Orders of the Day

Hon. R. Kahlon: In the main chamber, I call second reading on Bill 14, Tenancy Statutes Amendment Act.

In the Douglas Fir Committee Room, I call Committee of the Whole for the Budget Measures Implementation Act.

In the Birch Committee Room, I call Committee of Supply for the Ministry of Children and Family Development.

[1:35 p.m.]

[J. Tegart in the chair.]

Second Reading of Bills

BILL 14 — TENANCY STATUTES
AMENDMENT ACT, 2024

(continued)

A. Olsen: Now we have a situation where most Canadians are crushed by mortgage debt, and our federal government underwrites it. The government’s presence has only increased the confidence of lending institutions.

Withers writes: “Altogether, these policy interventions have contributed to historic declines in mortgage rates and an explosion in mortgage debt. However, far from making the home ownership more affordable, they’ve ultimately driven those competing to buy market-rate homes to borrow more and bid higher for the same product.”

He continues: “These policy interventions have facili­tated explosive growth in outstanding mortgage debt. Between 2001 and 2023, the real inflation-adjusted value of all mortgage debt in Canada rose from $600 billion to $1.9 trillion, more than tripling. At the same time, the real value of all household disposable income grew far slower, from just over $1 trillion to $1.6 trillion, rising a little over half. This unprecedented leveraging has made Canadian households among the most indebted in the world.”

We face a situation where the salaries required to afford a mortgage in most Canadian cities are two to three times what they are in reality. People who own a home are carrying a huge amount of debt, and those who wish to become a homeowner are, on all sides, forced to rent.

The Housing Minister’s efforts last year were under the guise of helping to make housing more affordable so peo­ple could move from renting to home ownership. But that’s unlikely to happen, and it is not happening. This is where we have to come to terms with who is actually purchasing housing units.

Withers writes: “Surging prices have different conse­quences for different types of buyers. While they’ve made housing decreasingly affordable for prospective first-time buyers, they’ve also dramatically increased the wealth of those who already own housing, ‘supercharging’ their bidding power.”

Remember last fall, when I laid out the potential devastating impact of the mass upzoning, turning single-property owners into multiple-property owners and an almost certain downward pressure renters would feel on their chances of becoming a homeowner, and how Stats Canada evidence shows the life chances of homeowners is orders of magnitude better than, therefore, their renter peers.

Not only are our policies regarding lending and borrowing making life for renters more difficult, but our policies regarding zoning are as well. It’s a double whammy. The result is an unsurprising and totally predictable rise of investors leveraging their borrowing power.

Withers notes: “Census data reveals that between 2011 and 2021, the number of condo apartments and houses rented out as investment properties grew four times faster than Canada’s overall housing stock. Investors almost doubled their ownership of condo apartments and in­creased their ownership of houses by almost a third.”

All the members of this House, save me and my colleague, are on the record voting against an amendment that limits access of real estate investment trusts, the most powerful real estate investors, which pose an existential threat to housing affordability and individual property ownership. It limits their access to the new housing stock created by the Housing Minister’s mass upzoning last fall.

We have been warning government and demanding they take action that is commensurate with the scale of the impact that these massive property investment corporations, who are continually leveraging their holdings to grow their holdings, but we’ve been brushed aside as doomsayers.

Don’t take our word for it. Withers writes:

“The Bank of Canada is also focusing much attention on the issue through its repeated warnings that investors’ growing prominence in the housing market is contributing to ‘strong demand relative to supply,’ heightened ‘bidding pressures,’ ‘rapid price increases’ and alarming ‘imbalances in prices.’

“In 2022, the Bank of Canada reported investors had become ‘much more highly indebted than other types of homebuyers’ and were ‘increasingly extracting equity from their existing properties to support new purchases,’ adding to a ‘feedback loop’ between rapid gains in house prices and the stronger demand for housing that investors generate.”

[1:40 p.m.]

It is important for a well-rounded discussion about housing policy that more voices than that of Tom Davidoff are on the record, that there are other academics who are thinking about these problems and have come from vastly different political, social and economic schools of thought.

However, this Housing Minister and our B.C. NDP Premier have put all their eggs in the basket of the advice that they got last fall and muted the voices of anyone who questions their philosophy. We don’t have an academic debate about housing policy in this House. Politics is about emotions, and I give the B.C. NDP credit that with their announcements and all their fragmented policies, they’ve created an environment where people will most certainly be led to believe that they’re advancing thoughtful and well-informed housing policy. But they’re not.

They’re engaged in politics and politics driven by emotions. This government has made you feel like they are serving you, while actually serving the vested interest of the status quo of wealthy and powerful forces that are fomenting long-term pain for short-term gain.

As I begin to dig deeper into the festering underbelly of the darkness that is being allowed to colonize our housing market and how our political system and, specifically, the housing policies that have been put forward by this government have been advancing over the past six months is entrenching it, I could not sit silent.

My push back has resulted in discomfort, but these questions need to be asked. We need to ask and answer: who is actually benefiting from these policy changes? How are they impacting the profitability of the private sector development community? Who is buying the housing stock we are building?

There are a couple of questions Withers asks in the first part of his three-part series: “Will Canada’s debt-driven and investor-driven decoupling of prices from local incomes come unhinged and crash in the near term? Will the share of housing owned by multiple-property owners continue to grow in the long run? The answers to these questions will depend largely on how governments choose to intervene. That, in turn, will depend on the public understanding of how and why they should do so.”

Bill 14 is an example of tepid interventions: a government more seriously considering their own political fortunes than safe, secure and affordable housing for all of our constituents.

Let’s go back to the specific measures that are advanced as initiatives to protect the interests of renters and landlords. Really, it is the 1.5 million or more renters in British Columbia who are most threatened. I think the evidence that I put on the record over the past several minutes has demonstrated the dire need for dramatic intervention.

Instead of dramatic intervention, instead of forcing local governments to protect affordability and special needs housing and support displaced renters, the B.C. NDP government dropped the ball, showing us their true colours and where their interests lie.

The province has forced local governments to do many things when it comes to housing over the last six months. They must blanket rezone. They must support transit-oriented redevelopment. Why then, when it comes to protecting the most at-risk people in our communities, does Bill 16 not do the same?

Instead, local governments can use inclusionary zoning to require that developers provide affordable housing when building minimum allowable densities in transit-oriented development areas. Municipalities will have the ability to enact tenant protection bylaws. These are not the dramatic interventions that we desperately need. Suddenly, in this bill, we get terms like “may,” “will have the ability to” or “can.”

After spending last fall talking about all of the things that this government was forcing local governments and our local community leaders to do, suddenly, when it comes to affordable and special needs housing, we have retreated from that forceful position that this government boldly took. These are not the dramatic interventions we desperately need, as 1.5 million renters or more in British Columbia find themselves living in precarity every day. This will only become more pronounced as the changes from the upzoning and transit-oriented developments start to unfold in the coming months and years.

[1:45 p.m.]

This approach raises questions about the role of the provincial government in being a protective force for public good, for the public interest. Bill 16 and Bill 14, both of these bills that we’re debating here, appears to offload this responsibility onto developers and local governments rather than take responsibility to remedy the issues that they have created.

We are going to see the mass displacement of tenants in the transit-oriented development and upzoning. Andy Yan, urban planner and housing researcher at Simon Fra­ser University, prophetically warned that the changes from Bill 47 last fall would result in transit-oriented displacement, not transit-oriented development.

Fifty percent of people who live in transit-oriented development areas are renters. Those renters tend to be middle- or low-income, and about a third of them are living in core housing need, a term referring to people living in dwellings considered unsuitable, inadequate or unaffordable. So these are some of the most at-risk members in our communities.

Seeing the writing on the wall last fall, experts warned that the province’s plan to dramatically increase housing density and transit hubs could lead to mass evictions of renters in low-rise apartment buildings. They feared a repeat of what was happening in Burnaby’s Metrotown and Vancouver’s Broadway neighbourhoods.

I am the designated speaker for this. I’m sorry that I didn’t note that at the beginning of it, but I’ve only got a couple of minutes left.

The Metrotown evictions of 2014 to 2019 were on a truly vast scale, involving thousands of residents. Developers scooped up walk-up apartment buildings with relatively affordable rents and tore them down to make way for luxury condos. A total of 15 multi-storey apartment buildings were emptied in 2016 alone. The Metrotown experience should have been a stark warning sign for a potential eviction maelstrom from the transit-oriented development.

In 2019, Burnaby city council decided to approve a tenant assistant policy, TAP. The policy came into effect in March 2020, and it was a direct response to years of tenant organizing and public pressure. It has been hailed as one of the most progressive tenant rezoning protections in Canada. If protecting tenants is so important to this government, why didn’t the province bring a tenant protection policy as robust and effective as Burnaby’s?

My prediction is that these bills will create a piecemeal approach to protecting renters. Currently landlords in B.C. must follow provincial rules if they intend to demolish a building, but this policy is too weak to do what it is intended to do. Depending on what city you live in, landlords may be required to provide additional support and compensation.

In 2022, Vancouver implemented strong tenant protections, but only for the Broadway plan area. These protections only apply to about a quarter of the city’s housing stock and don’t apply to the units in other parts of Metro Vancouver. As a result, the Vancouver Tenants Union members have been pushing for protections to be implemented on a citywide level. My prediction is that these bills will lead to more of this, more of a piecemeal protection, the deepening of inequality and the proliferation of a two-tiered housing system.

Andy Yan said that leaving decisions up to local governments raises profound concerns about the potential for displacement and evictions. I echo these concerns. Instead of taking strong leadership roles to protect the most at-risk people in our communities, the province has evaded their responsibility and passed the responsibility onto local governments and developers, and this is unacceptable.

Furthermore, the Housing Research Collaborative from the UBC Allard School of Law has published interesting perspectives on the amendments in these bills. I want to put words in their mouth, but my sense is that they framed the changes for renters in a better light than my “not nothing” assessment. However, I think we have a general agreement that these measures fall well short of the level of intervention that is needed.

The HRC raises the important point that it is actually detrimental for government to introduce eviction filing requirements for only some evictions. Why does the prov­ince only want data that reveals part of the picture?

[1:50 p.m.]

Why not require all evictions to be processed through the new evictions platform? Without requiring all notices to be processed through the platform, we create a scenario where we lack context of the full scope of the problem.

The HRC raises the added concern that by only requiring evictions for personal use through the platform, it could incentivize evictions for other purposes as they will be exempt. Further, the HRC notes that by limiting the filing requirement to just evictions for personal use, it becomes the renter’s responsibility to know “when they should be served an official notice.” The burden should be on the landlord, since they are initiating the action.

Additionally, they highlight missed opportunities for government to actually have the tools to “properly monitor eviction filings and create evidence-based legislation.” I try to remain in the critic realm more than the cynic realm, but I have extensively outlined over the past months…. I’ve questioned whether the B.C. NDP government is actually attempting to create evidence-based legislation.

The HRC comments extend to the above-guideline rent increases for households with minors. While agreeing that this is a good measure in and of itself, I agree with their concern, as well, that limiting it to minors fails many other vulnerable demographics that this government continues to leave in the darkness.

Firstly, the narrow application, households with minors, could actually have a detrimental impact on the households with minors. If landlords perceived this policy to be a limitation, then they could be less likely to rent to a household with minors and people who they may consider could become a potential household with minors. Landlords may target single parents, for example.

Extending the criticism further, what about our elders, people with disabilities and other marginalized people? Why did government exclude them from this policy? What about the couple with an elderly parent or grandparent in need of a safe place to live?

The HRC makes a valid point. Just make the change to ensure that landlords can only apply rent increases above the guidelines for the actual expenses they are accruing from the change in tenancy. They suggest time limiting, so it doesn’t go on in perpetuity.

Ironically, this initiative that is designed to make you believe this government is trying to limit discrimination could actually lead to increased discrimination. Perhaps we should have taken the impact of the growing portfolios of individual and institutional rentiers more seriously. Perhaps we should not be too quick to celebrate “not nothing” too vigorously.

The path we are on is troubled. The advice this government is seeking is from a different time. The policy they are implementing is insufficient, and our constituents are getting hurt. These changes are not nothing, but because the government is unwilling to go the full distance, it creates the space for more discrimination. It leaves decision-makers with only part of the picture when we could have the full picture.

The B.C. NDP knew that they could make a headline by taking some action for renters. Align it with the federal announcement, and renters will feel relief that finally their federal and provincial governments are acting on their behalf. But the real estate landscape is much bleaker than a part-way policy can address. In fact, the reticence of this government to actually go the distance is likely creating a host of problems that do not exist today and will be added onto the pressures that we’re currently feeling if they’re left unresolved.

I want to be able to celebrate housing policy that has been informed by more than just a few voices that government agrees with. I want to see a housing policy that is informed by a variety of political, social and economic philosophy. Unfortunately, that’s not our experience in current-state British Columbia.

Complex policy that millions of British Columbians rely on for their health and well-being, for their safety, their security, for their ability to flourish is being treated as political leverage in these bills. The hope it gives renters, especially those who just read headlines….

Will it make their rent more affordable? No, it won’t. None of the measures in these bills make rent more affordable. Will it increase their security? Marginally, perhaps.

[1:55 p.m.]

Like I said, it’s not nothing, but it’s far from what we need. In the grand scheme of things, when you have a government pretending their measures are more effective than they are, the salve to our economic aches and pains, then we are actually further from the serious discussion we need to have in our society about the systems we have in place and the results they are producing.

HÍSW̱ḴE SIÁM.

Deputy Speaker: Seeing no further speakers, the question is second reading of Bill 14, Tenancy Statutes Amendment Act, 2024.

Motion approved.

Hon. N. Sharma: I move that the bill be committed to a Committee of the Whole House to be considered at the next sitting of the House after today.

Bill 14, Tenancy Statutes Amendment Act, 2024, read a second time and referred to a Committee of the Whole House for consideration at the next sitting of the House after today.

Hon. N. Sharma: I call second reading of Bill 18, Vancouver Charter Amendment Act.

We’ll take a recess.

Deputy Speaker: We’ll take a five-minute recess.

The House recessed from 1:56 p.m. to 1:59 p.m.

[J. Tegart in the chair.]

Deputy Speaker: We’ll call the House back to order. Recognizing the Minister of Municipal Affairs.

BILL 18 — VANCOUVER CHARTER
AMENDMENT ACT (No. 2), 2024

Hon. A. Kang: I move that Bill No. 18, intituled the Vancouver Charter Amendment Act (No. 2), 2024, be now read a second time.

I’m pleased to rise in the House today to speak to this important piece of legislation. Until now the rules for Vancouver relating to land use planning and public hearings have been very different than those set out for other local governments under the Local Government Act.

[2:00 p.m.]

This legislation updates the Vancouver Charter’s land use planning framework by replicating key provisions from the Local Government Act.

Bill 18 does three things. It establishes the same rules around the holding of public hearings as those for other local governments. It requires Vancouver to adopt a city-wide official development plan and to update it in concert with its housing needs report in a similar fashion to other local governments.

Finally, the proposed legislation includes two other provisions intended to improve development approval efficiency, especially by providing council the authority to establish development application procedures by bylaw to help increase clarity to applicants and to streamline the existing process and by providing council the authority to delegate to staff a form of development approval for comprehensive development zones.

The proposed amendments are supported by the city of Vancouver. These key changes to Vancouver’s legislative framework for planning and development will help accelerate the timelines to build more housing.

With that, Madam Speaker, I want to thank you and all the members of this House. I look forward to hearing from my colleagues and to continuing debate today on the second reading of this bill.

D. Ashton: Thank you to the minister. Thank you for the introduction and the second reading of it. I greatly appreciate it.

I’m very pleased to be participating in the debate at this stage, addressing the difficulty that governments have had to try and address the housing issue that is being faced throughout this province. It’s my understanding that this bill is amending the Vancouver Charter to align Vancouver with other municipalities adopting an official community plan by removing requirements for public hearings in specific areas related to the official community plan.

Coming from municipal government and regional government…. We were always very envious of the Vancouver Charter. We always felt that they had the opportunities to be a lot quicker, a little bit faster on their feet, and didn’t have to go through what most municipalities did in order to facilitate development. It seems that there are changes in the wind, and this is being brought forward by the government.

A quick statement. If we are going to make affordable housing more affordable, we have to make it less expensive. How we have to address that, in my way of looking at it, is the maze of red tape that all levels of government are putting in place in front of those that want to try and develop. Also, the typical bureaucracy, unfortunately, that goes, again, through all levels….

I’m not casting stones at any level of government, but there always seem to be a lot of dominoes that need to be tilted before we can actually get housing on the ground and get it going up so that we can get families and individuals into those premises a lot quicker. I know that all of us in this House support increasing the housing supply.

I’m really glad to see that there has been some admission by all levels of government that regulations and taxations are a barrier to housing. I really, really hope that as the current government proceeds through the revamping and regeneration of some of these bills, opportunities are going to be presented to those that are in the construction business to facilitate construction a lot quicker than it is normally taking place.

We have probably all heard the stories that it can take three to four years in Vancouver. Please don’t quote me on that. I’ve never applied for a building permit myself in Vancouver. I’ve heard from some of my peers that by the time they get through the multitude of application processes just to get a building permit…. It’s years in the waiting. I think those days are long over.

Really, I’d like to see government consolidate, which I think they are trying to do at this point in time, with the city of Vancouver’s blessing. I hope it is being facilitated in an amicable way.

[2:05 p.m.]

I would also like to see that we start taking a look at the taxation issues that are being faced by all the citizens these days in British Columbia, especially those that are wanting to take the opportunity to build new housing, and the onerous amount of money that goes, it seems, to every level of government before a shovel can go in the ground.

I would like to say…. I welcome the opportunity to get to committee stage on Bill 18.

I really hope that the direction the government is taking on this, along with the city of Vancouver, will help facilitate a much quicker way of giving individuals the opportunity to construct new accommodation, new residences, whether they be ownership or rental, to encourage people to have that security and that safety of owning, if at all possible, but also being able to rent. We want to ensure that everybody that would like to has the opportunity to have a roof over their head and have a roof over their head that is affordable and not being stretched.

Many of our peers…. I will retract that. Many of the people that we know are being faced with having to look after the pennies and the nickels and the dimes to ensure that payments, whether rental payments and/or mortgage payments, can be met, especially in these days of upper inflationary tactics that are taking place in not only this province but also in this country.

Madam Chair, thank you very much.

Again, to the minister…. I really look forward to the opportunity of the committee stage on this with her and her staff just to make sure that, as is stated, this bill is going to provide the opportunity for those in the Lower Mainland, specifically in Vancouver, to facilitate the construction and development of residential housing much quicker.

Deputy Speaker: Recognizing the House Leader of the Third Party.

A. Olsen: Thank you, Chair. I’m the designated…. No, no. I’m not. [Laughter.]

Deputy Speaker: We would look forward to that also.

A. Olsen: I’m not going to mention the individual who would like….

Interjections.

A. Olsen: Yeah, exactly.

I rise to speak very briefly. Just a couple of remarks on Bill 18, the Vancouver Charter Amendment Act (No. 2), 2024.

Before I talk about a couple of the aspects of this bill and a couple of the aspects of policy that are being changed in this bill…. I do think that it is important to note that this is the second time that we’ve opened the Vancouver Charter up for legislative amendments this term. It’s the Vancouver Charter Amendment Act (No. 2).

I think it does need to be said on the record. The number of times that this government reopens bills that have already been amended is really remarkable. Bills are opening and closing and opening and closing. The fact that in less than seven weeks we have a bill that will be opened and closed twice is remarkable. Part of the challenge with this, from an organizational perspective, is….

Each time the bill opens and closes, regulations are created. There are regulations and powers that are created. It opens and closes again. There are new…. The fact of the matter is…. When you start to layer this on top of it, it makes it very difficult for the public to actually be able to follow exactly what’s happening and where the current situation is.

This is an opportunity to raise this on the record today. Bill 18 is a reflection of an act that has now been opened for the second time.

When the former government was in place, I understand that there were much greater controls around this. If a minister wanted to open their bill in a session, they were to have all of the legislative amendments there. I’m not saying that there weren’t bills that were opened multiple times in a session.

The standard practice should be that if you’re going to open legislation, do all the work that needs to…. Organize the policy. Do all the work that needs to be done. Do it. Close the bill. Go to regulations. As a friend of mine used to say at the council table: “Have a nice day.”

This bill makes some amendments to the Vancouver Charter to include public hearings and an official development plan that is guided by the housing needs assessment, development application procedures and comprehensive development zones. Some policy changes.

[2:10 p.m.]

Questions I have for the committee stage of this de­bate are finding out what the key differences are between an official community plan…. I know that my colleague who spoke before me talked about official community plans, but in this bill, there are actually official development plans.

That’s the first time that that has come up, so I’m wondering if there’s a new concept that’s being introduced. Perhaps we can get some clarity on that. Is an official development plan the same as an official community plan? Perhaps it’s in the Local Government Act or in the Vancouver Charter, and we get a chance to learn about that in the discussion at committee stage.

The other thing, too, is this is requiring public hearings. I understand there are public hearings that are required for more than just rezonings that have to deal with residential. So perhaps the answer to this question is that this is requiring the use of public hearings across a wide variety of different rezonings that are not strictly dealing with Bill 44. But Bill 44 negated public hearings. So we have a situation where after negating public hearings, we’re introducing public hearings.

I’m wanting to know if, just as we discussed this, the use of public hearing is more broad in this bill for the Vancouver Charter, and if so, how does Bill 44 impact that? Will public hearings then be required by Vancouver city council? Those are just a few questions.

I appreciate the opportunity to stand again, for the second time, and speak to the Vancouver Charter Amendment Act.

Deputy Speaker: Seeing no further speakers, I recognize the Minister of Municipal Affairs to close debate.

Hon. A. Kang: Thank you so much to the member opposite for speaking to the bill today and showing your support for the work that the city of Vancouver would like to do in collaboration with our government and supporting the efforts of our government in wanting to work with local government, especially, in this case, the city of Vancouver, to build more housing faster and more efficiently.

And thank you so much for alluding to what may be coming forward to the continued discussion and debate on Bill 18. I do look forward to that.

Deputy Speaker: Members, the question is second reading of Bill 18, Vancouver Charter Amendment Act (No. 2), 2024.

Motion approved.

Hon. A. Kang: I move that the bill be referred to a Committee of the Whole House to be considered at the next sitting of the House after today.

Bill 18, Vancouver Charter Amendment Act (No. 2), 2024, read a second time and referred to a Committee of the Whole House for consideration at the next sitting of the House after today.

Hon. N. Sharma: I call Committee of Supply for the Ministry of Health.

Deputy Speaker: We’ll take a short recess to get staff and the members needed for this debate.

The House recessed at 2:13 p.m.

Committee of Supply

ESTIMATES: MINISTRY OF HEALTH

(continued)

The House in Committee of Supply (Section B); J. Tegart in the chair.

The committee met at 2:24 p.m.

The Chair: I’ll call the Committee of Supply for the Ministry of Health to order and recognize the Minister of Health.

On Vote 32: ministry operations, $32,710,062,000 (continued).

S. Bond: Good afternoon. The minister is getting very practised at reading out very large numbers in his budget.

[2:25 p.m.]

The pathway is similar to what we had planned. We’re going to continue on with long-term care and seniors, and eventually we’ll move into health more broadly.

I do want to go back to one of the issues we discussed the last time we were together. We talked about how Alberta was using federal funding. Certainly, as I went back and looked at the minister’s transcript and my question, the minister suggested that we were talking about the bilateral and not on the seniors agreement. It is indeed the aging with dignity agreement that I was referring to.

I’m wondering if the minister could just go back and reconsider the question. In essence, the government in Alberta is utilizing the funding to offset high interest rates when it comes to viability for some operators. Obviously, they’ve been impacted by some of the extraordinary financial pressures that we’ve faced in recent years.

The minister had mentioned that the government was looking for ways to support the not-for-profit sector. Could the minister describe for me what those ways might look like and what options he’s considering, and also just go back to look at whether or not the work that Alberta has done and the model that they have used, in order to offset those high interest costs, is under consideration?

Hon. A. Dix: I won’t repeat at length the answer I gave previously to the hon. member: that on both inflationary and non-inflationary costs during COVID, we stepped up in a way that other jurisdictions didn’t. That’s an important consideration.

I think the member is talking about some of the challenges that are faced on the capital side. I think we could have a broader discussion on this.

I’ve said a number of times that on the health authority–owned and –operated side, we have about 45 facilities that were built before 1980. We have 17 facilities built before 1970.

With respect to the not-for-profit side, you see, actually, quite similar numbers. The costs in the not-for-profit sector are partly related to public policy decisions that have been made in previous times. If you look at the 90 licensed facilities owned by not-for-profit partners, 42 opened prior to 2000, 32 opened prior to 1990, and 15 opened prior to 1980, and there has been relatively little investment there.

The nature of RFPs, particularly in the noughts, favoured the for-profit sector, I think, in a general sense, although sometimes these things change. I would say that we have provided very significant support for care homes, and through the pandemic, I think, we were significantly more supportive than some other jurisdictions.

We do have to look, as some not-for-profit care homes are looking at major rebuilds, in some cases, and beds that we need. We could identify a number of not-for-profits in those circumstances, just as we can identify health authority–​owned and –operated care homes that are in that circumstance.

That is something on the capital side, which I think is what the member is asking about, something that I’m certainly interested in. I’m interested in two sets of things. One, how is it that we can ensure that not-for- profits are competitive in potential RFPs in the future? To a degree, they have not been, or were not, in some of the rounds of RFPs in the recent past, say the last two decades.

[2:30 p.m.]

Secondly, how do we support not-for-profits that are facing very significant bills and, in some cases, are different not-for-profits than they were when the care home was established, frequently not the people on the boards of directors, and so on, and not dealing with projects that could potentially run tens, even hundreds of millions of dollars in terms of costs. I think it is a legitimate thing to look at in terms of capital costs.

We have also, as the member will know, provided very significant support through the B.C. Care Providers and Denominational Health for the EquipCare program. It used to be called something else, and I kidded them about it until they changed the name. But very significant support both during the pandemic…. It’s significant, I think some $14 million last year. We haven’t announced the additional amount this year, but there will be additional amounts more, which allows them to provide important equipment supports. Their real focus right now is also some of the need to support climate change initiatives that we’ve seen.

Finally, in terms of investment directly, we’ve seen very significant investments to support, for example, air quality and climate change initiatives.

Those are some of the ways we’re doing it. I’m not, as I say, rejecting that particular notion, and we’re certainly looking at ways of supporting not-for-profits who are facing fairly significant capital bills in the coming time or remediation or renovations that are required now. Well, in a number of cases, as I noted, a significant number of cases, not-for-profits that were built…. Fifteen of them opened, for example, prior to 1980. That’s certainly a consideration.

[S. Chandra Herbert in the chair.]

S. Bond: Thank you to the minister for that answer. I’m glad to hear that nothing is off the table. I think it’s important at times like this that we look, and I’m a believer that we look at where best practice is in place and look at those items instead of starting from ground zero.

I want to move to the long-term-care funding model, and I’d like to ask some questions about per diems in particular. As the minister knows, per-diem rates are basically the daily funding that is allocated per bed to long-term-care homes. It’s a pretty critical part of making sure that we can care appropriately for older adults who live in care.

There are some discrepancies in how the per-diem rate is applied. It is not consistent. I want to raise, in particular, the Interior Health Authority and look specifically at the per-diem rate which Interior Health provides.

Currently, according to the work we’ve done, Interior Health provides an average per-diem rate of $237 per bed, and that is below the provincial average of $256 per bed. That might not seem a lot when you look at a per-bed amount, but when you look at a typical 100-bed care home, for example, that can be just…. It’s over half a million dollars, and that is a very significant challenge. There are very tangible impacts, and it makes it very difficult to retain staff, pay the hourly rates.

I’m wondering if the minister could shed light on why Interior Health, which is the example I’m using, consistently provides the lowest per-diem rates for long-term-care homes, which appear to be significantly below the provincial average and also by rates that are used in other health authorities.

[2:35 p.m.]

Hon. A. Dix: I’d say to the member, first of all, that’s one of the reasons why we’re having the review of the funding model, for just these very questions.

We received a letter from Terry Lake, the head of the care providers, on some of these questions, I think, last week. It’s our intention to sit down and take him through the material as well. Some of the material I’m going to take the member through now.

Historically, going back to say 2017-18, Interior Health did have a variance from the provincial average. I say that without irony for our meeting with former Minister Lake. That was developed largely because of RFPs that had been bid on over time by private providers. But it was the case that there was a variance from the provincial average that was larger in Interior Health than in other jurisdictions.

Now, we have had some significant impact on those per diems, particularly, for example, with wage levelling. If you look at the evolution over time of those changes and the impact to the per diems of the one-time investments, the wage levelling and other things, the largest beneficiary of those was, in fact, Interior Health. So there was a levelling of the differences between health authorities.

If you look at the variance from the provincial average now, noting that it was 4 percent for Interior Health in 2017-18, the variance, when all those things are consid­ered, is now 2 percent, so it was reduced. In fact, Interior Health has a better situation than there is in Vancouver Coastal Health now, when all of those factors are taken into consideration.

It is one of the reasons why we do have contracts that are frequently based, in the long term, on requests for proposals that came forward and were accepted, adopted. And then obviously the beds were brought into the provincial system in previous decades, whether it was the ’90s, the noughts, the 2010s, and so on. What we’ve seen when all of those things come together is a reduction in the variance.

There’s still a small variance for Interior Health, but it’s relatively small. The one with the largest variance to the positive is Northern Health, and there’s a reason for that. It is more expensive to do things in the North. It just is. And it should be. I’m sure I’m not going to have a debate with the member on that question.

If you look at it now, when all those factors are taken into consideration, the one with the highest variance is, in fact, Vancouver Coastal Health. Then Interior Health. Then on the plus side — really, right on it — Fraser Health, then Island Health, then Northern Health.

Those are some of the considerations in per-diem rates. We’re expecting shortly to have some discussions, as well, with Terry Lake and the care providers about those issues, because they’re important questions.

I think it’s fair to say that, especially, the private providers in the Interior really benefited from wage levelling. This allowed them to be much more competitive, and we needed them to be much more competitive. If it’s your loved one in a public bed, it doesn’t really matter to them if it’s a health authority owner-operator or a private bed or whatever. You expect a level of service.

I think with all of those things considered, the variance has been reduced. We’re going to have that discussion, as well, but that is also part of the situation overall. Interestingly, that variance, when all those things are taken into account, is less than the variance in Vancouver Coastal Health.

S. Bond: I appreciate that answer. I think the minister knows…. Certainly, I’m not going to argue about the Northern Health funding formula because we know it costs more. Communities are more dispersed. There are additional costs for heating and all of the things that happen when you have to provide services in a more rural or remote part of British Columbia. I understand being above the provincial average. Having said that, the impacts of that gap can be significant.

[2:40 p.m.]

In fact, I’m sure that the minister will hear from former Minister Terry Lake that we are seeing bed closures. We are seeing an inability for facilities in Interior Health to actually be competitive, even with the gap as it exists today, because it is about wages and trying to attract people. It’s tough enough to get people into the system, and when there is a challenge with a gap and their inability to attract staff because of those funding rates, the impacts are real. Significant concern about the potential of closures which have been referenced to us….

We certainly don’t need beds closing. If anything, we need to be ramping up the number of beds that we do have. So I appreciate that, and I would just urge the minister to continue to reduce that gap and ensure that there is equitable funding across health authorities, recognizing the actual costs of delivering service.

The other issue, and the minister may be aware of this as well, is the concern about the timing with which funding flows to providers. There has been significant commentary about the fact that funding flowing from the Ministry of Health to the health authority is often very delayed. We have actually heard stories of there being two-year delays, in terms of getting reimbursement for things during the pandemic — for example, pandemic-related expenses, things like overtime, infection prevention.

What that does is it destabilizes the sector. If there is an expectation that funding is going to flow, one would assume that there is prompt reimbursement from the Ministry of Health through health authorities to health care delivery partners. I think that’s the least they should be able to expect.

Could the minister speak to that issue? Prompt payment matters, and it causes a destabilizing impact in the health care system when people are waiting as long as two years in some cases to get funding that they are entitled to.

Hon. A. Dix: On the previous question, I would say I think it shows the real value of the wage levelling proposal that we did, that, in many cases, the relatively low wages that had been paid based on previously signed contracts and agreements made it impossible to deliver the service.

I’m very proud of the work we did on wage levelling in the early stages of the pandemic. It had a really positive impact, and as the numbers I just described show, it really helped in the Interior and Northern Health Authorities because wage levelling was the largest part of those one-time investments, and the two health authorities that received the largest share were the Northern Health Auth­ority and the Interior Health Authority.

In the Northern Health Authority, though, overall, the contracted sector is much smaller. The member knows very well that typically because of the nature of the competition for bids, and so on, that is much more a health authority–owned and –operated territory, in terms of long-term care, than others. But I just make that point in passing.

We meet every two weeks with Denominational Health, with B.C. Care Providers. Occasionally issues are brought forward of this nature. I’m told our staff does work with care homes, especially those that might be in somewhat precarious financial positions, to respond to them. Every single time there’s such a thing, it’s investigated. It’s part of, I think….

The strength of B.C.’s effort in the pandemic with long-term care was the regular meetings, the engagement on issues, the response to specific issues, the response by unions in the sectors to issues as well. I think that really brought it together. And the member’s own role, the sen­iors advocate — everyone came together in that time.

[2:45 p.m.]

The current situation, including in the funding review, is an extension of that. But certainly, when a specific case is brought forward, I really encourage Mr. Breen and Dr. Lake to bring those forward — Bob Breen is with Denominational Health, as the member knows — if there are issues like that. I know our staff is really committed to doing that. And that regular process of meeting, that direct involvement in, for example, the funding review, I think, is an extension of the good work that was done together by lots of people, but particularly everybody in long-term care.

I really credit all of the organizations involved, in particular, Denominational Health and the B.C. Care Providers, because they really have worked closely with us in this period. And the results, I think, compared to other jurisdictions where those relationships don’t exist…. I also want to credit the staff of the Ministry of Health, who really respond when these issues come up.

If there are other issues such as the ones the member has raised, we want to hear about them, and we’ll respond to them.

S. Bond: I appreciate that. I think that I’ve certainly found the ministry to be responsive when there are one-off kinds of situations. I want to make sure that the sector isn’t experiencing a systemic problem. When you think about it, it’s not the job of providers to, basically, be lenders to the government. It should be the other way around. And I’m even more concerned about small providers, because they do not have the cash flow to manage that.

I just wanted to be sure that on the record there is a reference to the fact that prompt payment matters. Ultimately, it impacts seniors in British Columbia if it isn’t done appropriately. I would hope that the minister and the ministry staff that are here today ensure that there are very concrete steps in place to ensure that payment is provided promptly when it comes to reimbursing our health care delivery partners.

I want to also raise the issue of something that matters so much when we have frail elderly British Columbians in long-term care, and that is food costs. If we hear from families and from others, often it’s about the quality of food. That is so essential. Imagine going from your life and, suddenly, you’re in long-term care. One of the things that matters a lot is how we actually feed and care for people. I’m very concerned about inflation and increasing costs.

If you think about the allocation for funding for food in British Columbia, as I understand it, and I’m happy to have the ministry correct me, the daily food cost per bed in British Columbia is $10.12. If you look at Ontario, they allocate $12.07 a day per person. If you think about what we’re facing in British Columbia, and Lord knows we raise it in question period on a daily basis, we have costs going up. When you are increasing the price of….

Sorry, hon. Chair, I was not saying that directly. That was the royal you.

Interjections.

S. Bond: I was going to correct it quickly, before the Chair did.

When we see increased costs at the gas pump, for ex­ample, transportation of goods, costs that farmers are…. It all accumulates. What that translates to is it’s a lot harder to provide quality meals when we are in a time of inflation and concerns about additional cost.

Could the minister describe for me what his intentions are related to the current daily food cost per bed, which is $10.12? How will he ensure that there is actually adequate funding to provide daily, nutritious and also culturally appropriate food? That is also incredibly im­portant. I know the minister is very sensitive to that. What are the plans for dealing with inflationary costs and the challenges of providing nutritious meals in our long-term-care homes?

[2:50 p.m.]

Hon. A. Dix: A couple of things. First of all, one of the values of the information we’re getting in the funding model discussions is getting the actual costs that people are spending. There are sometimes discrepancies, and those discrepancies are important because our providers have a huge responsibility. They also receive a very large amount of money, and we want to make sure that the resident in that care home who is not involved in that transaction — they’re just living there and eating there — benefits fully.

We did some significant — this was really focused on food — non-wage inflation funding in the two years im­mediately preceding this year, which had a significant effect. Inflation has come down somewhat, although food inflation is high. We took specific action for non-wage inflation. It wasn’t just the 160-odd-million dollars that we’d lifted wages in the contracted sector through wage levelling, for example. We focused on non-wage costs.

To give a sense of that and what we saw in terms of health authorities and food spending…. This is the overall spend, just to give a sense of what, also, providers are seeing.

The total amount we spent in ’21-22 was $67.5 million, and the total amount spent in ’22-23 was $82.4 million. That, in part, reflected the increasing number of people in hospital in those relative years and, obviously, the food costs in hospital and in long-term care. That was the health authorities. It also reflects the pressures, both the population pressures in general but also the inflation pressures on food.

The member is quite right. We were looking at this. This is an issue that was regularly brought up to us when we engaged with care providers in Denominational Health, and it’s why we provided, in previous years, non-wage inflation funding to support during those periods of high inflation. That was principally directed to food.

Part of the discussion in terms of the funding formula…. The information we gather is very, very important. We’ve taken action in terms of non-wage-inflation funding for the home and community care sector in general.

In addition to this, we’ve provided some significant support for Feed B.C. You see this if you go into long-term care. There are often care homes — not-for-profit, for-profit and health authority–owned and –operated — who are participants in that program and which look to ensure that more food is purchased and processed in the province. That’s principally the health authorities, but others have been part of that effort as well.

The member will know this. I totally agree that this is an absolutely critical part of the experience. That experience and that transition from living at home…. The kind of food one might eat at home and the kind of food that one might eat in a long-term-care home is very different.

I know the member for…. I met his eyes because we have talked about this issue on a number of occasions with respect to Summerland and other issues. He has routinely and vigorously pressed in my office, at different times, advocating for his constituents and seniors in his constituency on this issue of both delivering in terms of food costs but also ensuring the quality of food and that, in each care home, the quality of food is maintained to a standard.

This is an important question everywhere. I agree with the opposition critic. This is a very significant part of what we’re looking at in terms of the long-term-care funding review.

Also, this issue of non-wage inflation is something we were live to over the last couple of years and have worked very closely between the health authority and care home operators, and between ourselves and the care providers in Denominational Health and health authorities.

[2:55 p.m.]

S. Bond: Thank you to the minister.

I appreciate that. I know that the minister cares very deeply about long-term care and the people who are there, from his own personal experiences and mine. We have shared those.

My concern, though, goes to the fact that British Columbia is currently the most expensive jurisdiction in North America when it comes to gas taxes and gasoline prices. People might wonder why we’re talking about that in health care. It’s because all of those costs, ultimately, end up increasing costs elsewhere.

I would really urge the minister…. I will just ask this before I move on to another area. If there is a comparison, jurisdictionally…. Certainly, the numbers I have are that Ontario is currently at $12.07 per person, and B.C. is at $10.12. We are a more expensive jurisdiction than Ontario, so I’m concerned about that. I don’t know whether the minister has access or could provide me with a sense of what it looks like in the rest of the country.

It is one of the things, as the minister points out, that we hear very frequently. Making sure that people have nutritious, healthy, locally grown — all of those — fresh produce, those kinds of things, is really important not just to physical well-being but also that significant transition that people are making when they move to long-term care.

I would like to move to hours per resident day and national standards. The minister will be very familiar with the Health Standards Organization new national standards. We have this discussion probably every year we do estimates.

While it’s not prescriptive, and I certainly recognize that, the HSO new national standard cites 4.1 hours as being a minimal level of care acceptable, and that’s based on previous studies. The Ontario government is looking at increasing the hours of direct care for each long-term-care resident to an average of four hours per resident per day. The government of Alberta, in 2021, is increasing to 4.5 hours, but that is over a four-year period, so it’s not happening instantly.

Currently British Columbia provides an average of 3.51 hours of care, and that includes allied health services. Many care homes in our province are only funded for 3.36 hours of care. That was a target identified as far back as 2009. So it is a concern, in terms of the level of care provided in our province, to provide what is adequate to meet the needs of our older adults living in care.

Could the minister speak to what actions he intends to take to ensure that British Columbia keeps pace with other jurisdictions as they move beyond that 3.36 hours of care per day?

Hon. A. Dix: Certainly, we’re engaged nationally to make sure standards here continue to be raised. I would say…. I know the member will be disappointed if she doesn’t hear this annual presentation. I think she’ll be disappointed. So I feel like I have to go through the…. I feel compelled to do it.

Just to say that the 3.36 standard was aspirational. It was put in place in 2008, I believe, maybe 2009, as the member has suggested. We’ll know that the overall baseline, when I became Minister of Health, was 3.11, so we were well below the standard we ourselves had set to meet.

It wasn’t just that. The standard in health authority–owned and –operated facilities was much higher than that. The standard in health authority–owned and –operated, if memory serves me, was about 3.33. The standard in the contracted sector was more like 3.04.

[3:00 p.m.]

That was the baseline. We took action, as the House will know, to say that it wasn’t right that 85 percent of care homes in B.C. didn’t meet the 3.36 standard, so we took action.

That was funding that was overwhelmingly, and I mean overwhelmingly, to the contracted sector. Because to a degree, the health authority–owned and –operated sector was already at that level when I became Minister of Health. By 2020-2021, we already got to 3.37. In the most recent quarter, it went 3.11 and 3.25 and 3.28 and 3.37. Then in the Q4, ’21-22, as we get through that year, 3.57 is where it’s at today. So we’ve gone from 3.11 to 3.57 since I’ve been Minister of Health.

I think it’s easy to sometimes, these debates about statistics…. Occasionally, I’ve been known to use statistics in the House. These debates about statistics sometimes don’t fail to understand what we’re talking about here. We’re talking about…. When we talk about that increase of 0.46 hours per resident day, it’s about in the neighbourhood of 27½ minutes of direct care per resident per day. It’s not a theoretical question. That’s what it means. Per week that would mean close to three hours and 15 minutes. It’s the difference between where we were and where we are, and that’s a lot of care.

I want to give people credit because you can’t just do that. It’s not just an issue of funding. We have to find peo­ple. And that’s part of what the HCAP program, which I know the member will ask about later, is about. So this is where we come from. We’ve come a long way, and you can see the direction we’re going from 3.11 to 3.57. We see what other jurisdictions are proposing to do, some of it should be said, into the future. But I think that’s something for us to reflect on and to consider.

I want to provide just a little bit more information. Again, the health authority with the highest number of hours of care per resident day is Northern Health. The others are pretty much exactly the same. So the four other health authorities are 3.55, Fraser; 3.56, Vancouver Coastal; 3.57, Vancouver Island; 3.57, Interior Health, so basically the same number. Northern Health, 3.75, because of the nature of Northern Health beds and the disproportionate number of those beds that are health authority–owned and –operated and the specific circumstances of Northern Health.

I don’t think anyone would disagree with that but I want to say there’s…. Because of the previous question, there would be a question about how does it look across the province. They’re pretty even across the health authorities, except for Northern Health. I think it doesn’t bear repeating that there are some very specific reasons why Northern Health has higher funding and some higher costs and, in this case, more care per resident day because of the nature and the circumstances of Northern Health facilities.

Absolutely, those national standards are something that we are looking at very carefully. We’ve made, I think, some exceptional progress. More progress to be made.

S. Bond: Yes. It would be an understatement to suggest the minister uses statistics in the House. That is certainly something he does on a regular and daily basis.

I guess my specific question to the minister is: do he and the ministry have specific targets for an ongoing increase, moving British Columbia closer to, while not prescriptive, the targeted number of 4.1 hours as being minimum level of care? Has the minister set targets over a period of time to move British Columbia closer to the 4.1 hours?

Hon. A. Dix: Our original goal, as I described, was to meet British Columbia’s target, which was 3.36. We did that. We went through COVID-19, and we kept going effectively. And there are two real questions that we have to consider. One is, obviously, cost. You have to budget for that.

[3:05 p.m.]

Since we’re talking about Budget ’24-25, there’s no specific increase in those hours, although we’ve met a very significant new and record number of hours per resident day in B.C. So we would have to assess….

To give a sense of costing, I would say, just looking back to what the costing was of the 3.36, going to 3.36 from 3.11, we certainly spent…. I think the number was $240 million over three years to meet that costing, to meet that standard, to increase care hours in that way. If you were looking at….

That gives a sense of what we expected 0.25 to be. We have spent quite a bit above that to increase it even more, so we are absolutely assessing what the cost of a further increase is.

The member will know, considering that $240 million over three, which is 110 in the third year, just to put that there…. To get from 3.11…. That was the cost, 3.1 to 3.36. We’ve done better than that, and we’ve invested more than that. But that was 0.25. So if you were going to go, say, to 4.1, that would be an additional 0.74 hours per resident day from 3.36 and an additional 0.53 from where we are now, 3.57.

We’re examining what the cost would be of that. You have to also have a practical approach, through the HCAP program, in particular, and others, to staffing that. So those are absolutely things to consider. That’s the range of costs that we’re looking at. Probably, I would say if it’s 110 in third year, do 0.25, just double that and add inflation for the period in between, and you get a sense of what the cost would be.

Then there are other circumstances that we have to look at, but it’s certainly something we’re absolutely looking at based on the discussion of national standards from the HSO with respect to hours per resident day.

We’ve made a lot of progress. I think the investment we have made so far is significant, and in doing that, the progress, not what we’ve announced but what we’ve done, which is to meet our target and then blown past it, really demonstrates, I think, the commitment of the ministry and the sector. With respect to further increases, we’re absolutely reviewing that, reviewing the costs and reviewing that against other priorities in long-term care.

S. Bond: I am going to move on. There are so many issues to discuss on the long-term-care and seniors sides of things, but I also have health to manage. The hours are…. I’m not complaining, because this minister and I get to spend a lot of quality time together in here compared to many of my colleagues. But we will move on.

The minister didn’t want to disappoint me with his answer. Well, I don’t want to disappoint him with my question either. He is not going to be surprised that I want to talk about wait times for long-term care. It is very challenging, and we know that there is significantly more demand.

If you look back as far as March 2022, there were 3,430 seniors waiting for a spot. At that time, that was a 40 percent increase over the previous year. It has doubled in the past five years, and the wait time was 196 days. Within a year, the wait-list grew even further, and according to this year’s report, 5,175 seniors are waiting for long-term-care space as of March last year. The wait time is now 209 days.

I’m sure the minister would recognize how unacceptable that is. Think about being a family in British Columbia trying to care for their loved one, and they’re on a list, and it’s 209 days away, potentially. So I’m wondering if the minister could answer a very specific question for me. How many days are seniors in British Columbia currently waiting for a long-term-care space?

[3:10 p.m.]

Hon. A. Dix: Why don’t I answer that question quickly, because I think the member will have some follow-up and because There are a few things I wanted to say about it in terms of, especially, the obvious need. That’s why we’re investing and building so much long-term care in the budget we’re discussing, and we’ll talk about that maybe in a little bit.

Average wait times for admission to long-term care. We look at it two ways. From hospital, the number of days has reduced, from 2019-20 to ’23-24, by two days. This does reflect a challenge, I think, that we have, as well, in the hospital. It’s reflecting the need to address alternate level of care days in the hospital. It’s gone from 38 to 36 days from hospital. From the community, in that same period, it has increased from 80 to 134 days.

S. Bond: The minister is suggesting that today, seniors in British Columbia are waiting 134 days to get a space in long-term care if they’re coming out of community?

Hon. A. Dix: That’s the average. The circumstances will differ in amount for an individual.

The member, I think, was asking for the average. The average from the start of reporting…. We didn’t used to report this, and now we do, which is part of what makes these kinds of debates and discussion of real value. From the start of the reporting, average wait-time admissions for long-term care in Q1, ’23-24, is 134; from hospital, it’s 36. That gives a sense of those two categories.

S. Bond: The recent data that came from the office of the seniors advocate indicates that, in fact, wait times for publicly subsidized long-term-care beds is actually going up across all of the health authorities. That’s actually where the number came from. For 2023, on average, people waited 209 days. On average, meaning that there are peo­ple who waited much longer than that.

There certainly have been incremental infrastructure improvements. We’ve seen the addition of 362 new publicly subsidized beds in 2023. But when you think about the demand, that is a pretty limited increase. At the same time, there was a 12 percent decrease in the rate of long-term-care beds per 1,000 people aged 75 and older.

When you think about what the Conference Board of Canada said, which actually paints a very grim picture, they point out that in British Columbia, there will be a need for 30,000 new long-term-care beds in our province by 2035. Addressing this need last year, the minister pledged $2 billion to add 2,500 beds over the next decade. But in Ontario, they plan to build 31,000 new beds and upgrade almost 39,000 by 2028.

With 75 percent of the $2 billion already spent, nearly 1,400 of the committed 2,500 beds remain unaccounted for. Could the minister explain how he plans to address the shortfall with only 25 percent of the budget left, considering, and some will be shocked to hear this number, the average long-term-care unit costs approximately $1 million to build. The math doesn’t work.

The minister made a promise to add a certain number of long-term-care beds. The vast majority of the budget is gone, and we are short 1,400 beds. Could the minister explain how he intends to close that gap?

[3:15 p.m.]

Hon. A. Dix: Really, there’s a bit of compare and contrast here. Our budget to build out long-term-care capital is now $3 billion. That reflects the exceptional priority that we give to long-term-care capital. Just to put it in context, in the period, though, the ten years prior to my becoming Minister of Health, that number was $17 million — $17.6 million; let’s give full credit — over ten years before I became Minister of Health, as the population was aging. And we’re doing $3 billion.

I would say that number is probably around 180 times more in this period than it was under the previous period. I agree with the member that there’s been an underbuilding of long-term care, and there are two sets of issues involved in that.

One, we had 17 facilities that were built prior to 1970. So we obviously need to in some cases replace and in some cases upgrade those materials and those buildings and, at the same time, add new buildings and space. We’ll go over some the details of this, but the context is $17.6 million against $3 billion. That shows the level of priority that we give to this item.

To date, as I think the member noted, nine projects have been approved and funded from this envelope, using $1.4 billion of the funding, leaving $1.6 billion to go. Those include projects all around B.C., from F.W. Green, which we discussed in last year’s estimates, to long-term-care facilities in Campbell River, to Nanaimo, to Abbotsford, to Delta, to Richmond, to St. Vincent’s, to the West Shore care home in Colwood.

In addition to that, we have, of course, a significant investment in addition to the capital budget: in the Interior Health Authority, for example; in new long-term care, some of which has recently opened in the contracted sector. And we’re going to continue to invest.

What we’re seeing — I agree with the member that the process is expensive — is a simply unprecedented level of investment in long-term care. It’s required, I think, all over British Columbia. If you look at existing facilities, for example, in communities that are growing — such as Fort St. John, obviously in the Fraser Health Authority, with the changing community in Vancouver Island, communities like Quesnel — you see a real increase in demand.

We’re doing things both within the direct funding envelope and in the work we’re doing with groups such as Providence Living in Prince George, which is adding 200 beds in that community, and doing so in a way that was important.

It was important to me, that work that we’re doing with Providence Living in Prince George. It was important to me because we’re also doing another major capital project, which we’ll discuss later, around the University Hospital. What that allowed us was to make a major investment in long-term care without imposing those costs on the regional health hospital districts, which we did, for ex­ample, in the East Kootenays.

This is an exceptional investment in long-term-care capital that’s taking place right now, a historic one. And the reason it doesn’t feel as historic is that we’re effectively…. It involves, in total, when all of the things are under consideration, 4,078 beds. Of those, 2,235 are net new beds, and 1,843 are replacing old and outdated beds but giving us new beds, both of which are necessary.

S. Bond: I know the minister will understand that I’m going to agree to disagree. The fact of the matter is 1,400 of 2,500 beds are not accounted for. Yes, the minister can call the investment historic.

What’s also a big challenge is we’re going to need 30,000 new beds by 2035. According to the minister’s answer, there is no plan to actually meet that target. That is a significant concern when it comes to the fact that these units are now costing $1 million each. Think about that.

[3:20 p.m.]

I’m going to leave it there, because I have to move on, but 1,400 of a committed 2,500 bed units remain unaccounted for. Hopefully, the minister can provide, at some point, a plan to British Columbians for how he is actually going to meet the announcement that he made, which was 2,500. We’re missing 1,400.

Let’s talk about what the previous government did. One of the things we did was…. So 5,000 contracted long-term-care beds were constructed through requests for proposals.

Will the minister tell us today whether he intends to use the capacity of the private sector to help meet demand? What requests for proposals are planned for contract providers to bid on over the next five years?

Hon. A. Dix: A plan is what we didn’t have. We had a decade of non-investment. We’ve gone, in three budget years, from $1.3 billion to $2.039 billion, which we discussed in Budget ’23, to $3.2 billion this year. We’re building those beds. We announce those projects all the time. We’re going to continue to do so.

We also had a contracted bed process, which started, I think, in the Interior Health Authority, for 495 beds in 2020. Of course, we’re going to consider looking at further contracted beds, including the discussion, which I think the member and I had earlier, about ensuring that non-profit providers have real access in such RFP arrangements. Everybody knows, I think, that one provider got a very large share of beds in the noughts. The result of that hasn’t always been satisfying, although they’re working on their beds.

The short answer is that we have done RFPs. We have added, especially in the non-profit sector, significant beds, recently in Burnaby, for example, and we have the PICS project in Surrey. In all of those places…. Then on that side of things, we have the significant project, the 200, in the member’s own area, in a general sense, which serves her constituency and others in Prince George, with Providence Living.

There is a plan. It has been laid out in a budget. We have bed targets, and we’re building the beds. We’re making up, really, for a failure to do such investment in the past.

With respect to RFPs for contracted providers, of course we’re considering those.

S. Bond: The minister is, unfortunately, characterizing the past years in a way that’s inaccurate, and he knows that. To suggest there wasn’t investment is simply not accurate.

I’ll ask the minister again. How many net new beds will be built in the next five years? And I will add to that question. How many replacement beds, during that same time frame, will be built?

[3:25 p.m.]

Hon. A. Dix: The projects up to now add up to 4,078 beds. With the significant increase this year, in the planning stages are a further 1,276. In the former total, 2,235 were net new beds, and 1,843 were replacement beds. The new numbers, the additional ones, are 1,276, of which 302 are replacement beds and 974 are net new beds.

We have 45 health authority–owned and –operated long-term-care homes built before 1980 that are largely out of date, and no investment happened in the ten years before I became Minister of Health. Those are just the facts.

We are making up for this with the most significant investment in long-term care in history. I know that people may say: “Well, that’s not enough.” But it’s the most significant building out of long-term care that we’ve seen. We’re going to continue to do this work, but the fact is that we’re making up for ten years before that when that work wasn’t done.

S. Bond: I am absolutely going to avoid the temptation to have a question period like we experienced this afternoon.

We need 30,000 new beds by 2035. At this rate, we simply will not meet those targets, and people are going to be struggling.

Of the 495 beds promised in 2020, can the minister tell me how many are fully operational? Could the minister provide me with a specific update for the beds that were planned for Penticton?

[J. Tegart in the chair.]

Hon. A. Dix: The 90 beds in Vernon opened in February 2024. The 140 beds in Kelowna are scheduled for July of 2024. So in a couple of months. Contracts are in place for that. The beds in Nelson will be open in September 2024 and in Kamloops in 2025.

The Penticton process is one that shows some of the limits of contracting processes in small communities, I think, in terms of the availability of land. In that case…. We would say we were successful in other communities in getting qualified bidders, and we haven’t been in Penticton. What that reflects….

This has occurred before. We have to clearly review that, because that community needs beds and needs excellent providers as well. By Penticton, I mean Penticton and Summerland and the community. That process has not, so far, been successful because of a lack of successful bidders. This is frequently the case in smaller communities.

[3:30 p.m.]

It’s what argues, in some of those smaller communities, for different models, such as the one, for example, that we just are putting in place in Kitimat for dementia care in that community, where you have, perhaps, a smaller base of a long-term-care home and different costs.

In Penticton, we would love a major care home provider to step up and take that contract. That hasn’t happened yet in the case of Penticton.

S. Bond: Well, thank you to the minister. Let’s just remind everyone that those beds were promised in 2020, and some of them won’t open until 2025.

I want to go back for one quick question. I just was thinking through the answers that the minister gave me on wait times. Did the minister say that the 134 average days of wait was Q1 only in 2023-24?

Hon. A. Dix: Yeah, those are the Q1 numbers.

S. Bond: Could the minister provide me with the longest wait-time number for long-term care, the longest number of days that a senior would wait?

Hon. A. Dix: I’ll ask people to look through the health authorities to see if there are some of them in those circumstances. We have seen anomalies over time, I think, in a couple of health authorities, where people were on the list but weren’t actually waiting that long. They were on and then off the list, and so on.

I’m happy to come back to the member — we’ve got a few days, and we’re probably, maybe, at the beginning of estimates — in response to that question, in detail, as to what can happen to people in those circumstances. I think sometimes the anomaly case has its own specific considerations. It doesn’t represent a good example. But I’m happy to get back to the member with some answers.

S. Bond: That would be appreciated.

In 2021, the Canadian Standards Association introduced voluntary safeguards to ensure safe operating practices and, particularly, infection control in long-term care. There are a variety of things that they cover, including room occupancy and building materials. The minister has several times today referenced the fact that we have many aging long-term-care homes. In fact, we know they do not meet modern infection control requirements and design or align with the standards.

I’m wondering if the minister is considering and imagining how expensive that will be. It’s simply not feasible for many not-for-profit long-term-care homes. Has the minister explored the possibility of establishing a comparable renovation fund to support those homes in achieving compliance with national standards?

[3:35 p.m.]

Hon. A. Dix: One of the ways that we started doing that is by EquipCare, which was started under a different name by the previous government, a different name provided by the care providers. I’ll call it EquipCare. We’ve significantly increased its funding. That money is taken by the B.C. Care Providers to deal with and deliver on our behalf.

I’ll resist saying that we sometimes have other agencies deliver grant programs on our behalf. I thought I’d make the hon. member laugh today, at least. Did you see where I got in there? I was just making sure….

Interjection.

Hon. A. Dix: Don’t call for a review of EquipCare, which is a well-managed program. I know it’s well managed because it’s being managed by a former Minister of Health.

An example: $14 million last year, $6 million…. Because a lot of what we’re talking about is minor capital, it’s really important for both some for-profit providers but also for not-for-profit providers. What I’ll do on that side is…. There’s some detailed information on the grants, which I’ll share with the member, if that works for her.

As well, during the very significant investments we’ve made in infection prevention and control…. It is interesting, the approaches that you need to take, because some is capital. It may be a follow-up question. We’ve got the answer here about single bedrooms and the evolution on that side. That’s going to be greatly changed and reduced in B.C. by the capital plan that we’ve put in place.

What is interesting is that while it is true that some older buildings have challenges in terms of infection prevention and control, most of those older buildings are health authority–owned and –operated buildings, which measured up well in terms of infection control, during the COVID-19 pandemic, against just about anyone else in the country. That tells us how much infection prevention and control is about the outstanding staff work done by care aides and by nurses and by staff in our long-term care. So it’s not just a matter of that.

In terms of the issue of supporting the care homes…. The non-profit care homes, in particular, is one that I’ve discussed with the sector significantly in the last while, because it is a concern of mine. We depend on those beds.

I’ll just give an example of a case where we acted. There are a number of cases where we’ve acted for smaller care homes to address per-diem situations to allow them to continue to function.

In the case of New Vista, we provided some direct support at year-end. I believe it was year-end 2017-18. That decision, which allowed New Vista to proceed with its project — which includes support by the Korean-Canadian communities in culturally sensitive care, culturally appropriate care in that facility — meant we got all kinds of new beds, and we were able to, for the smallest amount of money, repurpose existing beds.

It’s now called Chénchenstway. I really would encourage the member to visit there. It is a partnership, really, for Providence Health Care, Vancouver Coastal Health and Fraser Health.

[3:40 p.m.]

We have the movement of people who are in multi-bed rooms that did not have good infection control standards — including at Mount St. Joseph’s, at Queen’s Park Care Centre and others — into the previous New Vista, which had been refurbished. It’s an example of just that kind of work with funds.

I have felt for a long time that we needed to support the non-profit sector, that they play a critical role in the community. If the member is asking if we need to have funds to support them in their capital needs over the next number of years, the answer, I think, is yes.

S. Bond: That was a long route to getting to yes, but I appreciate that, even a little journey past whether we should call a review or not.

I want to move on to something that is a really significant concern. It’s not just that we talk about often frail elderly British Columbians, but it’s a big challenge in the health care system. It is something where we have to do better: the issue of caring for alternate-level-care patients.

It is hard to imagine what it is like. Well, it isn’t hard for some of our families to imagine, because we’ve experienced it. An alternate-level-care patient is a patient who no longer requires acute care services, but there’s literally nowhere for them to go that is appropriate for the level of care that they require, whether that’s home health support or whether it’s placement in a long-term-care space.

If we look at the seniors advocate’s latest report, she pointed out that the number of ALC cases has increased by 8 percent over the past year, to nearly 23,000 people, with 84 percent of them being seniors. If you think about it, the average length of stay for seniors in alternate-level care is 21 days, but there are very significant variations in the average length of stay in ALC.

I can tell the minister that 84 days is the average length of stay for an ALC patient in Northern Health. That simply has to change. If we think about that, it’s a challenge from a number of perspectives. One of them is that we have the need to utilize every single acute care bed that we have. We have people in hallways. We have wait-lists, waiting times to get out of emergency. We need the beds for acute care, yet we also need places for people to go where they are going to be treated with dignity, respect and the level of care that they need.

Obviously, quality of care and quality of life is our first priority, but when you look at it from an economic perspective, taking care of a senior or caring for a senior in a hospital costs anywhere between $825 to $1,968 a day. Think about the impact when it comes from an economic perspective.

When you look at long-term care, it’s approximately $250 a day, more suited to the care level that is required. Not only that, but a hospital bed isn’t a place where an alternate-level-care senior should be for 84 days. That’s the average number. In essence, there could be a lot longer stays.

I would like the minister to outline for me what exact steps are being taken. We have short hours. What exactly is going to be done to deal with the increasing number of patients being kept in acute care beds when that is not the optimal place to look after them?

[3:45 p.m.]

I just want to take the opportunity to ask the rest of my question. The minister can either answer them all at once or can come back to me with the specific details. Obviously, I would like to better understand what the plan is so that we have seniors and others not waiting in hospital beds — but some very specific details.

How many base beds are occupied in acute care today by ALC patients? How many surge beds are there occupied in acute care today by ALC patients? How many are currently waiting for long-term-care beds? Not all our ALC patients are seniors. To that end, what proportion of the patients are seniors over the age of 65? Lastly, what is the average quarterly length of stay for ALC patients in each health authority?

I want to make sure…. It should start with how many ALC patients there are currently in each health authority. What is their average length of stay? I would like the minister to provide a very transparent, detailed picture of the situation when it comes to alternate-level-care patients in the province.

Hon. A. Dix: We can search it out. There were quite a few detailed questions there. Sometimes that isn’t presented in exactly the way that the member has asked. I’ll commit to do it, simply, at the beginning of tomorrow’s estimates, on some of the detailed questions, so that we don’t use up the member’s time now, if that works for the member.

I was just waiting for one really extraordinary fact: in the last five years, if you look at the British Columbia population over 70 and from 75 to 79, those categories of people have had the largest increases in the entire population. We have seen an increase of 42,000 people from 75 to 79. We have seen an increase of 16,000 people between 80 and 84, and of 9,000 people who are 85-plus. That is a growing population in the period leading into 2022.

We’ve just recently, in ’23 and ’24, had the two fastest years of growth in the history of the Medical Services Plan. We will talk about that. Yes, there is a significant demand. What I’ll do is provide some details of information we’re seeing on the ALC rate in general. It’s lower than it was in 2019-20, in ’22-23, but it varies by health authority. It’s the lowest in Vancouver Coastal Health. It’s the highest in Northern Health.

None of this is a surprise, and that was the case. It was the lowest in Vancouver Coastal Health ten years ago as well, and the highest in Northern Health ten years ago. Some of that is in the nature of the alternatives that are available to people when they go into hospital and, in some cases, in the types of acute care facilities we have and the nature of them.

With very significant efforts — this is a daily focus for us — we had, last week, on average, fewer people in acute care, but that number was in the neighbourhood of 10,100 overall in acute care. That really tracks to about 400 to 500 more than it was in the immediate years before that, at this time of year. We’re not comparing the highest, which was in the neighbourhood of the 10,400 that we were at in January, during respiratory-illness season, but overall.

[3:50 p.m.]

What we’ve done, of course, is increased, significantly, the funded beds in acute care to address that. We now have 9,929 base acute care beds, and we have surge beds as well. Typically, our statistics are based on base beds, and we’ll provide more of that.

I think the member was asking for some of the strat­egies in dealing with alternate level of care. I have really quite a lot of detailed information. What I would propose and each health authority it involves prescribing…. A lot of it involves home health, because that is sometimes the reason….

The wait-time statistics against going into long-term care are one thing. We discussed those earlier. What we’re concerned about, and what’s important in many communities, is ensuring that a proper level of home care and home support such that a person can leave the hospital and go home.

It involves both investments on the home care side, on, in some cases, the virtual care side and virtual care supports that might make that easier for some people in the community, and of course, places in long-term care.

What do you need to do? Well, you need to do, I think, the things we’re doing, which is build a lot of long-term-care beds. This is what we’re doing. Ultimately, if you’ve got a rising population in the very area where you need care, building, as we are, thousands of long-term-care beds makes a lot of sense.

What I’ll do for the member is both do a summary of my note here, rather than…. It would be like a ten-minute read into the record of the different actions we’re taking. What I’ll do is I’ll provide a summary tomorrow of the best we do with the stats we have on ALC beds, and then a summary of the actions in different health authorities, because some of the things you do in Northern Health are different than in Fraser Health.

If that would help the hon. member, then we can proceed, or I’d be happy to read it out, but I think this would be a better way.

Interjection.

Hon. A. Dix: Is it okay? Sure.

S. Bond: I appreciate that, and I’m fully cognizant of knowing, in a very in-depth way, the Health Ministry’s workload. It doesn’t even need to be by tomorrow, from my perspective. I understand the workload. As long as it’s through the course of our next number of days and post-break, that’s fine.

I will just signal that I’m going to move on to rural seniors, in particular, after we get through this step.

Hon. A. Dix: What we might do is if we get some, we’ll get some to you.

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

The committee rose at 3:53 p.m.

The House resumed; The Speaker in the chair.

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

Reporting of Bills

BILL 3 — BUDGET MEASURES
IMPLEMENTATION ACT, 2024

Bill 3, Budget Measures Implementation Act, 2024, reported complete with amendments, to be considered at the next sitting of the House after today.

Hon. A. Dix: I call Committee of Supply on the Ministry of Health and — some people might have thought that was the end of the sentence, but it wasn’t — the Ministry of Labour in Committee of Supply, Section A.

[3:55 p.m.]

Committee of Supply

ESTIMATES: MINISTRY OF HEALTH

(continued)

The House in Committee of Supply (Section B); J. Tegart in the chair.

The committee met at 3:56 p.m.

The Chair: We’ll call the committee back to order. We are dealing with the estimates for the Ministry of Health.

On Vote 32: ministry operations, $32,710,062,000 (continued).

S. Bond: I want to move on to…. I have a lot of questions about this, but I should probably think of a way to just reflect my deep concern about the report that was released by the seniors advocate, related to the health and challenges facing rural seniors.

The report is called Resourceful and Resilient: Challenges Facing B.C.’s Rural Seniors. Those are words that I use about rural British Columbians all the time, but the report overwhelmingly demonstrates that people who live in rural parts of British Columbia are facing greater obstacles in accessing services, affordability and disparity in resources. The seniors advocate summarized it by saying: “On all metrics related to healthy aging — access to care, housing, transportation, community supports and financial re­sources — rural seniors fall short of their urban counterparts.”

All of us should be concerned about that statement. I’m concerned about it very personally because it’s where I live. I’ve experienced it. I see it, and there are many MLAs in this chamber representing those parts of British Columbia who also have experienced that. I have a number of specific questions.

I have already raised the issue of ALC patients, and I want to just add this to the minister’s to-do list and the homework that he’s going to do. Rural seniors face a 27 percent longer length of stay in ALC. I would like, also, as the minister brings back the numbers, some sense of how the rural lens is going to be applied to the issue with alternate-level-of-care patients because it is not equitable across the province.

If you look at the report, 85 percent of ALC cases in rural areas are seniors. What that tells us is that we actually have to look at how we target investment in rural parts of the province to deal with those issues. So I would like to add the ALC patient information, and a rural lens being applied to that.

Let’s look at some other statistics. On average, rural seniors receive 19 percent fewer hours of home care. Can the minister describe for me what plans are in place to increase home care services to provide more equity for rural seniors?

[4:00 p.m.]

Hon. A. Dix: First of all, this budget focuses on home support. We talked a little bit about the federal funding earlier, but the federal funding is largely in the area of home support, a continuation of existing funding. I think when we were discussing the aging with dignity fund, the funding that we have with the federal government, that’s really status quo.

What we see in Budget 2024 is $227 million in incremental funding over three years to hire home support workers. There is a real focus, for the reason the member has expressed, in the delivery of home support services, which are materially affected by geographic and the associated costs involved in delivering home support services in rural and remote communities — in particular, the investment in community programs. For example, the $127 million over three years to expand and evolve the existing programs for seniors and to modernize the service delivery model.

As you know, some of this is Better at Home, which was started under the previous government. There’s a line through there and has been dramatically increased by the current government, providing its services: 93 programs across 260 communities, including First Nations communities. The increased funding is enabling the Better at Home basket of services to expand significantly and putting a greater emphasis on social connection.

Finally, I would say, and importantly, because you can announce budgets, but you need people. We know this. That’s why the HCAP program and its significant expansion into home support is making such a significant difference across the province. More than a thousand of those graduates — we’ve talked about 7,600 people come through the HCAP program — are supporting home support across the province.

There is a strong focus on the very things the member talks about. Some of those things and I don’t think we want to…. We’ll do this sometimes, I think, these comparisons, past-future. This is not a new problem in the delivery of home support services in rural communities.

What we need is to ensure both increased and im­proved transportation options, and we’ll talk about some of the things the government is doing when people have moved, and also improved and better access to virtual care options for people. Also, of course, the assuring that this very significant investment in this budget for both community-based programs and home support programs directly sees an improvement and an assurance of improvement and greater equality of access between urban and rural British Columbia.

[4:05 p.m.]

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

I think I’m going to just attempt to summarize some of the significant challenges and then perhaps ask a more general question, because the circumstances are simply not equitable.

When you think about what the report identified, particularly this and I’ll quote from page 33 of the report: “Rural B.C. has a proportionately larger and faster growing seniors population than urban B.C., yet it has less infrastructure and resources to support its aging population.” That’s the challenge in a nutshell.

When you look at the statistics, in virtually every single area — and I’m not going to canvass the whole gamut of services; we want to focus on health — it is right across the spectrum. I’m going to just highlight a couple of the critical gaps that exist.

In addition to home care hours, 17 percent of rural seniors lack a family doctor or nurse practitioner, and that is significantly higher than in urban areas. The affordability issue is a critical barrier for rural seniors accessing needed health services.

My questions there are related to why rural seniors have to pay additional dollars to travel to a community, potentially hours down the road, to get some kind of care?

The report also points out that there is a significant shortage of publicly subsidized long-term-care beds. We’ve talked about that. But here’s the statistic: 55 percent fewer beds per 1,000 rural population aged 65-plus. That is at a time when our population in rural B.C. is growing proportionately larger and faster than urban B.C.

The list goes on. When you look at the median wait times for publicly subsidized long-term care, it is twice as long as urban British Columbia. I could go on. I mean, there are a myriad of issues. I’m wondering what the ministry is doing to develop a comprehensive overarching approach to rural health care in British Columbia.

Heaven knows we have a Parliamentary Secretary for Rural Health. We have all kinds of people talking about their roles. Yet we need to actually see a well-articulated cross-ministry approach to the gaps that exist, depending upon where you live in British Columbia. That is simply not acceptable.

One of the most devastating things is the underestimation of patients that have to travel outside of their community for care. There are lots of really good examples of it. We’re going to talk about some of them in the health care portion because heaven knows ER closures are happening daily, diversion — the list goes on.

I would like to have the minister describe for me how the ministry is addressing the unique challenges that are posed by the geographic isolation of rural British Columbians, particularly seniors. If the minister could give us some degree of hope.

When this report was presented by the seniors advocate in communities across the province, the response was hard to watch. Rural seniors sat and listened to how their lives are not treated equitably. The thing is, as the title of the report points out, they are resourceful and resilient, so they often don’t rise up and increase public pressure. It’s our job to actually speak up on their behalf.

Could the minister describe for me how the ministry received the report from the seniors advocate and how they are tackling the gaps that are listed? There are lots of them. Is there a cross-government approach to trying to close some of those significant gaps?

[4:10 p.m.]

Hon. A. Dix: The answer is yes. It starts at every level of care, and I’ll talk about some of them.

On the acute care side, we are making some of the most significant investments the province has seen. Disproportionately…. There’s always a debate on these things, but we’re making very significant investments in the Northern Health Authority.

We went first to Terrace and to Fort St. James and to Quesnel and then to Dawson Creek. And we’ll talk about the investments in Prince George. In Fort St. James, which for me is a community that evokes the very problem and the very challenge the member talks about, we see a declining working-age population and a dramatically increasing seniors population, which presents real challenges.

It’s not just announcing something. You’ve got to staff it in that circumstance where the number of people who need a service goes up, the number of people who are there in the area and getting the service goes down. So, in Fort St. James, we’re not only building a new hospital but also adding long-term-care beds as part of that project.

On the capital side, we’re seeing very significant investment in communities, and this includes in long-term care as defined by the OSA report. The 90 new beds in Vernon, the 75 new beds in Nelson, the new beds in Fort St. James and the new beds that have just been developed in Sechelt are examples of projects in rural areas.

And further in long-term care, Comox and Cranbrook and Campbell River and even the Prince George project, which we may talk about in a few minutes, for long-term care are ones that would provide and do provide and support rural access. So major investment in capital and rural B.C., major investment in long-term care in rural B.C.

In addition to that, a significant rural aspect of the health human resources plan, and just looking at some of the actions in that plan, the new-to-practice incentive directly provides an incentive to rural and remote communities. That’s been the new-to-practice thing — because the member talked about access to a family doctor — which has transformed and returned a whole bunch of new doctors to family practice.

Specifically, as part of that, there are specific incentives and support for rural and remote communities. Health care workers in rural and remote communities are eligible. This is action No. 6 for the provincial rural retention initiative. They are obviously in partnership with Northern Health. There’s the provincial travel resource program, which for nursing is 186 nurses.

In addition to that, we see that incentives for workers in rural and remote communities were a key part of the nurse-to-practice ratios. For example, eligible nurses who fill high-need vacancies in rural and remote communities will receive up to $30,000. Eligible members, nurses who are part of GoHealth, which is really designed to support rural and remote BC, $15,000. It’s part of that student loan forgiveness program. Rural Coordination Centre, the locums for rural B.C. and the rural practice subsidiary agreement are just some examples of rural workers support that are significant.

There are more. I won’t go through any of those, but just to say that I think that the issues in rural health have to be part of every significant part of plan the government puts forward, and they’re very significantly part of the health human resources plan.

In addition to that, if you look at rural transportation…. I think this is an area where I have long agreed and long advocated for the need, as some health services are centralized, to support greater rural transportation. You saw that in what was delivered starting on April 20, 2021, with the very significant changes and improvements in the ambulance service. We’ll talk about that later, so I won’t get into that.

Both in terms of the fixed-wing and rotary service that are provided that strongly support rural B.C. but also ambulances on the ground, and really the focus of that initiative on communities…. We’re going to be talking about the specific progress. I think we’re going to be releasing some information publicly tomorrow about the progress we’ve made in rural communities and supporting ambulance service. In fact, the most dramatic changes to the ambulance service to BCEHS that have been made have been made to support care in rural communities.

Recently, as part of the ten-year cancer plan, the member will know a very significant improvement to travel for cancer patients, which I think is….

[4:15 p.m.]

I think what I’ll do is rather than go through in detail the success of that, I’ll share some of the preliminary data with the hon. member for the first few months of the program. But suffice it to say, there was a dramatic increase in access to care, both in communities, so when people were travelling for care but also in travel and transportation.

In every aspect of what we do, this is a focus of it, whether it’s health human resources, which is critical; whether it’s providing care in community; whether it’s ensuring that the capital projects in smaller communities are given the priority they absolutely deserve.

In the case of the Fort St. James hospital, I just say this. Sometimes I go: which government did what? That’s a hospital that had a ten-year life from 1972 to 1982, and subsequent to 1982, when that life was supposed to expend, we’ve had Social Credit governments and NDP governments and Liberal governments and now a NDP government again. We’re building that project, but it was a temporary modular hospital built in 1972 that we’re replacing and will be open in 2025.

Acute care, long-term care, home support, the health human resources plan, transportation are all key aspects of what we need to do to provide and support rural health. I think you see it in every initiative we take place, and I would expect to see it in every initiative we take place, because the needs and demands of rural B.C. are different than other places.

I will say, finally, the Better at Home program, which reflects the needs of communities, is community-driven. The average funding for that program was in the neighbourhood of $5 million, and it’s gone up, when I became Minister of Health, per year. It’s now $45 million. It provides care around the province, driven by community organizations around the province.

What we see through all of this is the focus and the absolute need for focus in rural B.C., where we see, in relative terms, a population that’s getting older and that presents — it’s not going to stop presenting — challenges. That’s why rural B.C. is such a focus of everything that we do.

S. Bond: Thank you very much to the minister.

I will simply end this section for now with a reflection on what the report of the seniors advocate said. What she said was: “While seniors everywhere are experiencing challenges, rural seniors face greater obstacles because they do not have the same level of access to services and supports as their urban counterparts. Whether it is access to a family physician, 24-hour acute care hospital services, diagnostics and laboratory, medical specialists, long-term-care beds, home care or ambulance services, seniors in rural B.C. enjoy less access than their urban counterparts.”

It shouldn’t matter where you live in this province. When you need health care, you need it close to home, surrounded by the people who care about you. And isolation or geography should not determine your health care outcomes.

One of the recommendations, which I think has really important merit, is the development of looking at this whole issue across a number of ministries. The recommendation is there needs to be cohesive plan developed that looks across all domains of healthy aging. It’s not just about the health side of it. It’s about housing and transportation and income and ensuring that seniors, wherever you live, have equitable levels of support to allow them to age well in their homes and in their communities.

I think it’s also an appropriate moment to reflect on the contributions of the seniors advocate, Isobel Mackenzie. The minister and I and many others were at her retirement event recently. It was interesting because very much celebrated in terms of the position that was created, the work that’s been done. I just want to express my gratitude to Isobel Mackenzie for stepping up and speaking up. That was her job. We certainly wish the new seniors advocate much luck, much success as he takes over the role.

I’m going to move on to the next topic now. We’ve also canvassed this a number of times, but it’s important to bring it up every single time we talk about seniors.

[4:20 p.m.]

I know the minister and I agree that seniors deserve respect and dignity when they are in long-term care, yet there are some very alarming statistics that describe what is a distressing reality. A third of residents in long-term care are administered antipsychotic medications, and 29 percent of residents are administered these medications without an accompanying diagnosis of psychosis. Both of these measures of antipsychotic usage are above the national average and have been increasing every year since 2018-2019.

Last year I asked the minister about this. He stated that there was an action plan to reduce this and meet targets. But as we see from this year’s updated service plan forecasts, targets were in fact not met.

Can the minister describe for me what strategy is being utilized to reduce the inappropriate use of antipsychotics in long-term care?

Hon. A. Dix: Before I get on to that very important question, I just want to say a couple of things to finish the section on rural health. Kelly Gunn, who the member will be familiar with, from Northern Health, has come to be part of our development of a rural health lens on everything that we do. She’s an important leader in this area and I think will do an excellent job.

Just to say, in general on family doctors, that’s why we’ve taken the measures we have, and I described the specific aspects of those measures that support family doctors in rural communities. There are many more. Just to say that 708 net new longitudinal family practice doctors is significant.

On diagnostic care, for example, in Northern Health, there was only one MRI machine in all of Northern Health when I became the Minister of Health, and we’ve significantly made a difference in Northern Health, maybe more so than any other area in the province, on diagnostics.

On long-term care, the long-term-care homes we are building not just in urban B.C., not just in the suburbs, but in rural B.C…. And on ambulance paramedics, I’d just say: 1,500 new full-time, part-time, permanent paramedic positions since 2017, 700 of which are in rural and remote communities. This is transformative for those communities, going from a set service which was basically not a permanent service in rural and remote communities to one that is. So those are significant improvements.

I know that Kelly will play a significant role. I know the member will know Kelly and know her commitment to rural health, and we’re very happy to have her as part of the team in that regard.

With respect to the use of antipsychotics, this is too high a number, and it’s the reason why we measure. We want to know. We want to ensure that this maintains and will continue to be a priority for us, and we have a working group that works on this that actively engages with key partners, with clinicians, with dementia care experts.

We, as the House will know, are actively looking and working and recently announced in Kitimat, for example, dementia villages, which we think will provide better overall care to people living in long-term care who are the majority now, who have some diagnosis of Alzheimer’s or other dementias.

What we are putting in place in our long-term-care quality framework, which I think we’ll be providing soon, is a strengthening of the monitoring and oversight of the use of antipsychotics in long-term-care settings, which is critically important, because frequently…. And we know this. This is one of maybe the most difficult statistics that we deal with in long-term care. It’s that a majority of people in long-term care, and this is from a seniors advocate report, don’t receive any visitors. So quality standards and oversight are critically important in this area.

We are ensuring that that is implemented in the long-term-care quality framework, because the numbers are high. I’m not satisfied with it. I’m not happy with it. Those measures had gone down slightly in the years just prior to the pandemic, and then they’ve gone up since the period that the pandemic was in place.

[4:25 p.m.]

That’s why we’re taking these actions in long-term-care settings and implementing that quality framework, which we believe will have an impact on that, on the ground, with people living in long-term care. But the number is too high. Even if it’s gone up a little bit and there’s an argument for it of what happened during the pandemic, nonetheless, it was too high before the pandemic.

So I would say it was too high ten years ago, and it’s too high now. That’s why the very significant efforts are being made by very thoughtful people to see it brought down. At the core of that is oversight, education and support.

S. Bond: Well, we do know that there were targets and they were not met. I appreciate the minister is not happy and the numbers are too high, and I couldn’t agree with him more. Perhaps the minister could tell me: who is responsible for executing the strategy? Is there a specific division in the ministry? How are we going to move forward with meeting targets? Who’s responsible for that? And is there a budget assigned to the strategy?

Hon. A. Dix: I’ll just mention five things. The ministry has developed a provincial policy that establishes clear expectations and accountabilities of health authorities and operators regarding the use of antipsychotics in long-term care, because while there is provincial policy, it has to matter on the ground. It has to matter in every care home, in particular, in B.C.

Policy ensures a standardized approach to the use of medications to manage behaviours and empowers the ministry to monitor the performance more closely in each health authority. Health authorities will be held accountable for prescribing levels and ensuring quality improvement actions are implemented. This will be implemented in June of 2024.

In April 2023, a provincial advisory working group was established to inform and support the antipsychotics-reduction strategy. That includes key partners such as Health Quality B.C., physicians, pharmacists, health auth­ority clinicians and dementia care experts — in other words, the people who really know how to deal with these issues. The group has met seven times to inform and develop evidence-based actions that ensure the appropriate use of antipsychotics in long-term-care settings.

Thirdly, the ministry has increased education resources to support quality dementia care in long-term-care settings. In April 2023, the PIECES program expanded to include all five regional health authorities, and by March 2025, there will be up to 140 active PIECES educators throughout B.C., increased from approximately 25 before September 2022.

B.C.’s aging-with-dignity action plan will increase de­mentia education resources, building on the PIECES person-centred approach by providing education to front-line staff in long-term-care settings. I think we’d all agree that that’s very important.

Fourthly, we’re supporting what’s called Reimagining Long-Term-Care, a quality improvement collaboration between Health Quality B.C. and Healthcare Excellence Canada. It supported 79 B.C. long-term-care homes with high rates of potentially inappropriate antipsychotic use. That’s focusing on where the problem is the most significant and aims to drive performance improvements through coaching data improvements and culture change.

Fifthly, we’re funding research that will inform and advance actions aimed at reducing potentially inappropriate use of antipsychotics in long-term care. The 2023-24 research seed grant funding includes determining strat­egies that have demonstrated success in the long-term-care sector nationally, provincially and internationally — and to reduce and sustain reductions in medications for seniors.

Those are five aspects of the direct actions that we’re taking to improve the situation.

S. Bond: Thank you to the minister for the point-by-point explanation. I think it’s important. It’s actually a devastating discussion we have to have, because what this amounts to is a chemical restraint. That is not anything considered to be best practice, for sure. Imagine how difficult that is for families and caregivers who really want to understand what’s happening. They deserve transparency and accountability.

[4:30 p.m.]

I appreciate the minister listing specific actions. I am very concerned about the fact that targets were put in place, and what we saw was — I’m looking at the chart in front of me — the numbers got worse, not better. That is devastating.

I am certainly not casting aspersions on staff. The work that they do is unbelievable. It is challenging. Very special people are called to care for people in long-term care. I know that very personally as a result of my parents’ situation in the past.

We have to do better. I certainly will be looking to see what we are doing to reverse that trend, looking at whether or not there is more funding available, for ex­ample, for behaviour supports, therapies and other non-pharmacological interventions. The challenge is going to become even more significant when…. We’re going to talk about dementia, shortly, but I did want to raise this issue. It is discouraging to know that the numbers got worse, not better.

I think it’s a story that isn’t told often enough. It is an important priority, and the minister noted that in last year’s estimates and said that there was a plan to reduce and to meet targets. Last year the target is going in the other direction, and we want to exceed it. It’s too high. We’ve raised this issue consecutively in estimates. It is something that families grapple with. Certainly, I think the bottom line is…. I would agree with the minister that we absolutely need to do better.

I want to move on to the issue of caregivers. When you think about the challenges that caregivers face and the ongoing, day-to-day…. On every single day, they do their very best to care for the people that they love and look after.

I would like to reference once again the bilateral agreement that was made, that was signed. One of the things that was referenced was strengthening “the appropriateness, safety and quality of long-term care by enabling consistent, appropriate standards of care and oversight” and supporting “aging in place through connecting frail seniors in their homes to a new outreach program through long-term care, providing supports, services and respite care.”

What I’d really like the minister to speak to is the sense of what…. When we think about the need for respite and how important that is…. Could the minister speak to how he intends to allocate funds, especially looking at respite and caregiver distress? How are we going to help support caregivers in a more effective way in the province?

[4:35 p.m.]

Hon. A. Dix: First of all, one of the issues the former seniors advocate and the current seniors advocate, Ms. Mackenzie and Mr. Levitt…. One of the things that we agree on, and I believe the hon. member does as well, is a real focus on adult day programs, on respite care. In fact, in my constituency, I made an announcement prior to the pandemic with Isobel Mackenzie that saw a very significant increase in those programs in those years.

They were profoundly affected by the pandemic. I mean, it is breathtaking what happened to the adult day programs. I care about all the programs, but it’s probably the one I cared about more than most, that I felt was personally part of the vision of what I wanted to do. We saw adult day program hours drop by 96 percent in the first year of the pandemic, because the programs were closed down, effectively. It was devastating for seniors and very difficult to deal with.

We have seen that rebound now. That’s year into year into year, and that’s a good thing. But it’s direct funding for home support, for professional services in the home and for adult day programs. It’s important and significant to that.

We’ve also doubled the funding for the Family Caregivers of B.C. to support caregivers and seniors. Obviously, very significantly in terms of caregivers, increasing the influence of families in long-term care, a measure that we talked about in estimates…. I know it was in a small room, and I think it was in 2022. The member and I talked about what we needed to do to get those initiatives in place, and we’ve done that.

The member referred to the Aging with Dignity fund, and one of the parts of that fund we’re most interested in and most enthusiastic about is some innovative ap­proaches to long-term-care delivery. For example, the idea that people who are living at home but are close to needing long-term care might spend three weeks at home and then have a week when they’re in the long-term-care facility and then back at home, extending out the period where they can be at home, but also providing relief to family caregivers and others.

This is amongst the specific initiatives that we expect to fund, not just with the Aging with Dignity fund, but obviously with provincial direct funding. I think that new approaches to respite care are critical in this time where we’re seeing a growing seniors population.

When most of that seniors population…. There’s a debate about whether you need long-term care, but I don’t think there’s much debate that we need supports in the community and greater ability and greater flexibility for people who want to stay at home but may need a week in a long-term-care home with the care provided there in order to do that. That might well extend the period that they live at home by months if not years, as a result.

Those are specifically the kinds of initiatives that we envisioned and we talked about in terms of innovative approaches to long-term care. Some of them also involve technology, being able to more effectively use remote patient monitoring technologies.

Really, periodic respite care in existing long-term-care facilities, I think, will go a long way to using those facilities more. You could imagine seniors involved in just the kind of program I talked about, the 21-seven program, over a month, who might be able to live at home. Actually, it would be less costly for the health care system in a way but also make it possible for those who are providing supports for them in the community, be they staff but also family members, to get the respite they need for the person to live their best life in those circumstances.

S. Bond: Thank you to the minister.

I know that there are great organizations providing support as best they can to many families who find themselves as care partners for a person for a long period of time. One of the things that is devastating to see is the exhaustion, the sense of wanting to do absolutely everything they can for the person they love, but there is such a lack of support, a place for them to get a break. It’s very, very difficult. The minister knows, and I know that ministry staff know, how painful that is.

I want to make sure, as we move ahead, that there is transparency about continued increases to adult day programs, respite programs.

[4:40 p.m.]

The reason it’s so incredibly important is we know that the vast majority of seniors live in community. They don’t live in long-term care. They actually live in community. For the vast majority of them, that’s where they want to be.

I think as we look at…. What do we need to do to pro­vide for an improved quality of life for people in the latter stages of their life? It’s make sure that they can stay home and be cared for as long as possible.

I want to recognize CARP. They sent a great article along. It’s called “Funds for Living at Home.” The minister will like this article. It says: “A good start.” It talks about the announcement that the minister referenced, including $227 million over three years to deal with community-based professional services, home support, those kinds of things.

I would urge the minister to have a look at that. Canadian Association of Retired Persons. Very active. They do great work as advocates. I did want to reflect that and thank them for the input that they’ve provided to me and, I’m sure, to the minister on a regular basis.

With that, let’s talk, I hope, for a few minutes about dementia. I’m sure the minister was as challenged, I guess, as I was when I saw the landmark study report No. 2.

When we look at the work that was done…. Very comprehensive. The challenge is the projection in the increase in dementia cases in British Columbia. What we know is that by 2050 the number of people living with dementia in British Columbia will nearly triple.

I think British Columbians need to understand how on earth we are planning and beginning to think about managing that. It’s not just the number. It’s who is going to be impacted. The impact on Indigenous populations, for example…. The number of Indigenous people living with dementia is expected to increase by 286 percent by 2050. That will actually exceed the overall population increase in a significant way.

We also know that there are gender differences. When you think about the diverse population…. The report predicts a 700 percent increase in the number of people of Asian origin living with dementia by 2050. One of the ones that is just very difficult to sort out is young-onset dementia. There are going to be a significant number of individuals under the age of 65 living with dementia by 2050.

There is already concern…. Long-term-care homes are often the place that individuals with young-onset dementia or acquired brain injury, all of those things…. That’s where they go. I’ve heard from families, personally, how difficult it is to see a younger adult in British Columbia be in long-term care for literally decades of their lives, because that is the only place they have to be cared for.

I know the minister, I’m sure, like I did, received a very thoughtful briefing on the landmark study. It’s deeply concerning.

Perhaps the minister could speak a little bit, having received the report, about understanding the need to be thinking much further ahead than we are. Perhaps he could speak to the plans that the ministry is beginning to contemplate when we think about the vast increase in the number of people and the diversity of people who will be impacted by dementia.

Hon. A. Dix: We sometimes have the dementia discussion in the context of long-term care. It’s important to do that because a majority of people living in long-term care have a diagnosis of dementia.

There are in the neighbourhood of 31,000 to 32,000 people living in long-term care in B.C. If one would assume two-thirds of those or, say, less than two-thirds have a diagnosis of dementia, that’s 20,000 to 21,000 peo­ple. There are approximately 67,000 people in the province living with dementia. So that means that the majority of people living with dementia are not in long-term care.

[4:45 p.m.]

Sometimes how we discuss these things…. Just recently the Alzheimer Society was here. We met. I was in, I think, Vancouver in the morning. I got back, and I met with them when I got back.

The ability of people to live in community is critically important. Sometimes what’s important for us to know is…. The discussion of Alzheimer’s and the discussion of dementia is a discussion of long-term care, yes, and community. The majority of it is, in fact, in community. So how does one create policies that support people in that circumstance? A good part of that is about building inclusion and understanding.

The number of people over 65…. I’m going to be 60 in ten days, so I’m thinking about this number now a little bit more. The number of people over 65 is 1.12 million, of which 30,000 live in long-term care.

The vast majority of that group of people doesn’t…. Their experiences as people over 65 are vastly different. When our life expectancy extends over 65…. The experience of someone in their late 80s and in poor health is very different than someone who is 67 or 68 or 69 and who is very active in their community. They’re active in their community. They may well still be working, or whatever the number is. When we’re developing seniors strategies, we have to look at the full development of those strategies across the board.

We are working on the final stages of developing a made-in-B.C. dementia strategy that builds on all of the initiatives we’re taking in this area and aligns with the national objectives of the national dementia strategy that was released in 2019. It communicates our priorities in terms of dementia care and services over the coming years.

I think it focuses on the following evidence-based areas. It’s very important, in this area and all others, to focus on the evidence. It’s improving understanding and building inclusion. That’s important for all of us. That involves all of us. Reducing risk and promoting prevention. Ensuring comprehensive and accessible services and support. Supporting caregivers, which we’ve just talked about, is critically important. And ongoing research and innovation, because we hope, through research and innovation….

The member and I were both members in this House in 2007 and 2008 when the then Premier of B.C., Gordon Campbell — who, I think it’s fair to say, had a particular interest in this area — as Premier, the member will recall, instituted an initiative in terms of research. That ultimately wasn’t successful in finding maybe the results they wanted but absolutely expressed, because you can’t start at the beginning of a research process and decide how it’s going to turn out at the end, and demonstrated the focus of research, which I think has been part of B.C.’s commitment in this area in terms of successive governments.

The ministry has completed extensive research and analysis of the literature in a cross-jurisdictional scan of 30 national, state and provincial plans and frameworks in order to develop the strategy. It’s being finalized. It’s my expectation that it will be available in the summer, in August. We’re working with key stakeholders, in particular, with the Alzheimer Society of B.C., to ensure that it’s informed by individuals and families living with dementia. It’s sometimes the case that those groups of people get lost in the development of a dementia strategy.

Over the next few months, a key portion of what we need to do prior to the release of the report is ensure Indigenous peoples and other groups…. Indigenous people, in particular, experience particular barriers in accessing dementia care and supports. The member just talked about the numbers. We’ll be consulting to ensure the strategies and initiatives are culturally relevant and safe and accessible for them as well.

That’s where we are in terms of the development of the strategy. This is increasingly going to be central to the way that we develop our society. The numbers say that.

We talked about rural health earlier and having that lens on everything we do. Well, in the health care system, this has to be part of everything we do.

[4:50 p.m.]

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

I totally agree there does need to be more education and awareness because for a lot of families, that doesn’t happen until there’s a diagnosis of dementia. Maybe not even a diagnosis, there’s just behavioural change. I shared the story at the ALS event that…. You know, we’re experiencing that in our family as we speak, and it is very, very difficult. Families right across the province experience that.

I wanted to be sure that I…. The aging with dignity bilateral agreement — there certainly was a portion of that funding…. It was outlined that a portion would actually go to supporting dementia care, and I think it’s important to reflect on that.

I will look forward to the strategy being released. I think the minister mentioned August. That’s, of course, provided we’re not on the campaign trail at that moment.

Interjection.

S. Bond: Yes, exactly.

Could the minister confirm that there is funding in aging with dignity? Perhaps give us a sense of what that funding will do and how it is related to the most recent landmark study.

Hon. A. Dix: There is an aspect in terms of improving dementia care. One focus, because it’s the absolute amount of money for that portion of the aging with dignity funding allocation, is $10 million over the period. That’s $3 million, $3 million and $4 million in the successive three fiscal years.

We’re focusing on, for example, the Alzheimer’s Society’s U-First! training. This is in response to sector partners. This funding will deliver education in a phased approach to front-line staff, including health care assistants, non-regulated allied staff and support staff, which is important. The funding will pay for staff time, course costs and administrative costs to deliver a program through virtual and face-to-face delivery.

Of course, this builds on the PIECES education program currently funded by the ministry, which is talking about providing quality care and focusing on quality care for older persons at risk or living with complex or chronic conditions. There’s lots going on in dementia care, but this aspect of it is focused on training and improving the quality of care, focused on health quality in the system. That was obviously a priority for the federal government and for ourselves.

S. Bond: I want to just talk a little bit more specifically about home support and home health. We’ve talked a number times in our discussions already about the bilateral agreement, with the $733 million over five years.

I would like the minister to perhaps describe for me…. There was an emphasis on, first of all, expanding and integrating home and community care services for seniors who have complex medical conditions and frailty. Could the minister describe…? It may overlap with some of the questions we’ve asked before, but it is important because it is talking about integrating home and community care services, especially for those who have complex medical conditions.

Could the minister describe how he intends to use the funding that is attached to that part of the bilateral?

[4:55 p.m.]

Hon. A. Dix: With respect to the aging with dignity funding, essentially that’s just an extension. The part that relates to home and community care is an extension of what we’ve been doing. They’ve been funding it in the $65 million range over the last period, and that just continues, essentially. We’ll be using it for the same good purposes we have been, but there’s not incremental money there.

In terms of the budget, the budget provides $354 million for home and community care for seniors. A lot of that is focused, of course, on respite care, on aging with dignity. We talked about the supports for community organizations and what they’re doing and, of course, home care and home support.

That’s really, in terms of seniors care, a very significant investment. But as I think the member might truly say and others would truly say, we’re seeing also a very significant rise in the seniors population. But this is a very significant investment that includes expanded training and delivery of services. Of course, I talked about the HCAP program earlier, so I won’t do that again.

In terms of the aging with dignity allocations, the home and community care part is a continuation in that sense. So while we’re glad that it’s continuing — and if it wasn’t continuing, we would be spending $65 million topping it up that we wouldn’t be using for other things — the most significant increases are the direct increases in the budget.

S. Bond: I’m sure the minister, like me and most other MLAs, hears about the need to expand the types of services that are available to home support recipients. Are there any plans to expand or increase the types of services that might be available to home support recipients?

Hon. A. Dix: This is a very significant increase in investment in home health, and it really reflects our priority over time. I spoke earlier about the significant funding for respite care and adult day programs, which is a major part of this. For people who don’t know, who think that adult day programs are…. Adult day programs provide a range of personal care, health care and therapeutic social and recreational activities. So an adult day program is different than an activity program for seniors in a community. It is significantly part of ensuring a healthier quality of life for all of the participants in those programs.

The increased investment we’re making in home health is intended to go deeper, especially with our existing…. Expand the number of clients, of course, but go deeper with our existing programs to provide more robust home health services so that people will be able to see their care needs met safely at home.

[5:00 p.m.]

The improvements that we’re proposing include providing more robust care management and care coordination. Clients have more contact not just with their worker but with the person who’s in charge of guiding their care experience. They may rarely see them now; they’re going to see them more. Expanding hours of service availability so coverage is more comprehensive and timely. And thirdly, increasing the flexibility and coverage of home support services.

It’s a matter, in many cases, of going deeper with our existing clients, ensuring that people directing their care experience and who can resolve problems for them are more actively involved in their care — which is, I think, very important — and of course, the increases that we would expect, given the demand for home support services in the amount of services we provide.

Those are the priorities as we set out this very significant investment in home and community care for seniors.

S. Bond: Thank you for that information. I want to just ask if there is any intention to revisit the choice in supports for independent living program or another form of self-directed funding. We know that seniors and families tell us that they value choice. Can the minister tell me if there’s any intention of revisiting the CSIL program?

[S. Chandra Herbert in the chair.]

Hon. A. Dix: I would say yes. That is something that we would seriously consider. When we’re talking about rural health, as we develop that, it may well provide us with some options with respect to rural health that the existing programs don’t have. I would say, though, that in a general sense, as we’ve made these mammoth efforts — the HCAP program, all the efforts for recruitment in the health care system — they’re having very positive results. We’ll talk about them later.

The challenge of not just funding services but getting services for health systems, health employers and contracted agencies are challenging, and they can be challenging for individuals as well. That idea of supporting seniors is something, in that way, that’s reflected in our support for them individually and also in our support for community organizations and others that provide services.

I would say yes, it’s something that’s absolutely worthy of consideration. It may well provide options in some areas of the province where there aren’t the same level of options now. It would even be a consideration to focus that on certain areas and see how it worked. Fundamentally, what we have to do — it has been central in the health human resources plan, in home support and in home care — is ensure that we have the workers we need.

We have a model in the HCAP program that is, I think, the most successful human resources program we’ve ever done in health care. It’s supporting our home care and home support system. We have to continue to do that. I absolutely think that is one area we can look at.

[5:05 p.m.]

I’ve had discussions with Isobel Mackenzie about this question as well. People do have access to what used to be called land tax deferment — I forget what it’s called now — which people don’t generally do. There are ways of accessing resources for a group of seniors, who wouldn’t necessarily have funded home support available to them and who might be able to access such programs, where Isobel Mackenzie succeeded.

I think we have to be imaginative about these things as well, and to support people where they are.

S. Bond: Thank you for that answer. I do appreciate that.

I do want to refer to some of the work that the seniors advocate has done. In February of 2023, the seniors advo­cate called for a fundamental restructuring of the home support system, mainly because she was highlighting the issue of financial barriers rendering services inaccessible for many.

I think people would be surprised to note that 70 percent of people who receive home support services in our province pay the entire cost themselves. That is a statistic that overlooks those who forgo seeking home support be­cause of financial constraints. They don’t look for help because they can’t pay for it. That’s really a significant impact for low-income seniors who are ineligible for guaranteed income supplements, and they struggle to access subsidized home support.

What the financial situation does — the advocate laid this out quite well — is create an economic incentive for seniors to try to transition to long-term care more quickly than they might otherwise have needed to.

I’m interested in the minister’s thinking around that issue. I’m wondering if there are plans to eliminate or reduce home support service charges, especially for low-income seniors who do not qualify for the guaranteed income supplement. I would also put on the record the fact that the majority of provinces in our country do not charge for home support services.

Hon. A. Dix: A number of statistics were put out there. I don’t think the coverage of home support is different between jurisdictions, so the circumstances of people paying when they need home support themselves is true in all jurisdictions. The difference that I think the member is highlighting is the issue of co-payments in our system here, which is a different question.

The majority, 67 percent, of our long-term home support clients are assessed at zero rate. You don’t pay a client rate for home support services if you receive income benefits, GIS, income or disability allowances or war veterans allowances.

[5:10 p.m.]

You have time-limited acute home health services — for example, two weeks after acute discharge, and so on. Those are the facts. Two-thirds of people, including the most significantly low-income seniors, don’t pay.

I had a bit of a discussion with the seniors advocate when we announced the aging with dignity agreement with the federal government. She seemed to think we should use the agreement to do this action, which is to essentially eliminate the fees for the 33 percent. We had a difference of opinion, because, of course, as I explained to the member, it was the same money we’d received before. So that money was not available for that purpose.

We’ve decided, this year, to very significantly invest in community health. And I’ve described that investment: the increase in case management, the expansion of hours, the increase in flexibility and coverage that we’re doing. Those, we decided, with those hundreds of millions of dollars of incremental spending, would be our priority.

The issue of the remaining co-payment for the 33 percent of home support patients who contributed co-payment is an issue that I absolutely acknowledge and is one we worked on. The question was in terms of this budget, which, as I say, very significantly invests in robust home health services. It was whether that was a priority against the expansion or the extension to those services, because you could use some of that money for that purpose.

Ultimately, in the budget, we decided not to do that this time, although I personally believe that’s a goal: to eliminate that client rate. In other words, if you say, roughly speaking, the 67 percent of clients who are the lowest income are getting a zero rate, well, the next 33 percent are obviously higher income than that 67 percent. But they’re not. They’re actually low to medium income.

We should address that issue. It is a priority for us, one I absolutely think the government should consider doing. As I say, we decided this year to dramatically increase funding for direct home support in the community, and we decided not to do that but, rather, to spend the money that way.

That’s a political debate, and I don’t disagree with those who see it as a priority to eliminate that rate for the re­maining 33 percent. We also, though, have to expand the number of people who are receiving publicly funded home support, and that’s what our initiative does.

S. Bond: I’m wondering about the family-paid home support. We know that that offers seniors and their families increased flexibility. It empowers them to prioritize things that contribute to keeping a level of independence. The support also helps preserve publicly subsidized care for those that are in need.

I’m wondering if the minister and his team are aware of the Quebec tax credit for home-support services for seniors. It reimburses seniors for family-paid home support to eligible independent living services. Is the minister aware of that program, and are they open to exploring a model similar to that?

[5:15 p.m.]

Hon. A. Dix: This is a relatively recent proposal in Quebec, and it’s of interest, of course. You can say that our focus of this very significant investment in home support is on people most in need of that support, access to getting the actual services, regardless of the issue of payment. That’s the people who are also the most vulnerable.

The Quebec proposal is interesting. I’d just note that most of the other jurisdictions like Alberta and Ontario don’t have that approach. But when someone engages in something, I think it will be worthwhile to assess it, study it and decide if that’s a good way to go forward, as against what this government is doing, which is a very significant investment in home support.

S. Bond: As we look at the contracts that are in place for family-paid home support providers, we know how important that is. The current contract rates paid to the providers by Crown corporations and health authorities don’t actually cover the actual costs necessary if we want there to be a high standard of care and to be able to recruit and retain skilled staff. So that is a limitation, and it impedes reputable providers accepting contracts.

To the minister, what measures is he taking to ensure that contracts with family-paid home support providers are structured in a way that aligns with the actual costs of delivering essential health care services? That’s absolutely critical, and they play an important part of providing service and supporting the broader public health care system.

The bottom line is: what is the minister doing in terms of contracts and looking at whether or not they align with the actual costs of delivering essential health care services at home?

Hon. A. Dix: I may have misunderstood the question, and the member can correct me.

The vast majority of home support services now…. We took back some contracts into the health authorities. We had multiple contracts in Metro Vancouver, and thankfully we took them back prior to the pandemic because it would have been very challenging otherwise. So we provide those home support services. We do, in places, supplement that with some private services as well from some well-known providers. I can provide the member with some information about the amounts of that should she wish.

I think what she’s talking about is asking if we should play a regulatory role on the family-paid caregiver side, which is not provided by us but provided by families. In other words, I think what she’s asking is if you’re not in that health authority care and home support system here, if the family is paying for the whole thing and you’re with an agency — I won’t name the agencies, but we could name one or two of them — that provides such services, whether, beyond the health regulation of those services, we should regulate the cost of those services.

That’s a question, but perhaps the member can clarify the question.

S. Bond: No, I think the concern is ensuring that when contracts are put in place and the rates are paid to providers by Crown corporations and health authorities, the rates in those contracts do not reflect the actual costs of the service provided. Does that help clarify the question for the minister?

The Chair: Sorry, maybe….

Member.

[5:20 p.m.]

S. Bond: Let’s try this again. Family-paid home support providers. Are we on the same page so far? Okay, perfect. They help Crown corporations and health authorities deliver care to clients beyond the capacity of the public system, so they are contracted by Crown corporations and health authorities.

The question relates to the current contract rates that are paid to the providers by Crown corporations and the difficulty that that creates in attracting reputable providers because of the contract rates.

Hon. A. Dix: In a general sense, I would say that it’s important to ensure that care providers are compensated appropriately. That’s why, in areas such as long-term care and others, we have taken such extraordinary action to do that. That enables the sustainable provision of private services.

I don’t think what we’re talking about here is generally health authorities. I think what we may be talking about are things such as WorkSafe, for example, which might provide a service, or even Community Living B.C., which might provide such services.

I don’t want to get stuck. I want to provide the right information for the member. So it may be that this might be an area we would come back to. We’ll certainly review the questions, and we can come back to it briefly, or maybe we’ll talk at the end of this and just make sure I’m going to get the right answer, because it’s important to get the right information, and we’re not quite….

It may be that an organization such as CLBC or others that are government organizations…. I think that might be what you’re talking about. Conceivably, WorkSafe, I could see that, are involved in contractual arrangements such as that. But we can…. Why don’t we just work with that? And we’ll just deal with it right at the beginning of tomorrow’s session.

S. Bond: Yes, we do not have time for me to try to ask the question for the third time.

I want to quickly touch on assisted living. A couple of other questions, and then I’m going to work through a couple more sections, and then I’m going to have one of my colleagues ask his questions today. That won’t relate directly to this set of topics, but in order to get everyone through these hours, we need to make it work.

According to the seniors advocate, on March 31, 2022, 785 individuals were waiting for subsidized, registered assisted living. That was an 11 percent increase from the year previous. So the advocate further reported that the number of publicly subsidized assisted-living suites has remained unchanged. In fact, the rate of assisted-living units per 1,000 population has gone down by 15 percent in the last five years.

Considering the advocate’s report and her commentary, it was interesting to learn the Ministry of Health staff are currently undertaking a comprehensive review of assisted living. I’m wondering if the minister could just give me a general sense of what the scope, the goals are, what the anticipated completion date is and if it will include….

When the report is done, will that include looking at how we’re going to keep pace to ensure we have the supply that we need, looking at our aging demographics? So generally, a little bit of an update on what the review is expected to accomplish, when it will be completed and made public and then a sense of whether that will include how we keep pace with an aging demographic.

[5:25 p.m.]

Hon. A. Dix: The member asked about the assisted living review. I’ll not go off on a lengthy presentation about this subject but rather stick to the precise question. Yes, so the following…. The ministry undertook a review of publicly funded assisted living operations from August to December 2023.

Here’s who participated: health authority leaders and clinical representatives from five regional health authorities and Providence Health Care as well as the First Nations Health Authority through in-person and virtual meetings; over 80 assisted living operators across the province were consulted through in-person site visits, virtual meetings and health authority-led town halls; B.C. Housing representatives, because they play an important role in the sector; the Ministry of Health assisted living registry; and the Ministry of Health senior services division directors and assistant deputy minister.

The feedback was organized into themes, including the assisted living registry; investigations and compliance; eligibility and access; and data and information. The following actions are underway to address the feedback received. The implementation of a new assisted living registry database that will improve data accuracy and efficiency. We are expecting that to be launched April 18, so we’ll still be at estimates. How about that?

Creation of a provincial best practices table to share innovative ideas and support a consistent approach to assisted living operations across the province. The first meeting of that is April 25. Increased proactive assisted living investigations to support operators to improve safety and quality. That will begin in June with the hiring of two net new dedicated positions to support this work. Once this first phase of initiatives is complete, further initiatives will follow.

S. Bond: Thank you for that update.

I would like to just reflect on the feedback we’ve gotten from assisted living operators. That includes the concern that the funding model hasn’t kept pace with client acuity and also infrastructure. I’m wondering if there is an intention to look at the funding model following the review in terms of those specific issues, acuity of patients and infrastructure, and whether or not the minister has discussed the concerns that have been expressed about the inadequacy of infrastructure with B.C. Housing.

Hon. A. Dix: Well, in terms of our review, that’s why we have engaged with 80 assisted living operators and engaged with B.C. Housing as well. The development of different seniors’ housing is a key priority of the Minister of Housing and one that we engage regularly on projects with them, including some of the projects people will know around the province. The actions in terms of both funding model and infrastructure are issues. Once the first phase of actions are completed, we will be moving on to those actions.

[5:30 p.m.]

S. Bond: Thank you to the minister. I appreciate that response.

Is there any intention to provide additional funding for mobility infrastructure, lifts, to support mobility needs and reduce workplace injuries for those who work in assisted living?

Hon. A. Dix: Yes. We’ve, as I said, topped up EquipCare in this year-end cycle. So basically, the assisted-living operators are eligible for that funding.

S. Bond: I want to go back to the issue of acuity for a moment.

Many assisted-living clients have already been assessed as needing long-term care when they’re in assisted living. That’s a significant concern because we know these individuals would be better supported in long-term care, where they would receive a higher level of care.

Is the minister able to tell me…? He doesn’t have to do it right this minute, but hopefully, he could share the information. Do we understand or know how many residents are currently living in assisted living and waiting to transition to long-term care? Is there a plan that looks at how we do that effectively and as quickly as possible?

So how many people in assisted living do we know are waiting to transition, and do we have a plan for how that happens as quickly as possible?

Hon. A. Dix: We obviously track some of that data quite a bit; we don’t specifically track that data. But I would say to the member that I think the way we view the problem or the issue — not the problem, but the issue — is maybe in the opposite sense: what can we do to support people in assisted living to stay in assisted living longer, rather than just having the answer be long-term care?

I know the member is not suggesting we shouldn’t do that, by any means. But looking at that problem and seeing what further supports we can provide in assisted living, which, in a general sense, health requirements being equal, would be seen as, maybe, a better place for people to be, in that sense.

Our focus in terms of this review is seeing: well, what does that group of people that we’re talking about need to stay and extend their stay in assisted living? And understand that there would be a moment, probably, where they would have to not do that, but that’s certainly the focus of what we’re trying to do.

S. Bond: Thank you to the minister.

I want to move to a couple of other issues, and then I’m going to have my colleague ask his questions.

I want to, actually, speak to the minister about the heat dome. I have to say that I’ve been in elected office for a long time, and one of the things that I know has impacted me more than most other things was the heat dome. The thought that hundreds of people died — frail, elderly, most of them…. I want to be sure that it is never forgotten, because we need to learn some very painful lessons from what happened and make sure it doesn’t happen again.

I’m wondering. There was recommendation 1(e) in the coroners death review panel that looked at the 2021 heat dome that was to coordinate an analysis and evaluation of the heat alert and response system of the pilot by the summer of 2023. I’m wondering if the minister can tell me if that analysis and evaluation of B.C.’s heat alert and response system has been completed.

[5:35 p.m.]

Hon. A. Dix: Perhaps the member could ask, because I know she had another question on this. A recommendation-by-recommendation analysis is just coming in. Maybe I would defer to the member to ask her next question, and then I could answer them both at the same time.

S. Bond: I’m happy to do that, because it is really about….

What I’d like to know is: was the evaluation done? We don’t have time to have an explicit, lengthy explanation of the findings, but that is what I’m interested in. It’s whether or not there were gaps found during that analysis.

I’m also interested in recommendation 2(e) of that same death review panel report: that by June 30 of 2023, the Ministry of Health, provincial health authorities and the First Nations Health Authority engage and consult with vulnerable populations — those were identified as elderly, persons with chronic health conditions including mental illness and local government emergency planners — looking at what needs to be done, evaluating and reviewing at the provincial, regional and local levels. I’m interested in that as well.

The seniors advocate raised a concern related to an evacuation plan. Her concern, and I share it, was related to the fact that there had not been a sufficient look at the need to have an evacuation plan when temperatures are at certain levels. It’s not going to be safe for a significant number of people to stay in their homes. If the minister could speak to those issues in particular, I’d be most appreciative.

I’ll move on to another topic while we’re waiting for those answers. I’m happy to have them provided to me even in writing.

Last year I raised the issue of something I hear about all the time from seniors. That is the cost of the shingles vaccine. We know that risk comes with age, and that is particularly true when it comes to shingles. Last year the minister told me that the matter was under review, at his direction. Can the minister now tell me what the outcome of that review was and if seniors in the province can expect coverage for the shingles vaccine?

Hon. A. Dix: With respect to the recommendations of the coroner’s service, all of the responses to those recommendations, to all the recommendations, are complete. What I maybe even notice in internal tracking documents…. I’ll get a copy and share it with the hon. member. But the ones that she specifically identified include No. 2(e), which is that the Ministry of Health, provincial health authorities and First Nations Health Authority will engage and consult with vulnerable populations. That one.

[5:40 p.m.]

The recommendation is completed, and additional en­gagement and consultation is ongoing. The unit conducted targeted engagement with partners via an online survey. An internal what-we-heard report summary was completed in June 2023.

On behalf of the B.C. HEAT committee, there was a further post-season engagement session with targeted partners and interested parties in fall of 2023 through winter 2024, with final B.C. HARS engagement March 2020.

With respect to the overall response here, which I think was asked, we note that B.C. HARS was implemented. The response system was implemented in June of 2022. So it was fully implemented at that time, but it is assessed every year.

The member talks about evacuations. You know the experience that health authorities have had. We had that experience in the summer of 2017 related to wildfires, and then very significant experience last summer when almost 1,000 people in long-term care were evacuated during the fires around Kelowna and other communities, in fact, because of different weather events. People in care in Merritt were evacuated twice. So we have, obviously, a lot of experience with all those issues.

But I would say that all of the responses to all of the B.C. Coroners Service recommendations are complete, and very significant action was taken to respond to the heat dome. In addition to that, I would add, very significant action was taken with respect to the B.C. emergency health services, which I think I spoke of earlier, and we’ll probably talk about again.

Finally, the member may be interested that we established through B.C. Hydro a program to fund portable air conditioners to help people stay safe during extreme heat emergencies. The proposal was 8,000 units over three years. We’re in the first nine months of the program. To date, 4,424 air conditioners have been installed since the program’s inception. In the first year of the program, we’re more than halfway complete in that work. We’ve received a total of 4,747 applications to date that have qualified for the installation of an air conditioner, and that resulted in the installation of 4,424 air conditioners.

We are continuing to look at the Shingrix vaccine, the vaccine against shingles. It obviously represents a significant improvement on the predecessor vaccine. Different jurisdictions in the country have very precise programs. For example, I think in Ontario, it’s for ages 65 to 69. Peo­ple just in those categories have access to the Shingrix vaccine. It continues to be something that we review.

As the member will know, we’re very committed to our program of vaccination. That led to a very successful year for vaccination against COVID-19 and influenza compared to anywhere else in the country, so we’ve established a system for it. We continue to review the value of adding the shingles vaccine to eligible populations.

There are, as you can see from other jurisdictions, some differences, in other jurisdictions that do provide some coverage, in the coverage provided, but they tend to be in very precise age groups of seniors and not generally available.

S. Bond: Thank you to the minister for the responses around the heat dome. I’m hopeful that if the minister has more detailed information about the reviews and the evaluations that were done, whether or not they identified any gaps, especially with B.C. HARS but also in terms of engagement and consultation, and how those gaps are going to be closed…. If there’s any further information, I would appreciate the ability to have the minister share that.

[5:45 p.m.]

I also would like to know…. I was going to ask the question about the air conditioner program. When it launched, I can honestly tell you, we tried to help a senior apply in our office, and it was not a simple thing. Apparently, it must have gotten somewhat sorted out, because there were literally thousands of people who had them installed.

But perhaps the minister can tell me. Since the program that he announced was over a three-year period and was for 8,000 air conditioners, we are past halfway, and we’re one year or nine months in. Does the minister intend to expand that program and ensure that particularly frail, vulnerable people in our province, particularly seniors, have the support they need?

I appreciate the ongoing review again this year about the shingles vaccine. I’d like to just ask also about the RSV vaccine. On August 4, 2023, Health Canada approved the first vaccine for RSV for those 60 years and over. It is shown to have a high degree of effectiveness at preventing lower respiratory tract disease. Ontario is currently providing some coverage, and certainly, I’ve heard from seniors here in our province wondering if they can expect the same.

Could the minister provide some detail as to when he anticipates a decision on coverage for the RSV vaccine?

Hon. A. Dix: With respect to the air conditioner program, on June 28, we committed to providing $10 million to B.C. Hydro, which we did. Sorry to hear some of the member’s constituents had difficulty initially. But the program has been, because I tracked it every week, really…. It’s remarkable work, not by me but by people out there, by people at B.C. Hydro who did the work, people who did the installations.

We have 4,747 qualifying applications and 4,424 in­stalled, which is pretty good. So we’ll obviously continue to look at that. That’s where the demand is now. It’s pretty good, pretty interesting that that level of demand is there.

We’ve done a lot of work, as well, with organizations like B.C. Housing to improve both air quality and installation in those facilities as well. But these are, really, individual homes, and basically, if you look at those numbers, roughly 94 percent of people whose applications have been accepted actually got air conditioners installed as we enter into a hot season.

That’s pretty good news, and obviously, we’re continuing to take applications. We are funded, really, for an 8,000 program, so we are not in need of doing that. But I think this is a program that makes some sense for people. It will help keep people safe, and that’s what we want to see. So that’s in terms of eligibility.

With respect to the RSV vaccine, the RSV vaccine, as the member said, is one available for seniors, and it was provided in a limited basis for seniors in long-term care in Ontario. There was, I have to say, without being critical of Ontario, an astonishingly low uptake on all their vaccines this year. I’m not sure what that’s about. I’m not in Ontario. That was true of the RSV vaccine, as well, in a general sense.

It’s being reviewed by the National Advisory Committee on Immunization. There were issues around both the availability and the recent approval of the RSV vaccine, but it’s going through the NACI process well now, and we very much follow their recommendations.

As improvements are made and more product becomes available…. There are currently two products — one from Pfizer, one from GlaxoSmithKline — that are approved for use. One was on August 4, as the member says. The other was on December 21. They’re the first vaccines ever authorized for RSV infections in Canada. Once that recommendation comes through, then our excellent team who deals with vaccinations, including the provincial health officer and others, will assess that, and we’ll go from there.

[5:50 p.m.]

Some RSV vaccine was available in B.C., in a limited way. I think the cost was in the neighbourhood of $230 last year, for an individual vaccination, somewhere in that range, but it was only approved for seniors. A lot of the concern around RSV was being expressed by parents of children, obviously. That’s the consideration now. It’s under review by NACI. Then once the NACI review comes in, we’ll take it from there.

S. Bond: I would also like to ask if the minister could provide me with the regional distribution of the air conditioners. I’m assuming that B.C. Hydro would have a breakdown of who applied where. I think it’s important to recognize that it’s an issue all over British Columbia.

I know we sadly had a number of people pass away in Prince George and in our region. I would just like to, hopefully, have the minister provide the regional breakdown and the distribution. I think it’s important for British Columbians to have a sense of understanding about that program, how it’s worked, that there are still units available — all that kind of information — as we head into, potentially, a very difficult season with drought and a variety of other things.

With that, I’m going to cede the floor to my colleague from Skeena for some of his questions.

E. Ross: To the member for Prince George–Valemount, thanks for squeezing me in here. Hopefully, we get you up to Kitimat to talk about these questions of Health in more depth. That’s not a question.

To the minister, my first question. Kitimat is always worried that we’re going to lose health services to regional centres like Terrace, Prince George, Vancouver and Victoria. It doesn’t help that we’ve had a number of emergency room closures over the last couple of years, as well as finding out that our ambulance service in Kitimat, a unique arrangement, was actually shared between Terrace and Prince Rupert — which, at any given time, left us without ambulance services in one of our communities.

So two questions rolled into the first question. Would the minister assure my constituents that Kitimat will not lose services to regional centres, especially since the Terrace hospital will be completed very soon?

I recently found out that there is some sort of an incentive formula put in place to attract and retain health professionals, including doctors. Is this true in the case of Kitimat? I’m hearing that Kitimat, over the years, has been overpaid, for some reason, by this formula. Is there a formula in place that actually attracts doctors away from Kitimat to practise in places like say, Smithers or Prince George?

Hon. A. Dix: I know there will be follow-up questions, but I wanted to start by saying I went to Kitimat recently, as the member would know. We announced the dementia beds. I just can’t tell you what a great initiative that is. I know the member agrees with this. I’ve heard him speak about it in the House, about the work of local communities.

[5:55 p.m.]

I think it’s so important for the future of long-term care in the North as well, in communities where you are not going to build, and you don’t need, a large care home, to be able to focus on dementia care in a community. I am just very profoundly grateful to everyone involved in that. It was absolutely an important thing to do.

While I was there, though, we did that and then we sat down. I spent time with doctors, nurses and health care workers to talk about all their issues in Kitimat, which are considerable. We talked about issues around the emergency room, about issues of recruitment in the community and what we’re doing. I’ll talk a little bit about what’s available in Kitimat and some issues we talked about.

The provincial rural retention incentive — the prototype was not in Kitimat; the expansion is in Kitimat, in that case. With respect to the rural subsidiary practice agreement, there’s an RSA premium of 18.9 percent and a flat fee, including a rural business cost modifier, of $29,289; the B.C. loan forgiveness program access in Kitimat; and the GoHealthBC community in Kitimat. That’s important more for nurses than for doctors.

I think I have the numbers here somewhere. Kitimat, in the period leading up to February 29, 2024, has received 1,267 nursing hours through that process, and there were also eight housing units procured, which is very important. We’re not talking about agency nurses. We’re talking about health authority travel nurses and those programs put in place to support hospitals like Kitimat.

We went through earlier — the member can find it in the Hansard Blues — all the different programs we are doing to bring people to Kitimat. Doctors and nurses in the community made specific proposals to me as well, about specific conditions they’re facing. I am reviewing those, and we are going to act on proposals that were brought to me. I went, sat and heard, from people working in health care in the community, what they’re facing and what supports they need in order to succeed.

One of those supports they impressed upon me was the need for diagnostic equipment, which is important for recruitment of doctors to the community. We’re doing all those in Kitimat for the tripling of the PRA-BC program, all the rural incentives, significant increases in family practice.

There are specific issues to Kitimat. We spent some time on them, and we’re following up on them, because they’re really important issues, including a CT scanner, which the member will know is a significant issue in the community as well. Kitimat is in a different situation than other communities, such as Fort Nelson, for access. What helps in Kitimat is having that equipment, when you’re attracting doctors, that doctors naturally would need. They want to work to the full extent of their practice.

With respect to Mills Memorial — which, I think, is the member’s question as well — what will be the impact of Mills Memorial on Prince Rupert, and what will be the impact on Kitimat? That is the concern in the region. I must say that everybody in the region supports the Mills Memorial replacement. I don’t think there’s any question about that. This is an extraordinary project. I was up, I saw the hospital, and it’s looking great. I think the member would agree with that. Construction is going to finish in September 2024.

Well, he thinks it looks very good, so there’s a difference of opinion there. He thinks it looks very good, and I think it looks great. I think it’s a big moment for them. There’s going to be a discussion in the community about naming, but we’ll call it Mills Memorial just for the purposes of this discussion.

There is a concern in other communities. I think the real concern in other communities, and the one that we focus on, is not that the service at the new hospital in Terrace is going to be great — it’s a great thing that we’re doing that — but that we continue to recruit people to Kitimat and to Prince Rupert. We have been focused on both those issues in both those communities that I visited on that trip. I visited 30 communities, and we’ve talked to people.

[6:00 p.m.]

The concerns were sometimes infrastructure concerns like CT, sometimes access to incentives for doctors, nurses and health sciences professionals, and sometimes very specific issues. I’m very appreciative to the doctors, nurses and health sciences professionals and to health HEU members in Kitimat, who really communicated their views of the needs of the community, and we will be responding in detail to them.

E. Ross: I was part of an advocacy group that was called to convene just a few months ago in Kitimat to talk about this issue, in terms of retention and recruitment of health professionals, because the emergency room was being closed down so many times and the ambulance service was being stretched out between Prince Rupert and Terrace.

Nothing really came of it, basically, because we didn’t understand the basics and the foundation of what the ministry and the Northern Health Authority were actually using to recruit and retain professionals. I had on good authority that this rural incentive program was actually being related as Kitimat being overpaid over the last couple of years, which I don’t understand.

For those millions watching at home, it’s going to be really hard for them to understand all these incentive programs, policies and rules, and all the different players in a room to try to figure out, one, how we retain and recruit, and two, how does this rural incentive program affect doctors and nurses in Kitimat, especially since Kitimat feels that they’ve contributed so much to the coffers of the economy of British Columbia — KLNG, for instance, Rio Tinto Alcan’s modernization project, as well as LNG Canada’s project.

But there it is. I think I did get assurances from the minister that, no, Kitimat will not lose health services to regional centres like Terrace, Prince George, Vancouver, Victoria.

The minister mentioned the CT scanner. That was the argument in Kitimat as well, that Kitimat not only raised the funds for a CT scanner to be purchased but they also wanted to use that as a recruitment tool for more professionals to locate in Kitimat.

Can I ask: why wasn’t the CT scanner in the 2024 budget? Because the donation from LNG Canada is time sensitive. That donation goes away if it is not utilized in a certain time frame.

Hon. A. Dix: Typically, what always gets put in budgets are items over $50 million, and we’re going to have a discussion of that, I think, on a number of items in this debate. The member will recall in the 2018 estimates he asked me about the Mills Memorial project, and if it had been approved at concept plan stage — which means it’s in the ten-year budget — why it wasn’t in the items over $50 million. It got there in the next year.

With respect to diagnostic equipment, that wouldn’t be the case. In other words, I’m a strong believer in expanding diagnostic equipment. We added an MRI machine in Terrace, in his community. So the proposal for the CT scanner is both a capital proposal, obviously, and an operating proposal. We have got to make sure we have the staff and everything to make it work and operate correctly. That project is before me, and I take from his question his strong advocacy for that project.

With respect to ambulance service, it should be said that overall response times in Kitimat have improved in the last two years, which is, again, not a tribute to me. Kitimat is an unusual situation. I think it may be the only one in the province where fire and ambulance are merged, right? It’s the only one in the province, which is kind of interesting. But we have, as you know, dramatically increased our resources for rural ambulance service, fixed-wing, rotary and on the ground. The very significant supports are in place.

Obviously support communities that are having issues with emergency room service closures, such as Kitimat…. Those have been in place. Those are both the case, and I appreciate the donation not just from LNG Canada but from other people who are contributing to a public fund­raising around the CT scanner in Kitimat. Certainly, the importance of that was strongly communicated to me by people I met there, from the mayor to the council, the community, the doctors, the nurses, the health care wor­kers.

[6:05 p.m.]

E. Ross: Thanks to the minister for that answer.

The obvious next question is timing. I’m reading into the minister’s answers in saying that Kitimat will not lose medical services to regions. I’ll leave that where it is.

Given the minister’s answer now, I understand why we didn’t see it in the budget. But that does beg the question: given the time sensitivity of the LNG Canada donation, when can Kitimat expect to see some kind of answer in terms of when the CT scanner will be built into the Kiti­mat Hospital?

Hon. A. Dix: June.

T. Shypitka: I was in my office minding my own business, and I heard something about B.C. Hydro, and my ears perked up right away. I thank the member for Prince George–Valemount for allowing me some time.

I wanted to follow up a little bit on the air conditioners that were supplied and the applications made to install. I think I caught that 4,700 of the 8,000 that were made available to be installed were made, and I think 94 percent of the applicants of that 4,700 that were applied for got in. That’s decent.

Does the minister know…. The member for Prince George–Valemount asked a question on a breakdown regionally, and I guess we will get an answer back on that. Does the minister know how many of the units were installed in apartments or multi-unit dwellings?

Hon. A. Dix: What I’ll do is I’ll add that…. The member for Prince George–Valemount asked me to get a regional breakdown. I’m not sure how…. B.C. Hydro may not be doing that by health authority, because that’s our organizing principle, but we’ll try and get that information by community or by region in some fashion from them.

In terms of where they went, we can also see where the air conditioning is with detached against apartments and other homes. That’s no problem to find that. It’s not out of 8,000. So 8,000 was what we funded over three years. So far, the takeup has been very good.

The teams involved, the teams of contractors, the teams of B.C. Hydro…. It obviously takes a while for a new program to get up and going, but they have been exceptional. This is maybe for somebody else’s estimates, but I just wanted to express my appreciation to the people doing the installations. This is really important work and significant work. To reach that level of applications received and to have them installed at this point is really exceptional.

I really appreciate the member’s question, because it’s important that his constituents and all our constituents are aware of the existence of the program that they may well be eligible for.

T. Shypitka: Thanks to the minister.

I think what the member for Prince George–Valemount and myself are trying to establish here is a metrics of success on the spread. How do we get those key performance indicators on “we’re actually doing our jobs straight across the province”? The minister needs to figure this information out from either B.C. Hydro or the health authorities.

I want to understand how the Health Ministry, understands or realizes what the actual success is of the program. I mean, this heat dome wasn’t isolated to the Lower Mainland. It wasn’t anywhere specific in the region. It was across the province. We need to understand the matrix and the success of the program in place.

That’s why it’s important for the member for Prince George–Valemount and myself to understand this, be­cause this won’t be the last heat dome that we’re going to see in this province. We want to understand that the process that the minister is trying to establish is successful. We won’t realize that success until we can see where the success is or could be.

Before the minister stands up: how many air conditioner units will be planned to be provided in 2024?

[6:10 p.m.]

Hon. A. Dix: What we did was provide, and the member is aware of this, $10 million. We estimated that would be 8,000 units.

The eligibility is the same eligibility as for B.C. Hydro’s low-income program. We’re not providing it to everybody, of course. They wouldn’t want us to or expect us to. They were focused on people who are eligible for that program, meaning people who are low income.

In terms of the total people who contacted or were eligible to contact, there were 5,864. Of those 5,864, 4,747 were qualified for the install on the basis of the program, and 4,424 air conditioners have been put in place. I suspect, and we’ll provide the information, that a significant portion of those were in Metro Vancouver. That’s because of the population base and everything else. But it was certainly in no way limited to that.

With respect to the numbers on the program, 2,445 were in apartments, 1,101 in detached homes, 105 in du­plexes, 171 in mobile homes and 599 in townhouses.

T. Shypitka: Thank you. Some good detail there.

The minister said…. It relies on the eligibility, who is eligible for the program. I think the minister would agree. There are many folks that should be eligible for the program. As the minister understands himself, the Ministry of Health is being overrun, to some degree, by our aging population. Nothing is more prevalent in rural ridings, where that age is increasingly higher.

I’ll take a look at some of these statistics, and I’ll compile that. I mean, 4,000 units in the last year and a bit, I guess it has been, pales in comparison to some of our southern neighbours. Oregon, for example, had a similar program. Washington had a similar program. Between those two alone, they’ve pumped out 24,000, six times what this government has done. It seems like they’ve got a fairly decent program.

My last question would be: why do you think…? Maybe these should have been heat pumps and not air conditioners. It’s something that has always puzzled me a little bit. We know how efficient heat pumps are. Those same vulnerable people that will sweat and have problems in the heat will probably be the same ones that will be vulnerable to the cold. We saw a cold snap.

If we’re talking about being environmentally friendly…. We know the hydrofluorocarbons that come from air conditioners aren’t very environmentally safe and sound always. Heat pumps seem to be the flavour of the day for the government — to get those out.

Why wouldn’t there be heat pumps instead of air conditioners?

Hon. A. Dix: I think the Premier has a T-shirt for the hon. member. He loves heat pumps too, I think.

Obviously, the Ministry of Health is not in charge of energy programs in B.C. These are free-flowing estimates, and I like that.

Our program is better than some of the programs in the United States. They gave the air conditioners, and they didn’t install them. We are providing the air conditioners, and we’re installing them. That, from a safety perspective, is a really important thing to do.

This was a demand program. In other words, people were informed. People who get…. Hydro can communi­cate quite well with customers. People who were below the threshold for B.C. Hydro’s low-income program were eligible. A very significant…. We estimated we would need 8,000 over three years. We’re more than halfway through that. That indicates the demand.

These were air conditioners targeted to a population in need. They responded to it, and they’ve been installed. Not throwing air conditioners off the back of whatever you throw an air conditioner off the back of…. I don’t think I could throw an air conditioner anymore. The member is more of an athlete than I am. He probably could do so. But that was the nature of our program.

I give a lot of credit for that not just to Hydro and not just to the people who are in the program but to the installers. Sometimes you’re installing. You want to install in circumstances where they’re safe for everybody. If you’d just given air conditioners away…. You can imagine what might have happened to the program — how subject that might have been to problems and resale and everything else that could happen.

[6:15 p.m.]

These air conditioners are there in those apartments, in those houses, installed, ready for people. I think that’s a really good thing. We can argue that it should be more.

With respect to heat pumps, you can argue…. I think that’s a different debate in a different ministry around those questions.

I do think that the program…. I just give a lot of credit, really, to the installers. To do that many air conditioners in that period of time is a real achievement by them, not by the government but by them.

S. Bond: I really appreciate my colleagues, their interest and their advocacy on all fronts. They do a really great job representing their constituents and in their critic roles.

I was going to start into primary care. I think that I’m going to just ask a couple more questions around climate change and emergency preparedness, if the minister is prepared for that.

Certainly over the summer, the McDougall Creek fire in the Central Okanagan forced thousands of people to evacuate their homes. Of course, that included vulnerable sen­iors in long-term-care and assisted-living residences.

I actually remember that quite graphically. I try not to hesitate to give credit where credit is due. The minister and I spent a lot of time on the phone with one another and with others in the ministry, including the deputy minister and others, providing regular briefings and talking about how we were going to manage, in the province, taking care of very frightened, frail, elderly people and their families.

I want to thank the minister for his willingness, not just on that occasion but on many occasions, actually, and for his commitment to reaching out across the aisle. He does it frequently. We can be fierce with one another in question period. We also recognize we have a similar goal.

I’ll just say this. I wish a lot more members of the government bench behaved in that way. It is very helpful. I have others who do the same thing, and I’m appreciative of that relationship as well.

We walked day by day, basically. I was given the opportunity to understand where seniors were being moved to, how they were going to be cared for, how we were informing their families. Very much appreciated. I do want to reflect on the anxiety that it creates, not just for residents and their families.

I should also point out my colleague, who is in the House with me, from West Kelowna. He was there every step of the way, supporting his constituents, talking to myself, to the minister. I just realized he’s in the House. He also did a fantastic job of standing up and saying: “We need help, and we need it now.” I do want to reflect on his incredible efforts during that very stressful time.

What I want to ask the minister is…. It went well. There’s also room for improvement, when we think about the potential of that happening again. One of the challenges related to the ability for care providers to bring care aides from another jurisdiction. In this case, it was Alberta. We needed extra help to transport. They wanted to do that on a temporary basis. They were unable to get them registered in time.

I’m wondering if the ministry is aware of that issue and whether or not they would be considering a temporary emergency registration class that would allow people to be registered for response efforts. That emergency registration allows eligible nurses to register quickly on a short-term basis.

Would the minister consider directing the B.C. care aide registry to create a similar emergency registration class to what is available through the B.C. College of Nurses and Midwives?

Hon. A. Dix: Yes.

Just to say and express appreciation for the member’s comments. I think that the member for Kelowna-Mission and other members…. It happened, in that case, that the majority of those affected were in opposition ridings. We tried to share all the information we had all the time. I think that’s the way to do it in those circumstances.

[6:20 p.m.]

They greatly assisted us. The questions don’t really…. People don’t choose who they’re going to ask the questions to. They’re asking questions to who they need to ask a question to. What we saw was exceptional work.

I remember that week very well. I was in Kelowna on Monday. The evacuation started…. The issues really came on Wednesday or Thursday of that week. I had driven back on the Coquihalla. We got back, and everything had broken loose.

Our teams, because the very teams we had met with at Kelowna General Hospital…. I know the member would agree with this. We had people working in Kelowna General Hospital who couldn’t go home. They couldn’t go home.

The level of stress that involves…. That people continued to deliver exceptional service is very moving. The very people I had met with on one of those days where I was spending the day meeting with people about health care issues, a large number of those people were all involved in that. I think our ambulance paramedics, our care aides, did an exceptional job, and we’ve got to do everything we can to help them.

So the short answer is yes. We’ll check the details of it. I don’t think that’s an issue. I think that’s an issue that we certainly will resolve before fire season this year, which unfortunately, tends to start earlier and earlier.

The short answer is yes, and thank you for all the work that was done.

Interjection.

The Chair: Thank you, Member. We do have time for one quick question, but noting the hour. Thank you.

S. Bond: Every minute counts in these estimates.

I do appreciate that response, and I know that, certainly, long-term-care providers and others will look forward to that.

I will end with this question for today. I know that B.C. Care Providers have submitted a request for year-end funding to top up the EquipCare B.C. program. That was very specifically focused on funding climate mitigation strategies in long-term-care and assisted-living homes. That included with air conditioners and HEPA filters.

Will the minister commit to providing those funds?

Hon. A. Dix: Yes. Since it happened already, I can really say yes, because, as members of the House will know, including those…. We seem to have more, lots of people here to hear the end of the debate.

Those decisions have to be made by March 31. We’d provided $14 million to the B.C. Care Providers.

I won’t completely trump my own announcement — can we still say “trump”? — by saying how much, but what I committed to the Care Providers is what was provided, and I think it’s important and valuable work.

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

Motion approved.

The committee rose at 6:23 p.m.

The House resumed; the Speaker in the chair.

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

Committee of Supply (Section A), having reported progress, was granted leave to sit again.

Committee of Supply (Section C), having reported resolution, was granted leave to sit again.

Hon. D. Coulter moved adjournment of the House.

Motion approved.

The Speaker: This House stands adjourned until 10 a.m. tomorrow.

Interjection.

The Speaker: Correction. We’ll be adjourned until 1:30 p.m. tomorrow.

The House adjourned at 6:25 p.m.