those that are on income assistance.

We’ve heard some of the stories of people supplementing, obviously, regularly from food banks, even hearing stories of folks having to resort to trash bins to get by. It’s that bad in some cases. And this isn’t just, obviously, a British Columbia problem. This is a bigger, broader issue.

Can the minister discuss what is being done here in British Columbia to help these vulnerable communities with the incredibly sharply rising inflation rates?

[3:45 p.m.]

Hon. S. Malcolmson: I know the member and I talked in some detail about the $49 million that we brought in, in supplementary estimates, for an unprecedented expansion of food security supports. I won’t go through that again. This is more about this year’s budget. On August 1, 2023, the maximum shelter allowance for income and disability assistance clients will increase by $125 per family unit. That’s the first increase to the maximum shelter rate since 2007. That increase will benefit over 160,000 people.

Also in this year’s budget, we have allocated $499 million, over the next three years. That’s $131 million in 2023-24, $183 million in ’24-25 and $185 million in 2025-26. Effective May of last year, 2022, a minimum shelter allowance was established to provide additional funds to help people experiencing homelessness, to meet their expenses. In last year’s budget, this allocation was $11 million, and that is annually, through to 2025, to support that minimum shelter allowance initiative. That’s something that was cancelled by the previous government.

In April 2021, monthly income and disability support rates increased by $175 per adult. That was the largest single increase in B.C.’s history and the third increase that we had brought in since October 2017. That increased benefits to over 224,000 people. Now, effective August of this year — the payments will be issued in July, but it’s effective in August 2023 — the monthly rate will be up to $1,060 for a single person on income assistance and up to $1,483.50 for a single person on disability.

Our income assistance rates for singles will be the second highest in the country. Our disability assistance rates for singles will be the third highest in the country. People who receive income assistance and disability assistance may also receive other supports and benefits, which I imagine the member might have talked about with other ministers, because they come out of other ministries’ budgets.

That could be subsidized housing, dental and optical care for children, free PharmaCare, employment services — which do come through my ministry. I’m certainly happy to talk with the member about our employment services and how we work with people on income assistance to have them supplement that income.

D. Davies: The list there, I appreciate that. Can the minister discuss what measures are being used to determine whether the funding levels, for those that are receiving income and disability assistance, are adequate — what the review looks like, to come to these numbers?

[3:50 p.m.]

Hon. S. Malcolmson: The member will remember that the Poverty Reduction Strategy Act was tabled in the legislation passed by this Legislature in 2018. B.C. did not have a poverty reduction strategy until that time. In legislation, our government has committed to reducing the poverty rate, from the 2016 market basket measure benchmarks, by 25 percent for all people and a 50 percent reduction by 2024.

The poverty reduction strategy, named TogetherBC, which resulted from that legislation, was released in 2019 and outlined the cross-government approach to achieving the Poverty Reduction Strategy Act goals. That requires the strategy to be updated every five years, with the next strategy due to be tabled March 2024. We spoke of that, earlier in our conversation today, about the work that’s happening right now. Public input is open until April 30.

In addition, as I know the member knows well, action 4.15 of the Declaration Act action plan commits our government to “incorporate Indigenous experiences and knowledge of poverty and well-being” into the updated strategy and into the ongoing poverty reduction efforts. So overall, work to renew the strategy is currently underway and will be informed by general and targeted public consultation and engagement and by Indigenous consultation and cooperation.

Some of the key investments and actions to date include, from other ministries: the child opportunity benefit, now called the B.C. family benefit; housing and homelessness initiatives; affordable child care; increases to the minimum wage; and other investments. Using the most up-to-date market basket measure — that’s 2020, which was released in March 2022 — B.C. has met its targets under the Poverty Reduction Strategy Act. Between 2019 and 2020, the overall poverty rate was reduced by 36.1 percent, for a total reduction of 52.5 percent since 2016.

Between 2019 and 2020, the child poverty rate reduced by 31½ percent, for a total reduction of 71.3 percent since 2016.

D. Davies: Hs the minister identified whether pressures on people receiving income assistance and disability assistance have gotten worse since the pandemic?

[3:55 p.m.]

Hon. S. Malcolmson: We are certainly hearing, as I’m sure the member is in his community, that inflation has hit vulnerable people very hard. In particular, the cost of food, the price of it, has come higher than other items. Inflation has had a magnified impact on the price of food. So we’re certainly aware of and concerned about that and the pressures on the cost of housing.

The member, I’m sure, will have adjudicated this with other ministers for their areas of the budget, but the increase to the shelter rate that we announced in this year’s budget is certainly a response to what we’ve been hearing from our clients about the cost of housing and the real pressures. There hadn’t been an increase in that rate since 2007. So it was important to do it this year.

Also, the impacts of food, again, directly led to the $49 million that we announced earlier this year to support people who are food-insecure in a number of ways.

Then the final thing I’ll say is that the conversations that we’re having with constituents across the province in the course of updating our poverty reduction strategy are absolutely informing our next steps. That’s active work we have underway. I’m very grateful to all the people that are taking time to let us know how we can better support them.

D. Davies: Does the minister feel that the income and disability assistance levels are at a level that adequately meets the needs of the most vulnerable?

Hon. S. Malcolmson: Our government has certainly shown its commitment to putting more money in people’s pockets — the most vulnerable people, particularly. We’ve increased assistance rates four times since 2017. Contrast that to the previous government, which raised rates $100 over 16 years.

The conversation is absolutely alive. That’s why we legislated poverty reduction targets for ourselves, in legislation. That’s why we’re right now in the conversation across the province about how we can best support people. We’ve shown our commitment to a continual increase in assistance rates, and that is work that we will continue to pursue.

D. Davies: We talked a little bit about the…. I guess we haven’t talked about it, but we’re going to talk about it now — the $300 clawback that happened almost two years ago now.

[4:00 p.m.]

I’m wondering if the ministry is looking at closing that gap. I know that some of it, $175, was reinstated. I’m just wondering if the rest of it will be part of an increase coming soon.

Hon. S. Malcolmson: Like all COVID supports, provincial and federal, SDPR did have a temporary COVID supplement that was in place. None of those COVID supports exist anywhere for any British Columbian or Canadian around the time-limited COVID supports.

As I said, we have increased assistance rates four times, a substantial increase in just five years. As this year’s budget shows — and, certainly, the input that we’ll get through the poverty reduction strategy — our track record is increasing assistance rates. That is work that we continue to be committed to.

D. Davies: Following that, the goal is to increase funding. I guess, to go back to the question, yes, it was brought in as a COVID support grant — the $300.

The question I asked a moment ago was: have things got worse since the pandemic? Obviously, they have been, substantially. The question: is there a plan, in the near future, to bring back the additional $125?

Hon. S. Malcolmson: As I think I’ve said to the member already, in this budget, we have a $125 increase to the shelter rate — the first increase since 2007. That’s the budget that the Finance Minister tabled. It’s the fourth increase to assistance rates in five years. That is the budget that is before us and that we are considering here in estimates.

D. Davies: One of the things that I’ve had a couple come up to me, ask and talk about most recently was at the advocacy days on the front lawn of the Legislature. When two people that are within the PWD show their love and want to move in together, get married and be a couple, there’s no benefit to doing that.

In fact, it’s quite opposite. There’s a penalty for when they get married, move in and become a couple. I’ve heard from a number of people over the last year and a bit that there are cuts when they come in together. I think this is also in the income assistance as well.

Are there any plans to be looking at ways to make this work for people that do want to get together, so that we’re not almost keeping people in a cycle of poverty by eliminating a significant amount of their PWD payments?

[4:05 p.m.]

Hon. S. Malcolmson: I know the member knows this. This is a long-standing policy. It’s been in place in B.C. for a long time. It is in alignment with most of the rest of the country.

That said, I’ve heard from Brent and Sonjia when they used to be constituents of mine. I’ve heard from Crystal, another constituent of mine. I really appreciated Crystal having this conversation in a very direct way with the former Minister of Social Development and Poverty Reduction. So I’m certainly well aware of the argument.

We are hearing it right now in the poverty reduction strategy, and it’s an example of a policy that might change as a result of the input that we’re getting from citizens across B.C. right now. That consultation is still underway, and it will result in a new poverty reduction strategy being tabled in the Legislature in 11 months.

D. Davies: Thanks for that. It’s kind of funny hearing lots of the names who obviously travel around the same social circles within the ministry and the shadow ministry. Like I say, I do hope there is something down the road that will see a benefit for many of these people that feel like they’re being discriminated against when they show their love and want to move in together with each other.

With that being said, that does conclude my questions for the minister today. I do want to thank the minister and her staff, many of which have moved on and are not here today, but the ones that remain. Please pass on my thanks to all of the staff.

My thanks as well, as I said in my opening remarks, to the thousands of British Columbians across the province that volunteer with organizations, work within our not-for-profit organizations to help make people’s lives better. I know the minister has visited many of these folks, as have I, and the work that they do on the ground with so little is commendable. I’m so grateful for the work that they do on behalf of British Columbians, as well as all the advocates.

The minister just mentioned Brent and Sonjia as being just two of many, along with Jeff Leggat. I’ve come to know them all really well because they’re here often, so I get a chance to talk with them quite often, as does the minister.

I know the minister obviously wants what’s best for our vulnerable population, for those in need. I do commit to work with her on whatever we can do to move forward and make things better for British Columbians.

With that, I’ll conclude my remarks.

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

Hon. S. Malcolmson: Thank you to my critic for the very constructive advocacy and the respectful conversation. I am grateful also to my staff team: my deputy, David Galbraith, and his team that have been supporting me; my chief of staff, Samuel Godfrey; my constituency assistant and executive assistant, Darcy Olsen, particularly from the constituency perspective, informing the work that I do and that we must do for vulnerable people.

I’ll say that as part of our intervention in the poverty reduction strategy, being able to talk with government caucus constituency assistants from across the province and hear directly about the kind of barriers that people experience and what kind of systems change, as we’ve been committed as a government to systems change throughout our five years…. That work is very much informed by people on the front line — all the service providers, all the advocates, all the people with lived experience that give their time to our work.

[4:10 p.m.]

Because of all that work, we’ve made poverty reduction a strategy in our government. We’ll have increased rates four times, including the largest-ever increase to assistance rates in 2021.

We restored the minimum shelter allowance cut by the last government. We increased those supports again, with an increase to the shelter rate by 33 percent. We’ll also have people on income and disability assistance seeing an increase in their earnings exemption.

Then there’s so much more work that is happening across this ministry — new technical standards for removing barriers to physical access, accessibility for people in British Columbia,a program delivery under WorkBC that is connecting people with dignified, respectful work that is appropriate for them and meaningful to them in a way that can supplement their income but also embed them more deeply into their communities.

I’m grateful to the SDPR staff and the front-line social service organizations that are helping us do that work. We will continue to support those most in need, and this budget this year does that. And there is more to do.

With that, Madam Chair, do I need to say anything? No, that is the end of it. Good luck with your next client in estimates.

Vote 43: ministry operations, $ 4,745,331,000 — approved.

The Chair: I will now call just a very brief recess. Please hold on to your seats, and we will begin shortly with the new minister.

The committee recessed from 4:11 p.m. to 4:18 p.m.

[R. Leonard in the chair.]

ESTIMATES: MINISTRY OF HEALTH

The Chair: I will call Committee of Supply, Section A, back to order.

We’re meeting today to consider the budget estimates of the Ministry of Health.

I now recognize the minister to move the vote.

On Vote 32: ministry operations, $28,526,258,000.

The Chair: Thank you, Minister. Do you have any opening remarks?

Hon. A. Dix: Thank you very much, hon. Chair — and to the opposition Health critic, the opposition members and the government members here today.

I wanted to just say a few things, briefly, off the top. As we were waiting for the previous ministry’s estimates to end, I was writing down a list of major reforms — page 1 and then page 2. We have 30 to 40. We’ll have an opportunity to discuss and go through those in detail, so I won’t go through them now. But I think what it illustrates is the commitment and work of the staff of the Ministry of Health. They’re represented, of course, in this room but also across B.C.

[4:20 p.m.]

I want to introduce, to my right, the Deputy Minister of Health, Stephen Brown, who I think — I was giving him a hard time a few moments ago — might be the longest-serving Deputy Minister of Health certainly in Canada and maybe in the history of British Columbia. He is looking really well. So it’s good news. That’s good news. As everybody in the Legislature knows, on all sides of the House, he’s an incredibly committed public servant.

To my left is Jonathan Dube, the Associate Deputy Minister of Health. We’ll have other people introduced as we go forward. Jonathan is responsible, amongst other things, for all things financial and the budget of $28 billion. That’s saying something. As well, he’s an exceptional public servant.

They represent a team at the Ministry of Health that’s incredibly committed to patients, to health care workers, to health care professionals and to the people of B.C. and the public health care system. So I want to acknowledge them.

I also want to acknowledge the work done, especially in this time of public health emergency, the COVID-19 pandemic and the overdose public health emergency that’s being debated in another House right now of the Legislature…. I just want to acknowledge the work of public health professionals everywhere in B.C., led by our provincial health officer, Dr. Bonnie Henry, but represented by many, many others, as I think she’d be the first to acknowledge.

I want to acknowledge our regional health authorities, five of which are led by exceptional women. I wanted to highlight one of them — not to say anything about all the others because they’re all exceptional leaders, the regional health authority leaders. But Cathy Ulrich — as the member knows, as a member from the North — is planning her retirement as president of the Northern Health Authority.

She started in 2007. I have to say that she has served the people of the North and successive ministers — that goes without saying — with her intelligence and thoughtfulness and generosity and commitment. I wanted to acknowledge that today while acknowledging all the people, mostly the people who work in health care in B.C. in these difficult times.

I just want to say this, to start with. I will speak about that from time to time — the commitment of health care workers in B.C. I know, and I think the member knows I know, how much she agrees with me about that, about their commitment.

Sometimes we get into these debates, and the response is: “Well, health care workers are incredibly committed.” It sounds like I’m suggesting that somebody doesn’t think so. I know everybody in this House thinks so. The former critic, the current critic for Health in front of me — they both believe so.

I want to make clear when I’m talking about that in future responses, which I inevitably will, that I am unbelievably moved by the work of health care workers — by those who clean our hospitals, who came in at the height of COVID-19 with the height of fear and heightened level of uncertainty and cleaned hospitals, to nurses and doctors and health sciences professionals and health care workers in long-term care and in the community. They are exceptional, and it is the honour of my life to work with and for them as Minister of Health.

I look forward to the debate with the opposition members.

S. Bond: I thank the minister for his opening remarks. I very much appreciate them, because I know that we will spend many hours together over the next number of days, and the questions, at times, will be uncomfortable. That’s how we drive change in the system. It is never a criticism of health care workers in the province, so I do appreciate the minister acknowledging that right off the top.

Certainly, we are going to miss Cathy Ulrich, but she’s still there and I know has agreed to work with whoever is selected for the very difficult task that she has at Northern Health. I do also recognize the exceptional professionals in the Ministry of Health. Again, the questions about their particular fields of areas of expertise are not about them. It’s about how we get to the best place, in British Columbia, to meet the needs of people today and in the future.

All of us recognize that there are some challenges. I know everyone is working flat out to try to sort them out, but this is our opportunity on behalf of British Columbians to raise those issues.

I think we’ve provided a bit of a road map to the ministry and to the minister in terms of the way we intend to work through the materials and the issues. The minister has always been very good about this. I will have some of my colleagues coming in from time to time. I’m trying to fit them into the appropriate places, but with time, it’s hard to know precisely. Our colleagues in the Green Party will be also scheduled in for some time as well, which of course is very critical.

[4:25 p.m.]

We’re going to start with long-term care. It was really interesting. I spent some time in White Rock on Friday, meeting with seniors. It was fantastic, actually, to hear from Ramona from CARP and Pattie from the Semiahmoo seniors group.

One of the things I wanted to just pass along…. I know the minister knows this. The seniors advocate is held in very high regard in British Columbia. She does a great job, in my view, of visiting various parts of the province, talking to seniors, and makes herself very available. I just want you to know that the seniors that I met with, including Pattie and Ramona and Ian and others, wanted the minister to know that those reports are really important. They would like to see progress made on those seniors advocate’s reports. So I promised them I would tell you that directly, and now I have done that.

Let’s start, if we could, Minister, with standards in long-term care. We know that certainly, during the pandemic, and following that…. We want to make sure that people who are older in our province and find themselves in need of long-term care have the quality care that they need. So obviously, the Standards Council of Canada, Health Standards Organization and Canadian Standards Association have developed two new standards for long-term care.

One of the things that I’m very concerned about is the fact that if we don’t provide additional resources, those standards are actually aspirational. The minister noted in January that the government was prepared to review the standards and do more if required.

Could the minister tell me today whether the review has been completed, and if not, when will it be completed?

Hon. A. Dix: A couple of things to say about this, and then we’ll dig into it a little more. We’ve provided information in response to the standard to the national body. They’re in a position of responding.

It’s our view that B.C. leads Canada on the majority of the standards, which is good news for B.C. and reflects the work not just done by the government and health authorities but by long-term-care providers and others in B.C., as well as resident councils and others.

[J. Sims in the chair.]

All of our new projects comply, for example, on the capital side, and new projects are complying with the standards. The member will know that one of the key standards, ultimately, is providing adequate staffing in long-term care. The standard in B.C. and the national standards are different. They’ll be looking at our standard, then providing their analysis of the gaps, and then we’ll have that process. So that’s the process that’s going on with the National Standards Organization.

But the member will know that in 2016-17…. This was part of Isobel Mackenzie’s work, to say to the people in Semiahmoo seniors and CARP and everything else…. She argued in her reports that 84 percent of care homes didn’t meet provincial standards, which were 3.36 hours of direct care per resident day. It was, on average, 3.11 in 2016-17. The funded average is 3.51 in 2022-23.

So on that important standard of staffing, which was critically important during the pandemic…. To a degree, we addressed those issues in advance of the pandemic. The important place where those standards were responded to, where the resources went, were largely public beds in private, for-profit and non-profit, for-profit long-term-care homes where the funding had been least.

[4:30 p.m.]

In general, the health authority owned and operated and met our provincial standards at that time. The federal standards are likely going to be higher than that, so we’ve provided all our information to them. I think there are about 117 measures. They’re going to be responding to that.

We feel, from our analysis, that B.C. is going to be, relative to other jurisdictions, very good. I will say, also, many times in the course of this debate, I think, we want to compare ourselves to ourselves as well. There’ll be comparisons to other jurisdictions, and it has some utility to do that, from time to time.

That’s where we are right now. We’re in a process with them. We’ve provided them with our information, and then they’ll come back to us. Then we’ll have, effectively, a gap analysis, and we’ll go from there.

S. Bond: I guess that’s really what I’m driving at. It’s the issue of a gap analysis, because, certainly, we need to make sure that not only do we meet but hopefully exceed the standards.

The minister would know that the Health Standards Organization actually focused on care. That was one part of this set of standards. But the Canadian Standards Association actually talked about physical infrastructure. Obviously, two important ways to look at the work that may need to be done in long-term care.

As I understand it, then, there’s been an analysis of the standards as they’ve been presented. That’s gone back. There will be feedback coming back to British Columbia. In the event that British Columbia does not meet the standards as they’ve been laid out, is British Columbia considering requiring long-term-care homes in British Columbia to meet the standards, whatever that eventually looks like after the gap analysis has been done? Would that be voluntary or mandatory?

The Chair: Minister.

Hon. A. Dix: Thank you very much, hon. Chair. It’s good to see you.

To put it in context, British Columbia’s legislation and policies address 91 of the 117 standards clearly now, in our view. As I noted, we’re well positioned against other jurisdictions.

What happens then, where legislation, policy or acts do not meet the specific standard, there will be a chance to advance that. So we’ll have to review that once it happens and then set priorities to respond to that, because we want to do, also, what’s best for people here.

This is a voluntary process, as is the accreditation process, but it’s an important process for us. I think British Columbians want us to be meeting standards. I think they’ll be pleased we’re doing that, as the national standards evolve — that we’re ahead of other jurisdictions. Clearly, the purpose of this process is to learn and to improve, and that would be our intention, voluntary or not voluntary.

S. Bond: Certainly, the chair of the technical committee made a number of comments about how comprehensive the standards were and, in fact, recommended that British Columbia follow the pattern of Quebec. In Quebec’s case, they set a national standard. They said they were going to make this. They were going to legislate it and make sure the homes were accredited and publicly report findings.

I think one of the things that is really critical to British Columbians…. We certainly saw that through COVID, when people were so deeply concerned about what happened in long-term care. We hear stories, from time to time, about the care that is or isn’t in place.

So I appreciate the minister’s answer, but I think British Columbians want to know that there is an expected standard of care, that providers will be held accountable and measured against those standards and that when necessary, there will be public information about those standards being met or not. When you’re trying to care for your aged parent, you want to be sure that kind of quality is in place. So maybe the minister could just speak to that.

Secondly, is he prepared, if necessary, to use legislation if it’s needed, if there are any changes required, on B.C.’s part, to deal with mandatory standards.

[4:35 p.m.]

Hon. A. Dix: The member will know that when she says legislation, that may not be legislation in the House. It may be regulations pursuant to existing legislation, which is frequently, as an experienced member will know and people will know, enabling. So I’d absolutely not rule that out.

I think one of the challenges, and why political accountability is important, as well, is that the 3.36 standard, which is an important standard, was put in place in roughly 2008, and we were there in 2017. It was partly the work of the Hospital Employees Union and Isobel Mackenzie and others who raised that issue into the public debate that brought change.

I say humbly that the opposition deserves some credit, and everybody deserves credit, because that’s what happened. We made a very significant investment at that time.

So in some cases, you’re talking about standards, and some of them involve the operations of care homes and the way we function, our policies and directions under existing budgets, and so on. Some of them involve political decisions by governments to invest in these areas. That’s also a requirement to do that.

If you were to change that standard, or we were to change, for example, the 3.36 resident day standard…. We’re at 3.51 right now in funded hours. But if we were to change that, then that has policy and also financial implications. We’re funding beds at a higher level of staffing.

The short answer is that some of the changes would require policy changes in our work. Some of the changes might require regulatory changes. It seems less likely that they would involve legislative change, but I wouldn’t rule that out — legislative change in, say, a new bill in the Legislature. But I wouldn’t rule that out.

S. Bond: I’m hopeful that the minister, at some point, will be prepared to share the gap analysis of British Columbia’s standing against those standards so that we can see, and basically, British Columbians can be reassured, that where there are gaps, those things are going to be closed. So I’m hopeful that the minister will agree to do that.

The other question that I’m interested in knowing is whether or not, if there are significant changes, there would be consideration for additional funding to operators in order to help transition to meet any new standards that might be put in place.

Hon. A. Dix: I understand the national organizations are late in responding to us. We were expecting to see their response in April. I’ll ensure that the member receives that information as it becomes available. The intention of an accreditation process is for there to be public accountability.

With respect to long-term-care homes, for example, what we’ve seen in the last number of years is very dramatic, often in-year increases in funding for those long-term-care homes. This most recent year, leading into September, I think, was a lift. I think it was 7.5 percent, which wasn’t what was originally expected, because circumstances changed. We can’t, in the middle of the year, when inflation for food is high, not respond to that when those are public beds and, say, private, for-profit and not-for-profit long-term-care homes.

So absolutely, if you were making…. The reason why we went from 3.11 to 3.51 was that we found the folks. That was the HCAP program and the infection control work and all the work that’s being done by post-secondary institutions.

But secondly, we funded it. The reason that there were 75 care homes under 2.8 hours per resident day was that they were being funded at that level. So if you want that funding to be higher, then, just in a general sense, you have to fund to meet that standard when it involves something that cost more money. If it’s something that is a change in practice, that may not necessarily be the case, and we see that.

For example, as you know, we’ve had a change, and it may be discussed later on this week, with respect to COVID-19. We funded a very significant role for people who essentially worked at the front of care homes in infection control. They were the ones who were monitoring proof of vaccination, and so on. We maintain the funding for that, believing that that group of staff people can continue to play an important role in the care home.

[4:40 p.m.]

Secondly, it may be the case that proof of vaccination or other requirements need to be made, including rapid testing, during respiratory illness season, and we think they play an important role. In that case, those were positions that were supported and funded because we were expecting new supports and new demands.

S. Bond: Thank you very much to the minister for the answers on the standards. I certainly look forward to future discussions about that as we better understand the gaps and how those are going to be remedied here in British Columbia.

We have a lot of material to cover, so I’d like to move on to the long-term-care funding model. The minister knows that, certainly, it is critically important to people who are delivering services efficiently. Also, they want to be sustainable into the future. We know that the pandemic exacerbated some of the funding challenges and fiscal pressures that operators felt, and the minister and ministry have committed to reforming the funding model for long-term care.

I’m wondering if the minister could tell me what the terms of reference are for the funding model review. We know that, in fact, there are certainly records of the terms of reference having been drafted as far back as October 2020. I’m wondering if the minister could tell me what the terms of reference for the funding model review consist of.

Hon. A. Dix: I could read them into the record, but perhaps it would be most useful for me to simply provide the terms of reference.

I’d just say in general…. The member referred to 2020, and that was a year for long-term care. What we’ve very significantly done, as the member will know, is significantly increase funding, to address both inflation and the demands of COVID-19, which have been, I think it’s fair to say, exceptional. That followed on very significant increases in funding leading into those periods.

Yes, we were looking at the reform of the funding model, and yes, it would have been my expectation — I haven’t checked back to my answer to this question, but I’m sure it would have been my answer — and our ambition to deliver those changes sooner than this.

The circumstances for both long-term-care providers and for ourselves, I think, meant that we couldn’t do that. It wouldn’t have been desirable, in the midst of the COVID-19 pandemic and the intensity — which is still with us, but is different now — to make those fundamental decisions and fundamental changes in the funding model at that time.

What we’ll be doing is bringing into place those changes. I’ll share the terms of reference with the member shortly. I think we’ll be able to get that very shortly and to share that with the member. Then we can talk about it, rather than me reading a whole bunch of material into the record.

Our goals are greater transparency, greater equity, consistency and sustainability. I think one of the challenges for long-term-care operators — be they care providers, Denominational Health, other independents, people who are affiliated with those organizations or, indeed, in health authorities — is the sense that they are providing, in some ways, the same service, but there are variations in funding requirements.

Now, that’s partly because there was a requirement under RFPs to build long-term-care homes that are intended to deliver public care, and there were arrangements around that. So those with less immediate and recent capital costs historically had lower per-diem rates than those of more recent homes. That was the circumstance that has been in place for some time.

I’ll absolutely share that. Those are our goals. Obviously, we have a working group that includes the health authority representatives — working with the ministry, but also the B.C. Care Providers, Denominational Health, unions as well — involved in the discussion of that funding model, so that as we work through it, we are consulting those who are affected in non-profit and for-profit organizations.

[4:45 p.m.]

S. Bond: I’m wondering. I do appreciate the minister…. I certainly don’t expect him to read the terms of reference into the record.

Interjection.

S. Bond: Thank you so very much. I would so very much appreciate that. So thank you for that.

Sorry. Thank you to the minister for that.

Could the minister tell me…? We know that the Ernst and Young report was completed in late 2020. Certainly, we understand that the pandemic delayed some work, but the funding is absolutely critical to addressing capacity needs in the system. We’re going to talk about things like alternate level of care patients and others who currently, in British Columbia, do not have a place to go. In fact, that’s why they’re in hospitals. So we’re going to talk more about that, in terms of capacity.

Could the minister give me as firm a timeline as possible for the completion of the work related to the funding model review?

Hon. A. Dix: We’re looking at late spring. So between now and June 21, I guess, is what we would call that for phase 1. That is the direct care funding envelope, which is the key….

Interjection.

Hon. A. Dix: June, yeah. By the spring of 2023.

Phase 2, which is the remaining operating expenditure categories, will be completed by the spring of 2024. There will be some policy work related to the capital funding envelope, and that will come later than that. The key element, which is the direct care, will be happening and be prepared this spring.

S. Bond: Thank you to the minister. I appreciate the answer. That’s very helpful.

I’m wondering if the minister can tell me if he or his staff have received any recommendations or reports, in addition to the Ernst and Young report and the phase 1 RKL Informatics reports, and if those are available to the public.

Hon. A. Dix: No, there haven’t.

S. Bond: Thank you to the minister for that answer. Could the minister tell me what the total cost of work contracted to RKL Health Informatics for the review was?

Secondly, have any additional contracts been signed for subsequent reports or for work with the company or other companies, and if that’s the case, also, what financial arrangements were made?

Hon. A. Dix: I don’t want to…. I know the member may have a number of questions about that contract.

What I would propose to do is…. It actually predates the people working in the area, their work. I’d be happy to provide that information in detail and the numbers in detail, if we can’t get it by the end of the day today, for first thing tomorrow so that she’ll have that opportunity to ask a question.

I don’t want to interrupt her line of questioning or pre-empt it, but it might take a little while. I mean, we should just keep doing the work.

S. Bond: The minister and his staff are always very good about doing that. I’m fine with that. If there are any subsequent questions, I can ask them once I see that information.

[4:50 p.m.]

Very important to me and to families is…. Will the families of residents that are currently in long-term care either individually…? I’m pleased to see the move toward family councils. I think that’s very critical, and I appreciate the government for thinking about that.

Again, the seniors advocate was very, very passionate about that, and having talked to her about that, I’m glad to see that happening. So will families of residents that are currently in long-term care be included in the discussion?

Hon. A. Dix: I understand that as a result of this review — all the regional health authorities have already met before April with the regional family councils — there will be a new provincial family council in June. They will be met with at that time.

I want to say, on the family council question, that this is something that we discussed at length. People, the member, may remember — it feels like a long time ago now — 2021. We discussed it at length in 2021. I was certainly an advocate for that at the time, as was the hon. member, as were members of other parties.

It’s something that we’ve worked hard to proceed with and that we achieved during the pandemic, which was a challenging time for families. I think it will make a significant difference, and it comes out of our collective debate in the House.

S. Bond: I do agree with the minister that one of the things that was…. There are a number of examples, but I really appreciate the work that was done collaboratively during the pandemic.

Obviously, the Leader of the Third Party was involved, myself and others — obviously, government members — working with the seniors advocate. And together, we had some very productive discussions and I think found ways to support seniors as best we could. Family councils are obviously a key part of that discussion, so I think it’s just critical that families have an opportunity to be engaged.

I also want to ensure that the work that’s being done actually looks at the total package of costs that operators face. When you stop and think about it, there’s compensating workers — obviously critical — but construction, debt-servicing, cost of inflation and also looking at the complexity of the people that are in long-term care.

We’ve certainly heard from people who work, and they’re amazing. When you stop and think about the B.C. Care Providers awards, you just hear the stories of how incredible the people are that were caring for older British Columbians. But they will also tell you that there’s increasing complexity, and that means it takes more hours to care.

I just want to be sure that the work that is being done looks at that whole spectrum of costs that impact operators in the province. Could the minister assure me that all of those things are being considered in the work that’s being done?

Hon. A. Dix: Absolutely. And the member, will recall and this was very critical during the COVID-19 pandemic — just to take a step back. People watching…. The majority of public long-term-care beds in B.C. are in private long-term-care homes, be they for-profit or not-for-profit.

One of the most significant decisions that I’ve been involved in, financially very significant, was the single-site order that was accompanied by wage-levelling, and the government took responsibility for that at the time. I believe that in the last fiscal year — the one ending, the most recent fiscal year — the number is $161 million, if memory serves. I may be corrected — but in that range of that cost. And that was picked up and has been picked up by the government.

We made a decision that it wouldn’t make sense to have a single-site order with people working at multiple care homes and having care homes that were paying workers much less than other care homes. So we made that decision, and I think we were the only jurisdiction in the country to do it. And in terms of just basic fairness to workers, setting aside the fact that that set of workers was that much money below the HEABC rate every year going into that period, that was justified for workers and to address profound issues in inequality and also recruitment.

[4:55 p.m.]

If we were in a situation where there was wide divergence in wages between different workers, it would have been very hard for those long-term-care homes that were paying their workers less to recruit more workers in that time. So that was a very important change.

If you look through the period, the annualized rate of funding increases from April to September 2022 is 9 percent. So that’s annualized. It’s not 9 percent in that period. That was the annualized rate for that period.

Then September to March, 7.5 percent. Then April to September 2023…. This was a decision made recently to make sure that…. We were looking at 3 percent increases and, realistically, that would have had significant implications for residents in long-term care. So these were the amounts we put in. These are significant increases, but they reflect, in many cases, increases in costs both for wages and benefits but also for food costs and others which are so important to the life of people in long-term care.

So yes, we do look at that. I mean, the purpose of the review is to do a better job than we have historically in getting that right.

Now, we’ve talked about the seniors advocate, who I have great respect for. She has expressed her own view on these questions — not always, shall we say, fully appreciated by care providers in B.C. So there are different views on this subject, and that’s part of what all of this consultation and work seeks to address.

S. Bond: And that’s why she’s the seniors advocate, because her job is to bring those views to the table. She does it well, I might add.

So I appreciate that. I want to just hone in a little bit on the work that was underway. We know that work had started in August of 2020, and it actually…. Information shows that the next step at the time, in August, was to look at doing some data analysis. That was going to look at the current funding model structure and distribution. The further work was going to be reviewing contracts between health authorities and long-term-care operators to understand variations in funding.

I’m wondering if that work has been completed — it was scheduled in August of 2020 — and if the minister could just summarize for me what the findings show, if that work has been completed.

Hon. A. Dix: A tool has been developed to better assess both the services provided and the financial supports provided. There have been, I think, as I understand it, six town halls with operators. The tool is ready and in place, and it’s starting to be used. That will give us a very significantly better line of sight into the key issues involved.

So that work did begin. It has taken longer than, I think, I initially would have expected, and it took longer because of COVID-19. It just did. I think for good reason, we have taken our time, and now that tool is in place. We are working with the operators to get data inputted, so those changes and that part of the change is imminent.

[5:00 p.m.]

S. Bond: Could I just make sure that I clearly understood that answer? So the tool has been designed, and it will actually monitor or look at whether or not there are variations in funding between the variety of health authorities. So the tool is ready. Is it already being utilized to begin to look at those contracts?

Hon. A. Dix: Yes. The tool is ready. A town hall and training has gone into it so that operators can use the tools. It will work both ways, depending on what services are being provided. It will give us a much better line of sight.

I think one of the issues that Isobel Mackenzie raised, certainly that we’ve raised, is a lack of line of sight into these questions. This tool — which has been developed by our teams, in, of course, consultation — is beginning to be used. It’ll be, I think, very helpful for everyone in the sector.

S. Bond: Obviously, inflationary pressures have been significant, notwithstanding the increases that have been noted and the work done during COVID to make sure that providers could manage more effectively. I’m wondering if there has been any modelling or analysis done in terms of the impact of inflationary pressures on long-term care and assisted living.

We know it’s impacting every organization, everyone individually. So I’m wondering if there’s been any modelling. Obviously, critical to looking at the funding formula. Has any modelling or analysis been completed over the past year looking at inflationary cost pressures?

Hon. A. Dix: Well, I think the financial model in the tool will give us much greater insight into the actual costs. But the process over the last couple of years is engagement with the sector, particularly looking at the non-wage costs, and then an assessment is made. That’s why you’ve seen such significant increases over the last number of years.

These numbers do come to me. I have some responsibility for that. What we’ve tried to do, in general, I would say, in particular in the last period as inflation has fallen somewhat, is to understand that some of the inflationary costs within the cost categories that long-term care providers provide, including things such as food, have been significant and, given the real challenges facing long-term care, particularly during the pandemic, to adjust for that.

So we have that process where we’re really focused, have been focused, on the operators and providers, including public and private. They come to us, say: “These are the natures of the inflationary pressures.” We’ve looked at them together and looked, particularly, at the non-wage cost pressures, wage cost pressures being always easier to understand — not always easier to deal with but easier to understand — and to make our adjustments accordingly.

Over the pandemic, we made significant increases at different times to support providers that were significant cost items. A lot of those came out of pandemic contingencies. But we’ve been working pretty closely with all of the providers, really, to make sure that those resources are in place. One of the challenges has been, as well, the need to provide more workers. That’s where programs — and we’ll get into this, I’m sure, in a little while — like the HCAP program and other programs are so important.

What the new model and new tool will help us with is, okay…. We’re saying these are what the costs are, and the operators are saying what the costs are, but they give us a much better eye into what those costs actually are. That’s a better way of assessing a situation than broad estimates of what the broad costs are for different components of inflation.

S. Bond: Thank you to the minister for that answer. I’m wondering if there has been any work done…. When we think about a draft funding formula, if there’s going to be changes or, at least, looking at the model, has there been any work done related to an alignment with a quality and accountability framework that will be attached or lined up against a new funding formula?

[5:05 p.m.]

Obviously, that matters as well. I mean, if more money is needed, we also want there to be a sense of accountability. So has any analysis or work been done related to that provincial quality and accountability framework?

Hon. A. Dix: What we’re taking is the work — including the work we’re doing with the national standards, the work we’re doing in the funding model advisory group, and all the work that’s being done in the quality framework — and aligning those. That work is happening with the health authorities and others.

The member is quite right that that’s a critical part of the process: to ensure that the quality that is required is seen in that process, but also — the new tool really helps us with this — that there’s a significant increase in accountability. More information provides us with an eye into what is, obviously, a very significant spending item for the people of B.C. — in quality, so important to the residents, first; to their family, second; and to all of us as well. That’s the work that’s going on.

The quality work is being done. The work with national standards is being done. Obviously, this funding model — the work of the long-term-funding-model advisory group and the terms of reference, which I’ve now shared with the hon. member — includes all of the health authorities but also some major providers.

I just say to the member for Prince George–Valemount: if you look at the group of people involved — representing the Ministry of Health, Fraser Health and the care providers — some of the most experienced and well-recognized care providers in the province are involved in that process as well.

S. Bond: Well, not so easy to measure is quality of life. What we really want to do is make sure that the people who work there are adequately and appropriately paid and that we have infrastructure that is conducive to living, in the most appropriate way possible, at that stage of your life.

I’m wondering if the funding model somehow — I know it’s not easy — takes into consideration initiatives that look at quality of life as well. I’m not suggesting it’s easy to measure, but we also want to make sure that we’re looking at that as an important component of ensuring that providers can create that kind of quality-of-life experience for people who are in the latter years of their lives.

Hon. A. Dix: The short answer is yes. You see that both in the terms of reference and in the approach to this. You see that question of quality of life, but I think it goes beyond the funding model.

We’ve been committed to a process, and it’s slower than we’d like, of increasing the number of single-bed rooms. As we’ve increased the number of rooms, the number of single-bed rooms has increased as a share of those rooms. You’ll see that some of the changes that are being made are important to that. We’ve seen that in the COVID-19 pandemic.

These issues are complicated. I can tell you from personal experience that, for some residents in long-term care, sharing the room and having more staff involvement in the life of their room, as opposed to being in one of eight single-bed rooms, can sometimes be better. There aren’t perfect answers to this, but that’s one set of things, and that’s the capital side of it. We’ll have an occasion, perhaps later on, to talk about the capital side of long-term care, maybe today. We’ll see with the member’s question.

I think we need to add beds, and we need to address — especially in the health authority–owned and –operated beds — the fact that some of our care homes are older and don’t meet modern standards. The fact that sometimes those care homes still performed better than some of the newer care homes is an interesting question, which shows that there’s not one answer to this.

[5:10 p.m.]

Of course, raising care standards and raising the number in the workforce in long-term care is critically important to that. I’d say, in addition, that’s why increasing the role of resident and family councils — empowering people, to the extent that they can, to make their own choices about which long-term-care home they can have — has been made more difficult in the pandemic. Those were changes that we made in 2019 and that I’m immensely proud of. That we allow people some greater measure of choice in the selection of their long-term-care home is really important.

All of those things, like more choice, more agency and, really, a philosophical question…. Many of the changes — including the measures that were brought in to keep people safe during the COVID-19 pandemic — can have an impact on the quality of life of people, on the measurement of safety, on limiting people’s ability to move around in the long-term-care home, if they’re able to do so, and in dealing with that, against the quality of life that we want people to have.

Sometimes, because I talk about diabetes too much — I promise not to do that in this set of estimates — I think about people who might like a particular type of food that might not be good for them. They might have developed type 2 diabetes, and they might love chocolate. I guess the question, at a certain point of life, is to ask themselves, if one loves chocolate, whether it might be possible to have some chocolate, even if that’s not the right thing to do.

Interjection.

Hon. A. Dix: Glosettes? Well, I know what I’ll be bringing on my next trip to Terrace.

I think all of those questions are important. I think they’re important questions, particularly, to reflect on after what we’ve been through in the COVID-19 pandemic, when so much has been sacrificed in people’s lives. People, if you look at it, live in long-term care, sometimes, for a finite period of time. For many of them, it’s the last years of their life. Making the quality of that life better has to be an important consideration as we continue to make improvements and ensure that people are safe and healthy.

S. Bond: Just taking a quick glance at the terms of reference — it actually fits with my next question — one of the things I noticed, one of the objectives, is a discussion on strategic approaches for the future delivery of long-term-care services in British Columbia.

One of the words…. I haven’t had a long time with the document, obviously — I appreciate it, though — but I don’t see the word “innovation.” I can assure you, as we look at the future state of the system, that we need to make sure we’re thinking about innovation. How do we do things differently? How do we create an environment? How do we create the kind of infrastructure that meets the needs of older British Columbians?

Could the minister just assure me, as the terms of reference are not explicit about that…? If we’re thinking of the future state, we need to think differently. We have to think about innovation. Would the funding formula consider innovation as that’s being developed?

Hon. A. Dix: I think so, and I think you see this reflected in some new projects. I really encourage…. After the session, perhaps, the member could discuss, with Providence Living, the work that’s being done in Comox and Courtenay, around the project there. That’s sometimes called dementia village, but that’s really innovation, the delivery of long-term care.

One of the things that is of concern to me…. We’re doing some work, the member will know, with Providence Living in her community as well. We want to build out more long-term-care capacity and services and adjust the way we provide care as well. I think if you look at the St. Vincent’s project — it’s also a Providence project, which we funded — or the new Western Communities project, you see some of these principles put in place.

[5:15 p.m.]

I know, as an MLA from Vancouver and as someone who lives in Vancouver Coastal Health, that we face — you see it in the St. Vincent’s project — an increasing demand for long-term care. We have, in the last few years…. I was looking. I think I have the numbers somewhere back here, but they’re dramatic.

We’ve added over-65… The average age in long-term care is 84, but the percentage increase in over-75s is even greater: an increase, just since I’ve been Minister of Health, of about 224,000 people over 65, net. The number over 75 is larger as a percentage.

So in cities such as Vancouver — there’s a housing debate going on right now in the House as well — we know that the available land is a question. We’re going to have to figure out new ways to deliver long-term-care services. Can we do it by, say, adjusting existing small apartments to become long-term-care homes, and have a series of those that might be able to provide long-term care? Will we have long-term-care homes that go up in a way that they don’t now?

Typically, a long-term-care home has a limited number of floors. Those are innovations that are capital innovations that are required. If you look at that project at St. Vincent’s, the approach of pods, working together and developing small communities within a long-term-care home, is something of real value.

The work that is done in spiritual care…. Last night, I had the opportunity to speak to the conference of the Canadian Association for Spiritual Care providers, who do a lot of work in this area. I can tell you that some of the most innovative work that’s done is done by people in that space — and, of course, recreation therapists and everyone else who works in long-term care.

There’s a whole process of innovation that has to be provided in the allied health professions. It’s so important to the quality of life of people working in long-term care: the ability to access movement, even if one is living, for example, with Alzheimer’s or other dementias. According to our most recent information, about 70 percent of people in long-term care are living in those circumstances.

That number has increased over time, and it creates real challenges. The tendency under those circumstances, of course, and we see this sometimes, is because one is unable to communicate, perhaps, on occasion in the same way that we’d normally want to, to be able to give people some degree of freedom. If they’re in those circumstances, freedom of movement is sort of at the core of what a dementia village is about.

The short answer is yes, I think that’s a key part of it. In any event, we are going to have to engage in innovation in providing care in the community and in allowing people to stay home longer. We’re going to probably talk about home and community care in a little bit, I would think — both from that side and innovation within long-term care — so that people can live their lives more fully.

All of those are elements of the discussion, and those are things that governments, over the next 20 years in British Columbia — and over the next year, yes; we’re talking about this year’s budget — are going to have to continue to build out. That’s done in capital.

Realistically, most people are going to be living in the long-term-care homes that we have now. So we can make capital adjustments in the existing facilities, and then there’ll be the new facilities, which may contain some of this innovation. We need innovation, shall we say, on the operating side as well.

S. Bond: We certainly do. We’ll have some discussion in the next little while, or perhaps tomorrow morning, about the fact that the vast majority of seniors are actually living in community. That’s where they would rather live. We need to think about that, in terms of what the future of caring for seniors looks like, and think about the investments on that side of the agenda as well.

I just would like confirmation of one thing, related to the terms of reference. Then I’m going to turn it over to two of my colleagues who have questions. I’m going to move on to infrastructure capital planning. I think each of them has a question or two specifically to that, if that works for the minister, related to long-term care. We’ll deal with health later.

Could the minister just confirm…? I am pleased to see that the representatives on the funding model advisory group include someone from a rural remote region and represent different geographic areas of the province. We know that it is not a one-size-fits-all situation in our province.

[5:20 p.m.]

Can the minister just confirm that there are representatives that meet that demographic on the advisory group? When he has answered that, then we’ll start with the MLA for Peace River North.

Hon. A. Dix: Yes.

D. Davies: Thank you to my colleague from Prince George–Valemount for the time to ask, in my case, just one…. I say a simple question, but questions are, obviously, never just that simple.

I’m sure that, over the years, the minister has probably received some sort of correspondence from either Margaret or Jim Little up in Fort St. John. Margaret is with the Save our Northern Seniors organization. I’m sure probably others have received emails from her. She’s quite the advocate for seniors issues.

One of the questions that she had and others have and I’m curious about is…. The third house of Peace Villa long-term care…. There are quite a few people on the waiting list for that facility. I’m sure it’s the same around the province. Waiting lists tend to be a regular thing.

There is a fear amongst the seniors community that seniors are going to have no other way but to be forced to leave their community, which is the worst thing, where they have family and such in their home community.

It’s an understanding that this has been in front of Treasury Board now for the last six-plus months. I just wonder if the minister can give us a bit of an update on when that might be coming forward.

Hon. A. Dix: We do have a number of Northern Health capital projects, obviously not just in Fort St. John but in other communities. I think in Smithers. We have work we’re doing with non-profits in Prince George, Providence Living, which we don’t always think of as a non-profit.

Those are items that are…. They’re not before Treasury Board in the sense that they’re scheduled at a meeting, but they’re at the stage where business plans have been developed by the health authorities. There’s a series of such projects around B.C. that are at that stage.

I may be talking to your colleague from Cranbrook soon — not that I favour him over the hon. member in any way, shape or form. I don’t want to suggest that. He’s a better curler.

In communities such as Cranbrook…. The member will know, and members who are from Kelowna will know, that there’s a facility in Kelowna called Cottonwoods. It doesn’t do well under what we call the facility condition index, for example. There are facilities around the province in those circumstances.

We are investing and have a larger capital envelope. So we’ll be making those decisions about the order of investment. Certainly, this is one of the projects that’s at the business plan stage.

D. Davies: If I might, as a really quick follow-up, then, to maybe cement the response more. It doesn’t sound like it’s even in front of Treasury Board. It’s still in the process of being prioritized and worked on.

Can the minister give us some sort of idea? Are we looking at decades? Are we looking at a year? What are we looking at as far as something that I can take back to the residents of Fort St. John?

Hon. A. Dix: Tell Margaret and Jim hello, first of all, and wish them my very best.

D. Davies: I will.

Hon. A. Dix: I say that with a little bit of kidding around. I know them, and I know how determined they are. Also, they’re the kind of people that every community needs. They’re really advocates for public health care in communities. I’m appreciative of that.

[5:25 p.m.]

When you get to the business plan stage, you’re well along in the process. I think it’s fair to say that in a number of communities in Northern Health, Fort St. John in particular, there are two sets of needs that I think are important.

Obviously, there are all of the challenges that come out of the hospital. Those are the health human resources needs that are everywhere. Secondly, there are some primary care needs, because it’s a relatively young community, and younger people have less attachment to a primary care provider. That’s something we’d like and want to work out to address. That’s a primary care question. The other is for seniors to be able to live a full life in the community, as the member says.

Those are priority projects in a number of northern communities around the province in Northern Health. It’s hard to imagine, where the member is, that Quesnel is in the Northern Health Authority, but it is. There’s a project there, for example. There are obvious demands in Prince George.

I would say this. Just in general, there’s a long-term-care question, but there’s also the housing and seniors housing question. Sometimes it’s in assisted living, but seniors housing more broadly. There are places where it may not be possible to build long-term care, where we have to have housing available for seniors where they can — if not through their period in long-term care — at least live in their communities.

That will be in the member’s own constituency. Fort St. John is a major centre, as is Dawson Creek in that other Peace member’s constituency. Those are important investments, but we now have a life expectancy, at the age of 65, which is basically 23 or 24 years. When you think of the start of the Medicare process in Canada, that was more like eight to ten years of life expectancy at 65, right? So there’s a longer phase of need there.

Yes, there’s a long-term-care need, and the Peace Villa developments are about that, but also there are other needs, such as assisted living and seniors housing needs, which are particularly felt in northern communities. As a practical matter, you’re talking about a housing question for people who may have resources but no way to spend those resources in their community that’s practical for their way of life. Those are the things that we have to work on.

On long-term care, we’re going to see significant investments in the next few months, I think, where we’re starting to build projects, letting projects for tender across the province. You’ve seen the beginning of it. There’s one in the Western Communities, in the community of Colwood, where there’s obviously an increasing demand, for seniors.

There’s one at St. Vincent’s, which is in Vancouver, but it’s a replacement with increased capacity in that community, Providence Health Care, which is near the B.C. Children’s and Women’s site in Vancouver. Then there are projects all over the province where we see that need.

You can tell the member for Kootenay East that I’ll be expecting him.

I. Paton: Thank you to the minister for allowing me to ask a few questions. In Delta South, we have a very aging population in the Ladner and Tsawwassen area, but we also have a rapidly aging extended care ward at our Delta Hospital, known as Mountain View Manor.

The history. My family, by the way, Minister, is very involved with the Delta Hospital Foundation, as you probably know. Historically, in 2015, Fraser Health requested that the Delta Hospital and Community Health Foundation partner with them to develop a business case for a new and unique long-term-care facility that would serve a dual purpose of providing both long-term-care and home health services. This was to replace the current, aging long-term-care facility on site, built in the late ’70s — Mountain View Manor, which is home to 92 residents.

Going back, Fraser Health Authority issued a press release in August of 2015, announcing a partnership with the foundation. In February of 2021, a business case was approved by the Fraser Health Authority board. This case includes a project that would see a facility with 200 beds, an increase of 108 beds, to the current facility, Mountain View Manor at Delta Hospital.

The location of the new three-storey building will be on the Fraser Health Authority–owned land behind the Delta Hospital, next to the Irene Thomas Hospice. The project includes a new 200-bed long-term-care facility, a day program for older adults, and respite. The current facility only has 92 beds. The new facility will have all private rooms.

Minister, this project has now been sitting at the Treasury Board since June of 2021, almost two years. Delta has one of the highest aging populations in Metro Vancouver. I am constantly getting questions from my constituents as to when this long-term-care home project replacement will be approved.

[5:30 p.m.]

To the minister, when can we expect this project to be approved? Who sets the agenda for the Treasury Board? What is the average wait time for a project to sit at Treasury Board?

Hon. A. Dix: I was going to refer some of those questions to the member for Prince George–Valemount. I think it would be fun.

There are always lots of discussions between MLAs, Health Ministers and Treasury Board. It’s an important project. It’s a high priority for me. I can tell the member — I’m not saying the project will be announced soon or anything like that — that when it’s announced, I will ensure that he’ll be there, should that happen.

It’s obviously a high priority for us, for obvious reasons: the demand and the increase in the number of seniors. If you look at Surrey and Delta in particular…. My colleague from Delta North sometimes calls Delta as Surrey’s good-looking cousin.

In any event, if you look at the two areas, you see that, collectively, they’ve actually been below the overall provincial standard in age, right? They’re younger communities as a whole. Surrey and Delta North are younger. Delta South is at the provincial average or slightly older in age. So the demand is certainly there. What’s happening in Surrey is that it’s coming up to see….

The member from Cranbrook is here, and I was just talking about him. There you go. You see how that works?

It’s a high-priority project for me. I’ll absolutely keep the member informed. I know that people are very interested in that development. They have been for a long time before I became Minister of Health, as the member suggests, and now as I’ve become Minister of Health. It’s obviously an important project, a priority project for us, as is the project that the member for Peace River North mentioned.

I. Paton: I’ll simply say that the foundation, time and time again…. I think I asked this question last year, possibly the year before as well. The foundation is ready to go. They’re such a fantastic, active group, but for them to fund this improvement has to come after the announcement is made.

Once again, what they’re asking is: can you give us any idea as to why this has been sitting at Treasury Board for over two years now? When could we expect an answer as to the approval of this new Mountain View Manor?

Hon. A. Dix: Clearly, it hasn’t been sitting at Treasury Board for the last couple of years. I don’t want to get into a debate about how the Treasury Board process works, but it has not been sitting at Treasury Board for the last two years.

It is a priority for us. The project is obviously a priority for Fraser Health and a priority for the community. We’re very proud of our collaboration with health care foundations. They play an important role. These are very significant projects, I should say, in the hundreds of millions of dollars in terms of costs.

While the foundation plays a critical role, ultimately, it’s the provincial treasury, all of us together, that plays the most important role. We want to maintain and build on the momentum of that partnership with the Delta Hospital Foundation and that work that we’re doing with the excellent people involved in that foundation, as the member knows.

That’s a priority project. It’s not the only one in the region. I think that we have significant demand, across Fraser Health, for long-term-care beds. That just reflects the growing population of the region. You see that in Delta, you see that in Surrey, you see that in Langley, and you see it everywhere else.

This is, as I say, not sitting in Treasury Board. That’s not how the Treasury Board process works. It’s a priority project for us, and we’ve set aside significant resources to invest in long-term care, particularly in replacements and enhancements, meaning an enhancements-in-capacity project for public health authority–owned and –operated long-term-care homes. The Delta project is one of those on that list.

T. Shypitka: Thanks to the critic for allowing me one question. I’m not sure if the minister is a modern-day soothsayer or perhaps just a little nervous. I’ll tell you why.

[5:35 p.m.]

The minister knows that a project that’s near and dear to our hearts in the Kootenay East is the F.W. Green Home. It was earmarked several years ago by our regional health board, as well as Interior Health, to be expanded from the 60 beds to 130. I think it’s a 70-bed expansion.

At that time, about three or four years ago I guess, the project costs, the capital costs were about $40 million, somewhere in that neighbourhood. We’ve been waiting ever since. Now that same project is probably north of $100 million, I would imagine, which is a bit of a concern because it has been prioritized. Funding has been allocated by the regional health board. As time goes, capital costs go up. So we’re a little concerned that’s not going ahead.

We saw Colwood get something similar to that. I believe it was a 200-some-odd-bed facility at $250 million. Colwood’s roughly the same size of Cranbrook. We’re quite remote in our area, as opposed to Colwood. So we’re wondering: when can we see that money? When can we put some shovels in the ground?

Hon. A. Dix: Thanks to the member for his question. Part of the reason we can talk about it fairly freely is…. His constituents should know the member has raised this with me. We discussed it in March and in February. I don’t think we discussed it in January, because we didn’t see each other in January. I know the member is advocating for it, and his constituents should know he’s been advocating for the project directly with me and that we’ve met and spoken about it on a number of occasions. It is a priority project.

I don’t think…. I would say that the comparison between one city and another is not maybe the most helpful comparison, in the sense that the Colwood project is about 250 metres from Langford. So if you add that together…. And it’s in a community where there’s a very large seniors population. There’s a justification for that project, as there is for F.W. Green. I don’t want to get into the comparison.

Interior Health, as we go through this round of capital funding of long-term care, will have projects. That I can tell the member. They’ll have, by any standard, a fair share of projects because Interior Health is seeing a significant demand in need for seniors and has tended to have in the past — I say “before 2017” delicately — fewer long-term-care beds per capita than it needs and that other regions have.

One of the things we’ve done to address that is the tender we put out for 495 long-term-care beds, which was in Kamloops, Kelowna, South Okanagan and, in that case, Nelson, which was part of that tender for 495 beds. Part of it is projects like F.W. Green, which is of interest, and like Cottonwoods, which is of interest for different reasons. Those are just some of the projects we’re looking at. This is a project that is important. It’s a project we need to build. As the member suggests, there is an inflation in capital costs.

I would say, finally, that this is the largest health capital program the province has ever seen. When we look at it, especially on the acute care side…. My friend, the member for Skeena, knows we’re in the midst of building a hospital in his community. It’s an extraordinary thing and will make an extraordinary difference in the lives of people, also in all the other communities, from Fort. St. James to Dawson Creek to other communities across Northern Health.

Then in Interior Health, obviously, the continuing work in Kamloops, the work on cancer and other such issues. Its’ a huge capital program by the government.

There is some difference between long-term care and hospital care. One of the challenges in hospital capital that we’ll get into is the relatively small number of companies that are able to do the major projects we’re looking at. There is more flexibility in long-term care and in smaller capital projects, such as the Fort St. James hospital project, the Stuart Lake Hospital, which, I think, had five or six bidders. There is some hope in that regard that they can do that.

That project is an important project. It’s one that’s at the business plan stage and we’re looking at. I can’t say more than that because we can’t announce or talk about Treasury Board until something’s approved by Treasury Board, but it’s obviously a needed project in his community, and I appreciate him raising this with me consistently over time.

[5:40 p.m.]

T. Shypitka: Thanks for the answer.

The minister says it’s the largest capital program we’ve ever seen, which is to be congratulated, unless, of course, you don’t see a piece of that pie. That’s what I’m advocating for. It’s all great to have the largest capital program ever seen. But if you don’t get anything, it’s not a good scene, right?

I never heard the minister say exactly when. He says he can’t say. But we have been waiting a long time. It’s been three or four years. I know our chair of the hospital board is getting a little frustrated getting an answer, or getting a non-answer, whatever you want to call it.

One more time to the minister: can you give us a ballpark? When can we see this plan go forward — within six months? Maybe a year?

Hon. A. Dix: Thank you to the member. As he knows, we go through a process of approval, and we are seeing a very large long-term-care envelope. As he rightly says, when costs increase, that reduces the combined number of projects you can provide. And I agree with him. I think what he was telling me in his own way is that all politics is local and that it’s hard for him to get people in Cranbrook behind the project in Dawson Creek. I need to talk to the member for Peace River South about that. But all of that is true.

I think in a general sense, what I say is just…. We see this. We’ve gone through a period in the first part of my period as Minister of Health where we’ve seen a lot of hospital capital projects advance and go forward at the tender stage, and they’re moving forward. It’s really exciting what’s happened, and what’s happening, in Dawson Creek and in Terrace, but also at St. Paul’s and in other parts of the province.

I think that what’s clear is that we need to invest in long-term-care capital as well. That long-term-care capital is directly linked to the value of hospital capital. The member for Prince George–Valemount talked about ALC beds. Well, if we’re not adequately building out long-term care, we’re going to have fantastic hospitals that are transformed too much into ALC hospitals. We don’t want that to happen at East Kootenay Regional Hospital. So that’s another reason for the project.

I can’t give the member a date, only that it’s obviously a high-priority project for Interior Health. I’ll continue to meet and be in touch with him, including with his regional hospital district, which has been very generous in their support for our initiatives, particularly the very successful urgent and primary care centre, one of our most successful in the province, in Cranbrook, which we developed with the local community there. It’s been very successful. That was work that was also done with the regional hospital district and charitable support in Cranbrook.

So we understand the support for public health care in Cranbrook. We’re going to continue to work on that and on issues that the member has raised around interjurisdictional issues between ourselves and Alberta, which is of real importance for people living on the eastern border of British Columbia.

S. Bond: I think that the minister hears from MLAs from across the province how concerned they are about making sure that there’s appropriate infrastructure and capacity in place to care for the seniors in their regions. So we look forward to hearing some more specific details about when the projects that have been mentioned today will hopefully move forward.

I want to try to work my way through the capital planning side of long-term care. This is just the long-term-care and seniors binder. The minister knows we have a lot of other topics to canvass.

I actually do want to talk a little bit about alternate-level care. The minister knows that it is a significant challenge for us in British Columbia. If we look at the seniors advocate’s monitoring report, she points out that there were 3,430 seniors waiting for a publicly funded long-term-care bed last year alone. In fact, we’ve seen long-term-care wait-lists more than double in the past five years. The number of seniors waiting increased by 40 percent in 2022 alone. So we can certainly point to the number of spaces that have been added.

[5:45 p.m.]

But what we know is that the list is getting longer. People are living longer in British Columbia. We know that we’re going to see…. As the seniors advocate puts in her notes in her report, we haven’t yet begun to see the pressures of looking at the aging demographic that we have.

What I’m concerned about is that 81 percent of alternate level care days in acute care hospitals were for seniors. The minister knows that that represents seniors who were ready to be discharged, but they have nowhere appropriate to go.

We’re not being disrespectful about raising this issue. We know that without having appropriate placement and care, many seniors are on hospital wards in this province. We know that is not acceptable for a number of reasons. It has an added complication, and that means that there are fewer beds available for acute care patients. We really have a situation that is causing major challenges in health care, broadly speaking. I hear it in every part of the province that I go to.

There are also variations, in fact, in how long ALC patients are in their particular hospital. Northern Health, for example, has longer periods of time where seniors who could go somewhere else are left in a hospital bed. I know that the minister knows that that’s not the most appropriate place for them to be. One of the things that we noted is that certainly, Ontario has committed to a massive building program in terms of looking at their long-term-care bed situation.

I want to start with this question. When we look at the government’s capital plan, the capital plan appears to account for acute care facilities, but it doesn’t appear to contain targets for long-term care. Could the minister tell me why?

Hon. A. Dix: There are a few things to unpack. I’ll give a couple of elements of the answer, and I know the member will follow up.

If you look at capital funding for long-term care, which is what we’re talking about in the planning around capital funding, you’ll see that the total funding…. This includes provincial funding and extra funding for that. Capital funding between 2009-2017 was $54.5 million. Between 2017-18 and 2022-23, this period, it was more than double that, but still not nearly enough, $145 million.

The amount in the overall capital plan is, for the next period, when you include regional hospital district contributions and government contributions, well over $2 billion. What you’ll see, as we lay out that plan and we lay out the projects in the next little while, is a very significant investment. What’s reasonable to say is: is that, in and of itself, sufficient to address the situation? A lot of our existing long-term-care homes have seen very little investment over time. You can see that in that period.

[5:50 p.m.]

The capital approach of previous governments was to essentially invest in capital through long-term agreements with private providers. That’s how it occurred. There’s a lot of debate about that. We don’t need to have that debate now. That’s one approach. We’ve taken that approach in Interior Health with the 495 beds I referred to earlier.

What you can see is a massive investment relative to the actuals of the last, let’s call it, 15 years in this period. Where that issue doesn’t always account or address the issue of ALC beds is that some of those will inevitably be replacement beds. We have some facilities in B.C. that have a low facility condition index, or not a good one. I always get confused as to whether not good is higher or lower with the facility condition index, but in any event, they’re not very good. So we’re replacing them.

This is the challenge with single-bed rooms. We’re doing some work to reduce the number of multi-bed rooms, as well, in some facilities. So there’s all of that work, but that’s just to say that what you’re seeing and what’s in the capital plan now will be the most significant investment in publicly funded long-term care that we’ve ever seen. That reflects the demand and the requirements that are before us, and I suspect people will be supportive of that.

I just wanted to say, with respect to ALC beds, that there are two issues here. We took, really, quite extraordinary steps, and I spent some time briefing on those steps, to move people into long-term-care homes. It has involved a lot of work on home health but also procurement of available private beds during this period, starting on January 3, basically, when we were sitting at 10,226 people in acute care hospitals. We wanted to reduce that number. We wanted to reduce the ALC number, and we did succeed, in that short-term period, in doing that by adding those beds.

But that has consequences, as well. As the member will ask, maybe, in her supplementary question, if you give priority to people in hospital long-term-care beds, does that not expand the wait-list for people waiting for those long-term care beds from community? If there’s a set number of long-term-care beds, unless you increase the number, which we did during this most recent period, through some extraordinary means, the priority given to ALC beds can also make wait times way longer in the community.

We have a very ambitious capital plan, which I’m happy to talk about in greater detail, understanding that the specific announcements that haven’t been made, aren’t made…. We have two major capital projects that appeared in the $50 million or above list in this budget round that we had in that list and then subsequently announced the one in Colwood and the one at St. Vincent’s, which is Providence Health Care, and we’re taking other steps to do that.

In addition, on the capital side, I think we’ve got to do more work in support of non-profit providers, in particular, to give them more capacity to rebuild existing non-profit facilities. We have to continue to look, I think, at RFPs that expand out for all providers to increase the number of long-term-care beds we have, such as the one that was announced a number of years ago and is proceeding in the Interior Health Authority.

The total number of ALC patients, finally, today, is 1,357. The total number waiting for long-term care is 509, and the median wait time is 23 days to admission. Again, some of that has been reduced in this immediate period. But what that will mean, as we look at data for waits in community, is potentially longer waits in community, and that’s why we have to increase the supply of beds.

S. Bond: Well, thank you to the minister. I’m not going to spend time looking in the rearview mirror. What we need to actually do is….

[5:55 p.m.]

First of all, by any measure, there are not enough long-term-care beds in British Columbia. When a single hospital can have up to 60 ALC patients in their hospital, we know that it is a significant factor in actually addressing the health care crisis we’re facing.

The specific question I asked was: why are there not targets? We certainly do that on the acute care side. At least it appears that there are targets on the acute care side in the capital plan but not on the long-term-care side.

It’s not just the seniors advocate. The Conference Board of Canada has projected that over 30,000 new long-term-care beds will be required in B.C. by 2035. So B.C. care providers have recommended that $1.6 billion be earmarked, over three years, to fund construction and operation of 5,000 new long-term-care beds by 2027.

Can the minister describe for me the process that is underway to analyze where that need is and how we’re going to start matching and ramping up the construction and provision of additional capacity for long-term care in British Columbia? It is not acceptable to have the high percentage of ALC days related to seniors in this province. It means they have nowhere to go. None of us think that that’s acceptable.

My question is: what is being done to analyze where the spaces are needed and how many we’re going to need? We’ve already had the seniors advocate, the Conference Board of Canada and others say that we need to start ramping this up. How is the government going to catch up? Can the minister tell me today how many new beds will be built in the next five years?

Hon. A. Dix: I’m not going to spend too much time in the rearview mirror, but I would say that in the two election cycles, the ’09 and ’13 election cycles, the $17.6 million in total public investment in long-term-care capital was not the right set of decisions, in my view — and, taking my own responsibility, we haven’t ramped it up as quickly as we ought to have since I became Minister of Health. That’s precisely what we’re doing now.

Of course, we do demand modelling. What they show is the stagnant nature in the numbers of long-term-care beds in the decade preceding the last five years. That had an impact and a gap developed.

So we are meeting that target through a number of processes. One, contracting. I talked about the Interior Health Authority. That’s not a small number of beds for them. That was done in 2020. Those projects are well underway and indeed under construction in a number of cases. Those are significant. To speak to the care providers, those would largely be contracted beds in those circumstances.

Secondly, we’ve brought, through the Treasury Board process — you’ve been hearing this from some members today — the largest investment in real dollar terms, I think, in this century, in long-term-care capital, to start to meet that demand, which is a twofold demand to address the facility conditions of those facilities and then increase the numbers.

[6:00 p.m.]

The third thing that we have to do is address — this is a key part of our discussions with the federal government — the direction of long-term care demand. We need to build out home and community care so that there’s less overall demand and better services in community.

All three of those things have to happen. What we have is a $2 billion plan and, on top of that, the purchase and the expansion of contracted beds; on top of that, supports for non-profits; on top of that, an effort to reduce that demand through home and community care. A lot of work and planning goes out to this. The member will know, when you go to the Treasury Board with billion-dollar proposals, that’s part of the work that’s required.

I think what it tells us is that the process…. There was a lot of debate in B.C. politics, really between ’01 and ’09, about long-term care beds, and that dissipated in the years between ’09 and ’17. We are picking this up with a massive program, but the member is entirely correct. We’re going to require a sustained buildout of long-term-care capacity over the next ten years, even if we’re successful in home and community care. That’s precisely what we’re doing.

S. Bond: Thanks to the minister for that. Perhaps just in a very short yes-or-no answer, does the government of British Columbia today have a long-term-care plan that has targets that line up with the fact that we have been told in British Columbia — by the Conference Board of Canada, by the seniors advocate and everyone else that spoke up — that we are going to need thousands of new beds in the next decade or so? Is there, today, a plan, based on analysis in partnership with regional health authorities, to say: “Houston, we have a problem”?

We have alternate level of care patients that are spending way too long in hospitals because there is nowhere for them to go. The minister hears it, and I hear it regularly. Is there a plan today that has targets, goals, a realistic analysis of how many beds we’re short and of how we’re going to get to a place where seniors do not have to languish as ALC patients in hospital beds?

Hon. A. Dix: Well, what we have is the most significant plan to build long-term-care beds in the 21st century. The projects that are approved, announced and in flight include 2,467 beds, again, in the next five years. Those are the approved ones, and those aren’t the only ones.

Part of the challenge in my head with the member and on behalf of the member is that some of these are projects that are going through a final approval process. They’ll be announced now, but this is a significant…. This is the most ambitious plan in long-term care during my period is an MLA. We’re doing that because we see the same thing as the Conference Board and the seniors advocate, which is the absolute need to increase the supply of long-term care; the need — we have to look at this — to increase the supply of assisted living; also the need to improve home and community care.

[6:05 p.m.]

It’s a multi-pronged strategy, yes, but long-term care is at the heart of it. That’s why you’re seeing project after project that’s significant. We have to be innovative with providers as well. We see this in what we’re doing in Interior Health with private providers, what we’re doing in a community such as Surrey with a non-profit provider, the Progressive Intercultural Services Society, and what we’re doing in other places across B.C.

S. Bond: In the past, contracted beds, 5,000 were built. It has continued in the Interior. Can the minister tell me whether RFPs will be made available for contracted providers to bid on over the next five years?

Hon. A. Dix: I think the answer is yes, there will be. We’ve gone through different processes. The Surrey project, which I think is a very exciting project, that we’re doing with PICS out there is with a non-profit provider.

I think there are three sets of capital things we need. We’re obviously doing a very significant capital investment that includes Providence Health Care, which is a major provider of long-term care, a major project in Comox.

I’m hopeful and ambitious that there will be a project in Prince George that will increase capacity there. They’re kind of part of the public system, but it’s Providence Living. It’s not Providence Health Care in that case. In addition, we have projects in different communities with non-profits and supporting other providers. So yes, I think we’ll see that.

The major investment, though, both for non-profits in particular and for the ones includes not just new beds but the remediation of existing beds, and that’s a key issue.

So when you see we have targets to significantly reduce the numbers of multi-bed rooms in our province, most of those multi-bed rooms are in health authority–owned and –operated care homes, because those are the ones where there has not been investment over a period of decades to the extent that needed to be. That work is done too. Some of this…. Not all the beds we have to build, unfortunately, are incremental beds, but a significant number are.

S. Bond: Thank you to the minister. He’s going to have to debate his claim with the government of Ontario, who is actually talking about their long-term-care building program being the largest in Canada ever, with an exclamation mark behind it.

I want to also just raise the issue that it’s not just capacity; it’s also physical infrastructure that’s actually in need of refresh, repair, upgrade — all of those kinds of things. I’m going to get to multi-bed rooms. Probably not right now, but I will get there. It’s bathing areas. We’ve got dining rooms that are crowded. We have narrow hallways. We have nursing stations that are too close to residents’ rooms.

The minister has been there, and so have I. I’m wondering if he could speak to the fact that while we have to have targets and a plan for the short term and long term, adding capacity, what is the plan for renewing long-term-care infrastructure in the province?

Hon. A. Dix: I think it’s what I was describing earlier. It’s that we have a significant number of long-term-care homes that require a transformation.

If you have a care home, what you want to do, if it’s 120-bed care home is…. In some cases, we will need to build and replace those 120 care beds, which might be four- and two-bed rooms — there might be, say, 50 rooms for that number of beds — and move, if we can, to a single-bed model, and then have care homes that meet seismic standards, meet modern standards in terms of size of doors and all the other things.

Some of the best care homes in B.C., as people occasionally tell me, are care homes that don’t meet those standards but have a great tradition of service, and that’s true of a lot of non-profit care homes.

[6:10 p.m.]

But the member is quite right. The capital plan has to do both. It has to raise up the level of care in health authority–owned and –operated care homes where there has been precious little investment over decades. Then, at the same time, we have to, in each of those projects, build incremental care beds.

That’s what you’re seeing in these projects. You’re seeing that at St. Vincent’s. You’ll see that in other projects we announce, where we’re announcing both replacement beds, usually beside a building, to improve the quality of the existing group of beds and add additional beds. Both targets are part of a long-term-care capital plan.

S. Bond: I know the minister is going to be handed a piece of paper very shortly here. So I will try to get this in. I’ll give him a bit of an advance…. I’ll ask him, and then he can do his homework overnight and be ahead of the game tomorrow when he arrives.

I would like to ask about the promise that was made. It was initially $1.4 billion. Last year the minister said it was $1.3 billion, in terms of the election promise that was made in 2020. The minister last year said that that was in the capital base.

What I’d like to know is: how much has been allocated, to date, of the $1.3 billion? Maybe there could be some sense of how many specific projects, how many beds, that adds up to. How many are net new? How many are replacements? That’s the $1.4 billion — which last year the minister said was $1.3 billion — that was in the capital base. Perhaps we could start with that tomorrow.

Then I’m going to quickly move on tomorrow to multi-bedrooms and get some sense of the timeline and the commitment that is related to that.

The Chair: I ask the minister to move the motion.

Hon. A. Dix: I will just say that the good news is it’s not continuing to go downward, if that’s what I said last year, from $1.4 billion to $1.3 billion. I hope it wasn’t one of those 1.342s or something, but it’s more than that now — significantly more than that now. I’m happy to report on that.

I move that the committee rise, report resolution and completion of the estimates of the Ministry of Social Development and Poverty Reduction, and — the second part of my sentence — report progress on the Ministry of Health and ask leave to sit again.

Motion approved.

The committee rose at 6:12 p.m.