HANSARD

NOVA SCOTIA HOUSE OF ASSEMBLY

COMMITTEE

ON

PUBLIC ACCOUNTS

Wednesday, November 5, 2025

COMMITTEE ROOM

2025 Report of the Auditor General - Planning and Acquiring Nursing Home Beds

Printed and Published by Nova Scotia Hansard Reporting Services
 

Public Accounts Committee

Susan Leblanc (Chair)

Marco MacLeod (Vice-Chair)

Hon. Brian Wong

Tom Taggart

Tim Outhit

Dianne Timmins

Lisa Lachance

Hon. Iain Rankin

Hon. Derek Mombourquette

[Marco MacLeod was replaced by Rick Burns.]

In Attendance:

Kim Adair
Auditor General

Brendon Campbell
Audit Principal

Monique Pfister

Audit Manager

Kim Langille

Committee Clerk

Gordon Hebb

Chief Legislative Counsel


 

WITNESSES

Department of Seniors and Long-term Care

Lora MacEachern - Deputy Minister

Janet Lynn Huntington - Associate Deputy Minister

Paula Langille - Executive Director of Infrastructure

Department of Finance and Treasury Board

Robert Bourgeois - Controller

HALIFAX, WEDNESDAY, NOVEMBER 5, 2025

STANDING COMMITTEE ON PUBLIC ACCOUNTS

9:00 A.M.

CHAIR

Susan Leblanc

VICE-CHAIR

Marco MacLeod

THE CHAIR: Order, please. I’m going to call the meeting to order. This is the Standing Committee on Public Accounts. The committee mandate is:

The Public Accounts Committee is established for the purpose of reviewing the public accounts, the annual report or other report of the Auditor General and any other financial matters respecting the public funds of the Province.

My name is Susan Leblanc and I am the Chair of the committee. I use she/her pronouns.

Before we begin, I’d like to remind everyone to put your phones on silent, please. If we have a need to leave in an emergency, we will exit through the Granville Street doors and then meet up at the Grand Parade.

I would also like to mention that today is Take Our Kids to Work Day and we have a kid in our midst. (Laughter) We have MLA Rick Burns’ son Carter, who is here watching his dad make magic at the Public Accounts Committee. Welcome to Carter. I hope you enjoy your time here.

I’d like to ask the committee members to introduce themselves with your name, your constituency, and your pronouns, please. We’ll begin with MLA Burns.

[The committee members introduced themselves.]

THE CHAIR: We also have officials from the Office of the Auditor General, the Legislative Counsel Office, and the Legislative Committees Office in attendance.

On today’s agenda we have officials with us from the Department of Seniors and Long-term Care with respect to the 2025 Report of the Auditor General, Planning and Acquiring Nursing Home Beds. Welcome to you all. I’d like to ask you to introduce yourselves beginning with the witness on my left - if you could tell us your name, your title, and your pronouns, please.

[The witnesses introduced themselves.]

THE CHAIR: Now I’ll invite Deputy Minister MacEachern to make some opening remarks.

LORA MACEACHERN: Good morning, everyone. In September, the Office of the Auditor General released its audit, Planning and Acquiring Nursing Home Beds. I want to thank the Auditor General for reviewing this program. Her recommendations are timely and beneficial. We have accepted all 10 and are making good progress, having already implemented just over half.

In 2021, this department was created with a mandate of making sure seniors can live with dignity and have access to the right care when they need it. I’ve had the pleasure of recently joining the department as deputy minister and am pleased to report that there has been significant progress. This includes establishing the Seniors Care Grant to help older Nova Scotians cover the cost of household and health care services, from which more than 162,000 people have benefited to date; supporting more than 40,000 people through home support, community nursing, equipment and funding programs; and building the workforce by providing free tuition for CCA training to more than 2,700 people.

Since the department’s creation, there have been record low workplace injury rates in continuing care; reductions in workforce vacancy rates across the sector; and a significant drop in the number of people waiting for home support - and there’s much more.

When this department was formed, the team looked at the projections and saw a growing senior population in need of more long-term care spaces. At the time, there were about 8,000 beds in the province, and about 400 of them were closed. Knowing those beds were needed, immediate steps were taken to open them.

At the same time, the team set to work on a key commitment of government and the department to add and replace 5,700 single long-term care rooms across the province by 2032. On that front, I am pleased to report that steady progress is being made. Five new and replacement homes are now open and another 18 are under construction.

Since 2021, more than 1,000 new and improved single long-term care rooms are in the system, and 2,000 more are currently under construction. When the work is complete, there will be more than 50 new and replacement facilities in communities throughout the province. It’s a historic investment in long-term care infrastructure - the largest in over a decade.

The work to create these new beds is the basis of the Auditor General’s Report. We were pleased that her report acknowledged that the contracts signed with service providers show evidence of value for money and that good work is being done by the department to assess the future demand for nursing homes and to use those projections in our planning.

We also appreciated her 10 recommendations in the report and have been working hard to implement them. For example, we have already taken action to improve monitoring of construction projects. We revised our process, documents, and contracts to allow for stronger checks and department involvement in the construction process. We have also acted to improve transparency by redesigning our website to ensure clear, transparent updates on progress and by improving records management by developing a records policy and completing the transfer of all relevant records from the Department of Health and Wellness.

In her report the Auditor General questioned the right-of-first-refusal process for replacement facilities. We agree that ensuring value for money through competitive procurement is important. We are committed to reviewing the approach for replacement builds going forward and ensuring compliance with the Public Procurement Act. As the Auditor General recommended, we will also be undertaking facility condition assessments and using infection control indices when identifying future replacement facilities.

There’s no question that we have an ambitious plan to build thousands of long-term care beds in this province - a plan that will not only help to create more spaces for older Nova Scotians needing care but that will also alleviate pressure on other parts of the health system. It’s a plan that will support economic opportunities in communities across the province with construction-related and continuing care jobs.

To be successful, we need to be strategic. We need to try new ideas, innovate, pivot, and continue to collaborate with our partners - and we will, because seniors need care they can count on. They need modern, new homes where they can live in comfort and dignity. The department is committed to providing those homes in the most efficient and fiscally responsible way.

Finally, I want to thank the Department of Seniors and Long-term Care. They work tirelessly and deeply care about their work. When recommendations like this are made, they review them closely and welcome the opportunity to make improvements.

Thanks again to the Auditor General and her team’s thoughtful recommendations. I am confident they will only strengthen our plan and approach.

With that, we are now pleased to take your questions on the Auditor General’s report and our response.

THE CHAIR: Thank you very much, Deputy Minister MacEachern. We will begin questions.

I just want to remind folks that I need to acknowledge you before your microphone turns on, so please be patient for that. Also, if a member has heard enough of an answer, they may flag me down and I will try to let you know that it’s time to wrap it up and we’re going to move on to another question.

We will begin with MLA Lachance, please.

LISA LACHANCE: Thank you so much to all of you for being here. I think we’re all concerned about making sure that seniors live with dignity and in safety. We know what the impact of not enough long-term care homes having is for seniors and families, and staff, who are also wanting to provide the best care. All of this in the context of an affordability crisis - seniors who are facing increasing costs wherever they are in the system, but if they’re waiting for long-term care and thinking about how pensions aren’t keeping track with the rate of CPI - we want the best for our seniors.

The 5,700 new and replacement beds that are targeted for 2032: Is progress on track? At this point, you said that there are five facilities that have been opened and 18, I think, under way, but only five have been completed. Will the target be met to replace the 5,700 new and replacement beds?

THE CHAIR: Deputy Minister McEachern.

LORA MCEACHERN: Thanks so much for the question. It’s a really important one. We’re feeling really confident with our plan. I’ll start by reiterating that it is a very significant plan - 5,700 new and replacement beds in this province, the most historic investment in well over a decade. It’s a big project. It’s a multiyear plan. We are really pleased with the progress we’re making.

At this stage, to have five facilities opened and accepting new residents and having new and replacement beds in various communities across the province is a great achievement. We’ve got 18 under way, as you mentioned and as I mentioned in my opening remarks. Some of those are very close to completion as well. We’ve got new and replacement beds that are coming into the system all the time. It’s 1,000 new and replacement beds already and 2,000 new and replacement beds under construction. We’re really pleased.

We’ve got a dedicated infrastructure team, led by Paula here at the table. They are working through the plan. We’ve got the support and commitment of government. We really do appreciate the recommendations of the Auditor General. They came at a good time. They have identified a couple of areas where we can increase our monitoring and it can be helpful, so we’ve taken those steps already to ensure that those recommendations are implemented.

LISA LACHANCE: You’re talking about the plan that the department has and that makes you confident you’re going to reach the 2032 goal. I’m wondering if you could briefly talk about what that plan looks like and if you could table that for the committee to review.

LORA MCEACHERN: Again, I appreciate the question. I may turn it over to my colleague Paula to give a little bit more detail on the plan. I would emphasize that it’s very much publicly available. One of the recommendations of the Auditor General - we had a website that had information on the progress of the various builds. That has been available, and we’ve been doing press releases and doing all that we can to get good information out there about what our plan is.

The Auditor General also had a recommendation around revamping our website, so we’ve taken that step. Anyone can go on there. It’s an interactive dashboard - a picture of the province, and you can click on your community and get an update on what we’ve committed to change, what relates in your community, how many new beds or replacement beds will be available. I encourage everyone to go on and take a look. There is excellent information now that’s available on the progress.

I’ll just turn it over to Paula to see if she has anything else to add.

THE CHAIR: Ms. Langille.

PAULA LANGILLE: What I would add to the deputy minister’s comments is that the dashboard is updated quarterly. We’ll have regular reporting. We do recognize in construction that there are always new developments happening throughout. I have a very dedicated team who are working with the service providers as they move through the process. They have their finger on the pulse. They understand where projects are, where they’re at, and where they’re moving toward, and we support them in moving those along.

[9:15 a.m.]

We’re quite confident that we’re going to be able to meet those deadlines of 2032, because we have a very collaborative approach with all of our service providers and moving those projects through all the different stages.

LISA LACHANCE: With that goal of 5,700 new beds - if all of the new beds were created today, it wouldn’t actually clear the wait-list. I’m wondering how that target was chosen and how you’re considering that fact - that even with this ambitious commitment for 2032, we’ll still likely have people on a wait-list.

THE CHAIR: Deputy Minister McEachern.

LORA MCEACHERN: We’ll just emphasize that it is a historic commitment that is being made - 5,700 new and replacement facility beds across the province is a very significant commitment. We’re already seeing the benefits of that with 1,000 new and replacement beds in the system and 2,000 more to come. Our wait-list in long-term care is trending down, so that’s a positive thing. The amount of people on the home care list is trending down, so again, quite positive.

The other point that’s really important to make here is that we understand that the need isn’t just about more beds in the system. It’s also a reflection of the importance of a focus on advancing home care in the province. We know that Nova Scotians also want to be able to live in their home. There are some folks who want to be able to continue to do so, so our emphasis is on home care as well.

THE CHAIR: See how easy that was? (Laughter)

MLA Lachance, please.

LISA LACHANCE: I’m just going to revisit and then go on. In terms of the target number, how confident are you that that will make a significant dent in the wait-list? Related to the current wait-list, I’m wondering how many Nova Scotian seniors who are on the wait-list are currently waiting in hospital, and how much does it cost the Province per day to have someone waiting in the hospital?

LORA MCEACHERN: So a couple of questions in there, I think. I’m going to try to make sure I’ve got them all for you.

How is our wait-list doing? Is that the first question? There are about 2,000 on the wait-list. Our medium wait-list time is about 60 days. As I said that, that medium time has decreased. That’s a positive thing.

In terms of the amount of people who are in hospital, I don’t have the exact numbers, but I think it’s about a couple hundred who would be waiting in hospital for spaces. I would also just mention the importance of those who are in - waiting for a spot in long-term care - they, in most cases, are eligible for home care. About 80 percent of those people are receiving home care. Their needs are being met in another way. We’re moving just as fast as we can to provide those beds for them.

Again, the significant investment - we’ve got homes opening all the time here. The bed count is increasing.

LISA LACHANCE: You mentioned that there are a couple hundred folks per day waiting in hospital. Could the department table some information on that - whether that’s by quarter or however we understand the exact number of seniors who are waiting in hospital for a long-term care bed? Do folks who are waiting in hospital receive priority status on the wait-list?

LORA MCEACHERN: There is a process and a policy around how that works. I might just turn that over to the associate deputy minister to give you those details.

THE CHAIR: Ms. Huntington.

JANET LYNN HUNTINGTON: What I would say is when you are on the wait-list for long-term care in Nova Scotia, your needs can be met, and you can be placed under a variety of circumstances and scenarios. Coming from hospital is absolutely a way to get into long-term care. However, what I would say is that so is coming from community, which is what we want. We have a good mix of community placement and hospital placement. There is no one faster route. The needs of individuals are triaged based on their needs at the time.

I’m going to take a few minutes, if you don’t mind, to talk about a recent example with Opal Ridge, our newest long-term care facility that we opened about a month ago in Bedford. What we’re seeing with that particular admissions process - and we tried something new there - is we’re taking people who want to transfer into Opal Ridge. They’re already in existing long-term care facilities and they’re transferring. We’re backfilling the transfer and we’re taking people directly from community. We have seen that particular pilot or prototype for admissions working really well at that facility. The placement from community and hospital is about a 60-40 split, depending. I’ve seen the numbers at 52-48. The numbers are balanced.

What I want Nova Scotians to know, though, and I think the important message here, is if you need a placement in long-term care and you have needs, you will be placed. It’s a triage process. If you need other examples of support, as the deputy minister mentioned, we will get you home support and we will get you what you need.

THE CHAIR: MLA Lachance.

LISA LACHANCE: Back to understanding the target and whether it’s truly going to meet our needs - between 2018 and 2022, so under the former Liberal government and

the current PC government - there were 2,000 new or replacement beds announced. However, in the report, the Auditor General wasn’t able to find a record of assessment - so why that number was chosen, and being able to back up the decisions, which obviously is really important when we are talking about such a historic investment.

Some of the nursing home beds were announced just before the 2021 election, so there wasn’t implementation. At that changeover, what sort of analysis was done to see if this was the right number, the right approach? I think this also links to a question around the Government Records Act. As the Auditor General highlighted, the Government Records Act was not followed and folks in the new department were unable to access the information about what had been done in terms of this commitment.

So: a little bit more about the relevance of this commitment and how it’s backed up.

THE CHAIR: Deputy Minister MacEachern.

LORA MACEACHERN: I believe you’re referring to a portion of the report where the Auditor General had referenced about 1,000 beds - that there were facility condition assessments done and the records weren’t able to be provided to the Auditor General. It just gives me an opportunity to explain that a little bit. Before any decisions are made, or before the decisions were made around the 5,700 commitment, facility condition assessments were done. There is a matrix that the department uses, led by Paula’s team, to determine based on the risk criteria what areas are in most need.

Assessments were done before the decisions were made relating to the 5,700 beds that we are actioning on. What the Auditor General found is because the department came out of the Department of Health and Wellness, the Department of Seniors and Long-term Care had no problem providing the relevant records for the assessments that were done after the department was created. There were some records that were mixed in with the Department of Health and Wellness records. It was a challenge to provide those.

The team feels really confident and can say that that work was done. The challenge was actually providing the physical paper to the Auditor General when she requested it.

I’ve got two follow-ups to let you know - to provide comfort. Some steps have been taken. All of the records have now been transferred from the Department of Health and Wellness to Seniors and Long-term Care. They’re all held now by the department. The department has a records-management policy in place and staff are being trained.

The other thing I can tell you is that the facility-assessment records that weren’t able to be provided to the Auditor General - a reassessment was done of all of them - Paula would be able to speak to that in more detail - and it confirmed high numbers of need for those beds. It basically confirmed everything that was done.

THE CHAIR: Order, please. MLA Lachance.

LISA LACHANCE: In terms of moving forward with this commitment - also in the Auditor General report, there was a note that so many of the replacement beds weren’t going through competitive procurement processes. These are large contracts. They’re 25-year contracts - historical investment. I think time and time again, we really consider it important that government use competitive processes so that we know we’re getting the best for Nova Scotians.

This isn’t just about following one process versus another. Governments have limited money. We’re in a debt crisis at this point in this province. We need to know that we’re doing the absolute best.

Why aren’t you using competitive processes for the replacement beds?

LORA MACEACHERN: Value for money - fiscal responsibility - is very important and we’re factoring that in as we execute on government’s significant commitment here. What I would say is in terms of Recommendation 1.5 - we have accepted that recommendation. Our view and our advice is that the Public Procurement Act has been and continues to be complied with. We do recognize the crux of the Auditor General’s recommendation there is that it would be a good idea for us to look at the approach going forward as it relates to the current process for right of first refusal for existing facilities.

We are taking a look at that. That’s part of the work that’s happening now. We’re looking at the best approach for those circumstances going forward.

LISA LACHANCE: Of the contracts that have been signed, I think to date the government has refused to release the signed contracts - just clarifying on that. That seems unusual. I’m wondering, could contracts be provided to this committee so that we understand what’s being put in place?

LORA MACEACHERN: We are certainly open to providing all the information that we can that’s publicly available. Sometimes when it comes to contractual issues involving third parties we do have to take those considerations under way. That’s what the Freedom of Information and Protection of Privacy Act would require of us. We carefully consider the information that we make available.

I would just make a few additional comments. We certainly make good information available, as I said, on the website about the progress of builds and public accounts. There’s quite detailed information about each facility and the amount that’s spent in terms of operation and construction for each facility. There’s good information that’s available on costs.

I’d also just point out Page 27 of the Auditor General’s Report where she says, “Although the right-of-first-refusal process is non-competitive, we observed evidence the Department’s approval process and contracts have characteristics demonstrating that value for money is being achieved within this approach.” So the Auditor General has reflected that our current process has good value for money. However, we recognize that it’s important to take a look at that, and we will continue to do so.

THE CHAIR: MLA Lachance with two minutes, please.

LISA LACHANCE: I think we have the highest expectations when we’re talking about seniors. The policies and procedures are there so that there’s consistency no matter who’s in a department or where that department sits and that sort of thing. I think competitive processes are really important to make sure we’re getting the best for Nova Scotians.

In terms of actual care being provided right now, nursing homes are committed to the 4.1 hours of care per resident per day, but only 62 percent are delivering at this standard. I think this has a lot to do with staffing shortages. I’m wondering if you could talk about what percentage of staff positions are vacant across long-term care facilities in the province.

LORA MACEACHERN: I can give you some stats that are really encouraging. In terms of long-term care, the most recent stats are 6.6 percent workforce vacancy, which is a solid decrease trending down. For home care, it’s 10.8 percent, and again, it’s a solid downward trend.

I’d be happy to talk more about the 4.1 hours of care if there’s time. I can move that over to my associate deputy minister to speak to that.

THE CHAIR: Ms. Huntington, and there are 15 seconds. Go ahead.

JANET LYNN HUNTINGTON: Long-term care facilities are reporting for the first time that they have no vacancies in long-term care. We actually had Penney Campbell from MacLeod Cares Victoria Haven Nursing Home in Glace Bay here at a Public Accounts Committee not that long ago talking about that.

THE CHAIR: Order, please. We can maybe get back to this another time.

We’re going to move on to MLA Rankin, please.

[9:30 a.m.]

HON. IAIN RANKIN: Thank you for all your work, of course, on this issue, and to the Auditor General, on an important report.

I also want to talk about Recommendation 1.5 and maybe look at the explanation a little bit more from a legal perspective on why the Public Procurement Act wasn’t followed. I think it is worrying, because this isn’t the only category where the government has chosen to use sole-source contracts. In this case, it was talked about that there is a right of first refusal from the current operators that the government has chosen a multi-billion-dollar contract with. In fact, 85 percent of the replacement beds are being approved outside of the law, is what the Auditor General is saying - the Public Procurement Act. The Auditor General noted that the Act doesn’t allow for the right of first refusal, so my first question is how legally this was justified and if that legal advice came within government. Is this a lawyer who reports to government, or was there independent advice given that allows the department to approve these multi-billion-dollar contracts by not following that Act?

THE CHAIR: Deputy Minister MacEachern.

LORA MACEACHERN: Happy to speak more about this recommendation and our response. The Public Procurement Act provides the acquisition of goods and services. The kind of funding and the kind of arrangement that’s at play in this scenario falls within the realm of a grant. It’s a different type of funding that’s provided. That’s . . .

THE CHAIR: Order, please. MLA Rankin.

IAIN RANKIN: How could it not be a good or service? This is a public service that is in the form of an operating grant, but it’s still a good and service that Nova Scotians count on.

LORA MACEACHERN: It comes down to the way that the Public Procurement Act is worded. We have advice and confirmation that the Public Procurement Act is being complied with. However, I really do want to get to the heart of the point. The Auditor General’s recommendation is really, to our understanding, about the opportunity to do a competitive procurement, not about whether there’s an absolute need, but really about the opportunity and whether that could - even though the contracts and the review that was done by the Auditor General showed good value for money, is there an opportunity there?

We understand that, and we think it’s very appropriate for us to be looking at what those opportunities are. That’s the kind of work that’s happening right now: looking at whether there should be another approach going forward. We’ll have some updates on that once we get through our report work.

IAIN RANKIN: I appreciate the willingness to review and look at it. The Auditor General found that there was some good work in the contract itself, but did not really show that there is a full value for money assessment absent going with one provider. Let’s say for the sake of argument it was decided at the start that Shannex is the one we want to go with. Where was the assessment that looks at other opportunities - like if there was a shadow bid? Did the government say, “Let’s use our in-house strength of the knowledge of the sector, the fact that we have examples of contracts?” Where was the value for money assessment so that Nova Scotians can be confident that by going with this one tender they did get value for money?

LORA MACEACHERN: This is a model that has been used for quite some time, going back several decades, I would say. This is a historic commitment that’s being made. We are looking at all of the options going forward. We’re really pleased with where we are so far in our plan. We’re really pleased that we’ve got five new facilities in place and 18 more to come. Great progress is being worked. This model has shown that it does deliver, but we are very happy, and we think it’s important to continue to look at ways that we can achieve value for money and have the best approach possible moving forward. We’re going to do that.

At the end of the day, we’re working really hard to provide seniors with an opportunity to get the good care that they need and to live in dignity. We’re going to continue to work on our plan at pace. We’re listening to the recommendations that we’re receiving, and we’re focused on doing it in the best way possible for seniors.

IAIN RANKIN: I appreciate looking forward, but part of doing better looking forward is assessing if the most appropriate action has been taken and the best value for money. We’re talking about $15 billion of spending. Nobody is saying that the operator that is getting these contracts isn’t a good operator; they’re a well-respected operator. They may have even actually won all the tenders, but at least then there would have been other providers that would have bid. These processes do ensure that pencils are sharpened when bids come in for government to assess. It begs the question: Why? I haven’t heard why the government chose to go the path of approving these contracts for decades out - billions of dollars. What were the considerations given to avoid going to tender?

LORA MACEACHERN: I may include some of my colleagues here to pick up on some of the answers. As I said, the model that has been in place for the replacement builds has been in place for quite some time - for decades. It is a model that has worked. There are a number of operators in communities that have long-standing relationships in communities. They’ve been not-for-profit organizations in many cases that have been operating. Trying to find that right approach - this is the approach that has been working so far.

As we’ve said, we do recognize that it’s important to always take a look at this. We understand the Auditor General’s Recommendation 1.5, and we are looking at the options and the best approach going forward. As I said, we’re committed to our plan and we’re making it happen in terms of new beds and replacement beds all across this province.

THE CHAIR: Order, please. MLA Rankin.

IAIN RANKIN: I understand that you’re happy with process, but just because something has happened in process for government for decades doesn’t mean that we can’t improve. I think the things about the qualifier of saying that the proponent has been a long-standing operator - all of those things could be put into the criteria of a bid, so if there is some kind of value given to an operator’s relationship with community, why wouldn’t you consider putting those things in that you value to keep that proponent in place in a competitive tender, just to ensure that we’re keeping these proponents honest and maximizing, truly, the value for money?

THE CHAIR: Deputy Minister MacEachern, I’m going to step in here and say that we’ve been dancing around a question for a long time, and I appreciate MLA Rankin’s getting at it from many sides, but if you could give us as direct an answer as possible, that would be very helpful.

LORA MACEACHERN: In answering your question, we are considering all the options. As I’ve said in the last few moments, we are looking at all the options. We’ve accepted the Auditor General’s recommendation. We are looking at the options going forward. As I said, we’re really committed to our plan, and we’re committed to doing it in a cost-effective and efficient way to benefit Nova Scotian seniors.

IAIN RANKIN: Chair, the department is saying they accept the recommendation, yet they haven’t been following what the recommendation has been asking for. It’s tough to actually discern whether or not the recommendation will be fulfilled if there’s no agreement that the Act wasn’t followed or not. The Auditor General has clearly laid out that the Act doesn’t allow for right of first refusal, yet the department is saying that the Act does allow. So I just want to confirm that the contention of the department is that they can continue to use right of first refusal and not tender out and follow the recommendation of the Auditor General at the same time.

LORA MACEACHERN: What we’re saying as a department is that we understand the recommendation of the Auditor General; we understand the importance of value for money and for those important considerations. We are looking at the options going forward in terms of our approach for replacement builds across communities.

IAIN RANKIN: It’s hard to get a direct answer on this. I’ll just end by asking the Auditor General, if I could, that if the department continues to use first right of refusal, are they actually following and accepting Recommendation 1.5 in the report? If I could just get the comments of the Auditor General, and then I’ll pass it over to my colleague.

THE CHAIR: Ms. Adair.

KIM ADAIR: Good morning, everyone, and thank you for the opportunity. I think the exchange articulates that you understand our finding quite clearly. In our view, the right of first refusal is not in compliance with the Public Procurement Act. These are 25-year service agreements including the operating component and a major capital component in excess of $15 billion. Right of first refusal is not in compliance with the Public Procurement Act, and in our view, we’re saying that all of these beds, initiatives, projects, and contracts should go to public tender.

THE CHAIR: MLA Rankin, do you have anything else for the Auditor General?

IAIN RANKIN: No, I think I’m good. I think that’s helpful. I think it helps the committee.

THE CHAIR: We’ll move on to MLA Mombourquette, please.

HON. DEREK MOMBOURQUETTE: I appreciate everybody being here with us today for this very important conversation. I do have a question around the replacement facilities, in the sense that there are some replacement facilities that are being built next door to the older facilities. In some certain cases you have the new buildings being built immediately next to the ones that will be obsolete or used for something else.

My question is around that. Who’s responsible for that? If it’s a not-for-profit, are they responsible for the old building? What’s the process there?

THE CHAIR: Just to clarify, MLA Mombourquette - who’s responsible for the old buildings, or for the decision to make buildings?

DEREK MOMBOURQUETTE: What is the life of that building after the new one is built? Who is responsible for that building? How is that going to work from the department’s perspective?

THE CHAIR: Deputy Minister McEachern.

LORA MCEACHERN: There is a policy that relates to that. I’m going to turn it over to Paula to give you some more information on the disposal policy of government.

THE CHAIR: Ms. Langille.

PAULA LANGILLE: To the deputy minister’s point, there is a disposal policy that we, the Province, have that outlines the different options for the service provider. These are not owned by the Province. These are owned by these third-party entities. They have the option to retain the building, to sell the building, or to demolish the building and sell the property. Those are sort of the main options at this point that they would have.

That policy has also been looking at if there are opportunities to repurpose that space. We would work with other government departments to see if that building has other opportunities to meet government mandates.

We work very collaboratively with all of our service providers on considering what options work best for their organizations and also for the Province’s mandates across the continuum of departments.

DEREK MOMBOURQUETTE: That’s going to be an interesting situation for some of those service providers. They’re significant buildings. A lot of them would still be useful. Some of them may not be as much. I mean, one of the main reasons you see multiple governments talk about this was because of the lack of adequate space - bathroom situations in some of the facilities, et cetera. It’s something that we’ll be watching closely.

This is an important conversation. As my colleagues have said on both sides, you’re talking about billions of dollars here of taxpayers’ money that is going into a plan that is going to stretch into the 2030s. Are you confident, based on your projections right now, that you are going to be on budget?

LORA MCEACHERN: I mean, that’s absolutely something that we take under careful examination as we work through the various projects. As I said, we’ve got a dedicated infrastructure team. They monitor closely all the projects that are under way. There are a number of tools and policy approaches that they use in order to be able to ensure proper monitoring.

I would also, again, say that the Auditor General made some good recommendations for us around monitoring. There were four particular recommendations there for monitoring. That would include monitoring to ensure it stays within budget. We’ve implemented all four of those recommendations already, so within just a couple months of the Auditor General’s Report, those were done. We feel confident.

DEREK MOMBOURQUETTE: To confirm, the projects that are currently under construction, they’re on budget?

LORA MCEACHERN: I will turn it to Paula to give a little more detail. It’s her infrastructure programs. She can give more details on that.

THE CHAIR: Ms. Langille.

PAULA LANGILLE: We do recognize that we’re facing escalating construction costs, and it’s not unique to long-term care facilities. We’re building hospitals, schools and housing. We are working very collaboratively with all of our service providers in ensuring we have our finger on the pulse. If they start having issues when they’re going - they do go to public tender. They go out to a competitive process. They ensure that they’re getting the best competitive price as they move forward. We’re working with them collaboratively from the design all the way through to occupancy, so we know exactly that we’re getting efficient designs and streamlined costs, and if there are things that pop up, my team works with them. They do a couple different step process.

[9:45 a.m.]

They would look at the budgets that we’re getting. We are managing all of these projects. We would be able to compare them to other like-size facilities in similar areas and provide some advice to say: These are things that you can consider. We would also look at value engineering, making sure that some of the components that are in the building are being looked at. That could be space; maybe some of the space is a little too large. We could refine that. Some of the finishes as well. We want to make sure that they’re durable and safe and that they can last however long we need them to and provide quality care, but not necessarily high-end finishes, which is similar to when we also look at the fixtures and the equipment that they’re putting in these buildings.

It’s the same as if you and I are going out to buy a car. We would love a BMW, but we’re like: a Toyota would probably be just as durable. We want to make sure that these are cost-effective solutions, and my team works very collaboratively with them to make sure that they’re cost-effective solutions. We streamline as best we can, and we ensure that they get the best value.

THE CHAIR: MLA Mombourquette with three minutes.

DEREK MOMBOURQUETTE: I’m still looking for an answer on whether the current projects that are under construction are on budget. I think that’s important. It’s an important conversation not only from the conversation we’re having here about the recommendations that are coming from the Auditor General, but also the fact that we are in a historic deficit in this province right now. I don’t see a path the government is presenting to address that.

Recommendation 1.7 suggested that the department review the contracts between service providers and third parties to protect the interests of service providers in the province. This is largely because there has been no defined change order process. Has the department changed their RFP documents to require that all contracts be submitted to their department for review? The department’s target date of this change was September 30, 2025.

THE CHAIR: Deputy Minister MacEachern with a minute and a half.

LORA MACEACHERN: First of all, just to follow up on your earlier point, the budget health is strong. It’s strong. That would be our answer to your question there.

In terms of Recommendation 1.7, yes, we can confirm that that is complete. We have taken immediate action to implement that recommendation for the contracts. We’ve set up a process. We’ve revised our FDAP process, and all contracts will be reviewed to ensure going forward that they protect the interest of the service provider and the Province.

THE CHAIR: MLA Mombourquette with 40 seconds.

DEREK MOMBOURQUETTE: Forty seconds; I probably won’t get a question in here. I just think this is an important conversation to have as committee members. As I’ve said, this is probably one of the most significant long-term investments that you’re seeing over multiple governments in addressing a significant wait-list. It will also be interesting to see how contract negotiations go as well. That is a big conversation right now with potential strike action happening in the future. With that, I’ll leave it now and pass it over to my colleagues.

THE CHAIR: We’ll move to MLA Timmins, please.

DIANNE TIMMINS: It is a huge accomplishment and goal for the future, and it’s very important for our seniors and their communities. I see some great things happening, and I hope to see some really good things coming ahead in this. My question is for Deputy Minister MacEachern. In your remarks, you mentioned that the department is investing in more than just long-term care. What are you doing to support seniors who want to stay in their homes, especially related to the wait-list that you had mentioned?

THE CHAIR: Deputy Minister MacEachern.

LORA MACEACHERN: Advancements in home care and supporting those who want to continue to live at home is a really important objective of the department as well. I can list a number of excellent initiatives. My colleague here, Ms. Huntington, has been deeply involved in this for a number of years, so I’m going to ask her, if there’s time, to do so as well, but I’ll just highlight a couple to start with.

The Seniors Care Grant: You’ll be familiar with that. It was put in place in 2021 when the new minister took over and we had a dedicated department here. It’s a grant of $750, and 162,000 Nova Scotians have benefited from that so far. It provides help with household costs and health care services that might be needed, all supporting people to continue to be in their homes.

We have also supported 40,000 Nova Scotians on a regular basis with home support, community nursing and equipment support - a significant number of Nova Scotians receive that support to be successful and continue to live in their home. We’ve expanded the VON clinics across the province. There are community clinics where people can go and get services. They’re now in eight locations across the province.

The Province has put in place a CAPABLE program - a CAPABLE pilot. Associate Deputy Minister Huntington can speak more about that. I also wanted to mention our Age-Friendly Communities Grant projects have supported 41 organizations with ways to help seniors keep active and healthy.

I would also mention our support for the Canadian Red Cross. Red Cross has equipment-lending programs and bed-lending programs. Those are extremely important. We’re investing in that so that seniors are able to get those basic things that are very important in order to be able to continue to live comfortably and happily at home.

I will turn it over to Associate Deputy Minister Huntington to add more to that.

THE CHAIR: Associate Deputy Minister Huntington, please.

JANET LYNN HUNTINGTON: Thank you, Deputy Minister. You touched on all of our high points, but what I would like the opportunity to share today is that the Department of Seniors and Long-term Care is really designed to support Nova Scotians in a continuum of support. The deputy minister spoke about some of those programs today.

If we think of the frailty scale, and we think of low frailty, we think of early days. That’s when we’re talking about the CORAH programs and the CAPABLE program. These are the upstreaming programs that helps Nova Scotians in their senior age who are doing well but they need physical activity, they need to be getting recreation, and they need to be socializing. We have a plethora of programs. Many of them are free for Nova Scotians in communities across the province. That helps them when they’re on the low end of the frailty scale.

Then they’re moving across the frailty scale and they need a little bit of help. That’s when we’re talking about the things that the deputy minister referenced: home care for 40,000 Nova Scotians, equipment-loan programs, home oxygen. These are things that are helping Nova Scotians live their best lives at home where they want to be.

We know as we age, seniors need more support. That’s essentially what we’re here talking about today: 5,700 new and replacement beds so that when Nova Scotians get to that need at their frailty scale where they need some extra supports, we make sure we have the supports for them when and where they need it.

It doesn’t start at 85. It doesn’t start at 62. Seniors age. It’s 55-plus. We’re working - 65 - all of that age of continuum of supports to make sure that wherever they are on the frailty scale, they have the supports they need to live the best lives when and where they want.

DIANNE TIMMINS: A lot of your services are updated on the website? Good.

I’ll move on to another question, please. There are five newly built nursing homes open to date and more to come. What do these nursing homes look like? In particular, can you help us understand the standards of the design and space that you’re providing for them?

LORA MACEACHERN: I’m going to turn that one over to Paula Langille.

THE CHAIR: Ms. Langille.

PAULA LANGILLE: I’m very excited to talk about this, because these are complex health care systems and they are modern workplaces for the staff who work there. We do want long-term care to be a place where people want to work. That’s been sort of the goal of Seniors and Long-term Care.

These spaces - they’re wonderful. They have all single rooms, single washrooms - that has been a cornerstone of continuing care since 2007. We’re leading best practice in that way. We also have smaller households. If you have been in an older nursing home, you may see that sometimes they do have shared rooms, shared washrooms, and they could have maybe a number of residents in a household. We have reduced the size to no more than 16, up to 24. We find that that provides a nice calm environment for residents who may have responsive behaviours or just to provide an overall feeling of home-like. These are their homes. We want them to feel home-like, not institutional. Those are the things that we put into this.

Also, two of our minister’s favourite spaces, which is a hair salon where residents can go and get their hair done, and also OT/PT space. They have places to do walking programs, they can go on a recumbent bike, stay active, stay moving, which is very important. Also in these household sizes - we call them households or neighbourhoods - they have their own independent dining spaces and living room spaces where they can do activities with all the residents on the rooms.

They also have a community connection room, where the community can come into the facility and they can have gatherings. It could be at Christmastime, it could be with the Lions Club, a variety of things. They have opportunities for space to engage with the community. These seniors want to stay connected to the communities, which is very important. These spaces provide these opportunities.

We also have what we call spas for our residents. That’s where they have their bathing units. They have their tub rooms, they have their shower rooms, they have opportunities to have meaningful personal care taken care of, which is very important. These spaces are also dementia-friendly. We have window boxes outside of each resident’s room where they can put little mementos. It’s a pathway finding for them so they understand, “That is my room, that’s my space.” They can very easily do that.

They also have access to secure courtyards so they are able to get outside. It can be through fenced areas, or they have large balconies so they are able to go outside and still be observed by staff, which is very important. I would also say, where we are leading edge with private rooms and private washrooms, we also have shown that this is an improvement on infection control, which has been a key learning point for us through the pandemic. Having those reduced shared spaces has helped with infection spreading.

One of the things that I do want to end on is that we’re building these buildings, but we also want to make sure that they are sustainable going forward. Seniors and Long-term Care has taken that initiative to say, “We want these to be 25 percent better than current energy building code requirements,” so that we’re able to reduce the greenhouse gases that we are producing, which is a huge undertaking with our facilities. It is very much a collaborative approach. We work with these service providers on the design all the way through to opening. We want to make sure that these are successful builds that residents and staff are getting the modern, home-like environments that they are deserving.

I would also add, I forgot: We do cap the size at 144 rooms. Again, that is just to cut down on that institutional feel. We feel that when you have a smaller home, it cuts down on the noise, it cuts down on some of that institutional feeling you may get in larger facilities.

DIANNE TIMMINS: You did answer my other question regarding the cap size. I really appreciate your detailed answers regarding the centre itself. I see a great value for our money within design of the homes as well. Thank you for the detail, and I’m looking forward to visiting one of the new homes in the future. I’m going to pass it on to my colleagues for the next question.

THE CHAIR: MLA Outhit.

TIM OUTHIT: Thanks, folks, for being here and answering all our questions today. The question I have is regarding debt. The government recently changed how debt for long-term care homes is reflected in the government’s budget. This was based on the AG’s recommendation. Can you explain what this change is and how it affects the Province’s budget?

THE CHAIR: Deputy Minister MacEachern.

LORA MACEACHERN: We’ll turn it over to Rob from the Department of Finance and Treasury Board to answer that. (Laughter)

THE CHAIR: Mr. Bourgeois.

[10:00 a.m.]

ROBERT BOURGEOIS: There was a change in the 2024-25 public accounts. Previously, what the government would do is the homes that we would lend to service providers would be recorded on our books as loans receivable. During this audit, the OAG, when they dove into it, they looked at the accounting for long-term care, and they came to the conclusion that those loans receivable didn’t really - the contracts underlying the homes didn’t really meet the definition of loans receivable.

We dove into it during 2024-25 year-end and came to the conclusion that they really weren’t loans after all, and they were more like capital assets. Right now, what we do on our books is - and we made the adjustment in the 2024-25 public accounts - we record all of the homes that we finance as tangible capital assets on our books. What that means is through that adjustment, we added $880 million to our net debt of the Province. Any of these contracts that we, in the future, will extend funding financing will be reported as tangible capital assets in the future, not loans receivable.

TIM OUTHIT: It’s funny how sometimes your personal life and your work cross over. In my own situation, we’ve taken advantage of equipment - not for me, but for my family - and home care. I’m not there yet. I have been able to tour some of the new facilities and have been so impressed with them. That leads me to my question, and that is: Can you provide some details of one of your most recent facility openings? Maybe Moody Hall, maybe Opal Ridge Hall. I’ve been so impressed with the design, and maybe this is a chance for you to tell us a little bit about it.

LORA MACEACHERN: I think I will turn that one over to Paula Langille.

THE CHAIR: Ms. Langille.

PAULA LANGILLE: We’ve had five facilities open over the last two years. They are wonderful spaces. They are, as I mentioned earlier, single room, single washrooms. They have the community connection space. The most recent one, Opal Ridge Hall, which is over by Penhorn area in Dartmouth - pardon me? (Interruption) You do, yes. These buildings are modern facilities. As we’re moving forward, they have great welcoming environments. They have a lot of light coming in; they have the ability to make residents feel like they’re still connected to their communities. These spaces, as I’ve mentioned, they do have the community connection space.

The ones specifically in Opal Ridge Hall and Moody Hall, they have a feature there they call Main Street. They have a façade showing a schoolhouse or a town hall. They have an open space when you come in. It does make the residents often feel like they’re still in the community, even though they’re in a long-term care facility. That is a design feature that one of our developers has done. There are other features. We want to make sure that we are bringing the community into the nursing home, and that’s part of the reason why we have these community connection rooms. We want to ensure that seniors still feel part of the community and that they are enjoying their modern spaces.

Same with staff. That is the other piece, as I mentioned earlier. They need modern facilities. They need to be able to provide quality care that they do in any environment, but this helps them be able to do that a little bit better.

TIM OUTHIT: Congratulations and thank you for that approach. It’s certainly appreciated and it makes a difference. I’m going to hand over to MLA Taggart.

THE CHAIR: MLA Taggart.

TOM TAGGART: Thank you, folks, for being here. I have to say that this is one of the - I don’t know the right word. I’ll call it the most rewarding. On our side, I’ve probably been on the Public Accounts Committee as long as anybody. I have been. This is a good-news story. It’s great stuff. Despite some best efforts to find little crinks or ways to move away from the positive story, I think it’s great work. I have had the unfortunate in a sense experience of - through my mom and other family members going through the long-term care facilities, new and old, and the challenges of getting into them. I’m just absolutely thrilled with what we’re doing here.

One of the questions that the AG has asked was about - I’ve heard it several times, from 2019 to 2021, 1,000 beds that couldn’t be accounted for or rationaled for or whatever. How many of those 1,000 beds were under construction or had shovels in the ground?

THE CHAIR: Deputy Minister MacEachern.

LORA MACEACHERN: I’ll turn that over to Paula.

THE CHAIR: Ms. Langille.

PAULA LANGILLE: All of those 1,000 beds are currently in development and many of them are in construction.

TOM TAGGART: I’m saying between 2019 and 2021, how many of those beds were under construction?

LORA MACEACHERN: There was very little under construction prior to 2021. I think that’s the point we’re trying to bring home to the committee. There was little activity happening. Seniors really were underserved by aging infrastructure and the lack of beds. That’s the reason for our plan.

TOM TAGGART: It’s been stated here this morning that there were 400 or 500 beds existing that couldn’t be staffed from - I guess when the new department was formed. It’s also been reported here this morning that we’ve trained somewhere between 2,000 and 3,000 CCAs at no cost to fill these positions and that we’ve gone to that 4.1 patient to provider deficit.

I understand that the previous government had a program that paid 50 percent of the tuition and then I think that was cancelled. I’m wondering if you have any record of how many new people came into the industry or the business in that time. That’s a period of time that we are focusing on here, right?

THE CHAIR: Yes, thank you, MLA Taggart. We have two minutes. Deputy Minister MacEachern, please.

LORA MACEACHERN: I’ll ask the associate deputy minister to answer this question.

THE CHAIR: Associate Deputy Minister Huntington.

JANET LYNN HUNTINGTON: You are correct. In the early days of the department, we had several hundred beds - around 400 beds - closed due to staffing. We had low interest in careers in continuing care, so we could not fill the seats that we had. In particular, the Nova Scotia Community College always has a standard allotment of seats for CCAs, and they couldn’t fill them.

When the announcement was made that we would be offering free tuition for CCAs, obviously great interest in that program. The commitment was 2,000. We’re at about 2,700 right now. We still see a great interest in a career in continuing care.

What we’ve done, and what we’ve really focused and worked hard on the last number of years is not just building a CCA. Once you become a CCA, what else do you want to do in continuing care? Our goal - our kind of raison d’être - is to make continuing care a sector of choice. We want to be a Canadian leader in attracting and retaining a workforce in continuing care.

We are looking at things from becoming a CCA - which we’ve done, and we’ve done really well - to once you are a CCA, what do you want to do after that? Maybe you want to be a CCA forever in long-term care or home care, and that’s great, but if you want to become an LPN, how do we help work with you to support that? We’ve done a lot of work with our training institutions and our training partners to get CCAs who have an interest in being LPNs or RNs, get them involved in education and training and support to do that. We give them all the tools that they need to be successful.

We want them because they actually want to work in continuing care. They don’t want to become an LPN and go to a hospital. They want to stay where they’re at. We have an obligation to help support them to do that. All of the efforts and all of the things we’ve been working on have got us to where we are today, and that is the lowest vacancy rate in home care and long-term care that we are aware of.

What I would say is . . .

THE CHAIR: I’m sorry. I have to call order on that. Thank you very much.

I’m going to move over to MLA Lachance, please.

LISA LACHANCE: I think what you’re hearing is that we all want to celebrate progress in long-term care, but we’re also going to ask questions about how it’s being done. I think it’s really important - this whole question of value for money is tied up in making sure we get the best for Nova Scotians. Every dollar spent is a dollar that isn’t addressing another priority. These are important questions.

I really want to recap and make sure that I understand: Is it the department’s intention to follow the Auditor General’s recommendation, move away from using right of first refusal, which the Auditor General has clearly stated is not compliant with the Public Procurement Act, and actually follow the Public Procurement Act and initiate competitive processes for all new and replacement long-term care beds?

THE CHAIR: Deputy Minister MacEachern.

LORA MACEACHERN: Yes, we are very much looking into the potential approaches going forward. That could include public tendering of replacement builds. We’re looking at the options. That work is not complete yet. It’s very much under way, and when we have more information, we’ll share it.

LISA LACHANCE: I don’t know what the process is - there’s an Auditor General Report, but when a department chooses not to follow the Public Procurement Act, it is a law. I don’t understand how other options can be considered when this is the expectation when spending public money. I think you talked about this happening for decades and it’s been working. Actually, the question is, it hasn’t been working. We had an incredibly long wait-list. We had people in shared rooms. This is all part of improving things.

I want to go back to the question of 4.1 hours of care. What is the percentage of seniors in long-term care facilities now in Nova Scotia who receive the 4.1 hours of care?

LORA MACEACHERN: I’ll turn this over to the Associate Deputy Minister.

THE CHAIR: Associate Deputy Minister Huntington.

JANET LYNN HUNTINGTON: At this point, we can report that 98 percent of long-term care facilities in Nova Scotia are receiving funding for 4.1 hours of care.

LISA LACHANCE: You said they’re receiving funding. If, due to staffing constraints or something like that, they aren’t able to achieve that target, what happens?

JANET LYNN HUNTINGTON: What happens with 4.1 hours of care is you get to a certain level of staffing where you’re eligible for the funding. That means you’re able to go out and hire those FTEs and those individuals to be able to work in those positions. That’s what those organizations are doing. They have to report to us quarterly on how they’re making out with implementing 4.1 hours of care.

There will always be some fluctuation; there will be an individual who is sick, that type of thing, but we know they’re using it; they value that money. That was an investment of several hundred FTEs into the system to get to 4.1 hours of care. That was monumental for the department, and it was a sector game-changer.

LISA LACHANCE: Just to be clear, in the last quarter of reporting around this requirement and goal, you’re saying that 98 percent of Nova Scotian seniors received 4.1 hours of care in the last quarter?

JANET LYNN HUNTINGTON: I’d have to get the data from the last quarter.

THE CHAIR: We can follow up on that. We’d love to see that. Thank you. MLA Lachance.

LISA LACHANCE: I think not just the last quarter. If the information is available quarterly, if we could see that over the past couple of years, that would be great. I also wanted to ask about shared bathrooms, certainly an important part of providing dignity to seniors in long-term care. Is the department prioritizing the movement toward single-room occupancy, and what is the percentage currently of long-term care residents who share a bedroom or a bathroom?

LORA MACEACHERN: I can answer most of that question. I’m not sure if we have that data, but if not, we’ll look to provide it. In terms of prioritization, absolutely. I think that’s quite evident by the fact that we’ve got this big commitment of 5,700 additional new and replacement beds. They are all single beds. There’s no shared washroom; it’s single washroom, single bed. We are introducing new into the system: 1,000 already, 2,000 more to come. We are very much prioritizing replacing those situations where there are shared bathrooms and shared bedrooms. We’ll continue to do so as we move forward and monitor what’s there and continue to prioritize.

LISA LACHANCE: What is the current percentage of long-term care residents who share a bedroom or a bathroom?

THE CHAIR: Ms. Langille.

[10:15 a.m.]

PAULA LANGILLE: Currently, we have 35.9 percent of long-term care residents who are sharing a room or washroom, but this building that we’re taking 5,700 rooms is our pathway of how to move forward to improving single rooms and single washrooms. There hasn’t been a generational investment like this for a decade. This is our pathway forward in how to do that. We’re also . . .

THE CHAIR: Order on that one. MLA Lachance.

LISA LACHANCE: Sorry to cut you off. I only have a few minutes, so I’m just going to ask a further question about quality and safety for seniors. For-profit operators of long-term care homes have a higher number of proven complaints against them under the Protection for Persons in Care Act. Has the department applied penalties to long-term care providers that have these proven complains? Are fines levied? How is follow-up managed within the department?

THE CHAIR: Deputy Minister MacEachern.

LORA MACEACHERN: I think the member’s referring to the Protection of Persons in Care Act legislation. That’s administered by our department. We’ve got a dedicated team that looks into complaints that come forward. I can tell you a little bit about the process. Calls and referrals are made to the general intake line through Continuing Care, the Nova Scotia Health Authority, and then those referrals are passed on to our department. There’s an inquiry stage where an investigator looks at whether the situation applies to the Protection for Persons in Care legislation. If it does, it will proceed on to an investigation of the complaint.

I think you were looking for some results in terms of what happens. The conclusions under the legislation are either that the allegation is founded or not. It’s really directed at the facility in terms of directives. If it’s determined to be founded, there are directives that can and very much are made against the facility and steps that they need to take. An action plan is developed, and monitoring is done to ensure that those directives are carried out. I can tell you in terms of stats that 2024-25, there were 88 investigations under the PPCA. Investigation found 64 were determined to be founded, and this resulted in 358 directives issued to facilities.

I would also point out that oftentimes, the calls that we receive, in terms of issues, do come from the facilities themselves. About 80 to 85 percent of the calls received come from the facilities. They let us know and we send people over to take a look.

THE CHAIR: MLA Lachance with about two and a half minutes.

LISA LACHANCE: You talked about the process and the 358 directives. I’m wondering: Have fines been issued to providers? Not to get away from the part where we believe that competitive processes are necessary under the Public Procurement Act, but in your use of right of first refusal, is the record of service providers considered in that decision-making? Have fines been levied, and is this considered when you’re looking at future contracts?

THE CHAIR: Deputy Minister MacEachern.

LORA MACEACHERN: I don’t have the data on fines. I don’t believe that it’s a common feature of the steps that are taken. What the Act provides for and the common steps that are taken are the directives. Those are steps that the facilities need and must take in order to remedy the circumstances that may have led to the situation. If it’s determined to be founded, the directives are that there’s an expectation on the facilities to make changes. As I said, there’s an action plan that’s put in place, and our team monitors for steps being taken to achieve that action plan.

THE CHAIR: MLA Lachance with one minute.

LISA LACHANCE: A recent example: Judy Austen was a resident in a long-term care facility in Halifax. She fell and broke her hip. Basically, video footage showed that the staff failed to provide the right level of care to her in that case. With incidents like this, does the department take that into account when considering which long-term care providers should receive contracts?

LORA MACEACHERN: I’d start by saying what you’ve mentioned there is certainly concerning. Anytime there’s that kind of incident that’s occurring in a facility, it’s of concern to us. That’s why we have our dedicated team, and that’s why that legislation is in place. Steps are taken when those circumstances occur. That’s really what I can say. We expect our facilities to take good care of vulnerable citizens. That’s what the legislation is there for. As I said, we’ve conducted 88 investigations last year alone and issued 358 directives. I think it speaks to the seriousness with which the department takes these matters.

THE CHAIR: Order, please. We’ll move on to MLA Mombourquette.

DEREK MOMBOURQUETTE: We’ll go back to some numbers. The government announced, of course, a 25-year commitment to long-term care service providers would cost $8.6 billion. Has that number increased at all?

THE CHAIR: Deputy Minister MacEachern.

LORA MACEACHERN: I will actually turn it over to Rob to speak to that.

THE CHAIR: Mr. Bourgeois.

ROBERT BOURGEOIS: That $8.6 billion was referenced in the public accounts for March 31, 2024. That same number this year for long-term care facilities is now $15.6 billion. It has increased.

DEREK MOMBOURQUETTE: That was the follow-up. In the public accounts, there was the additional $7-billion request. That $7 billion, can you give me a breakdown? That’s a substantial number to request. Can you give us a breakdown of what that’s for? Is that for facilities? That additional $7 billion, will it be tendered contracts?

ROBERT BOURGEOIS: In total, that $7 billion covers 48 new facilities or new contracts, and nine new service and development agreements, which would include some development construction costs as well. All 25 years out; 39 of them are updated service and funding agreements for existing facilities that were entered into in 2024-25.

DEREK MOMBOURQUETTE: I go to the conversation we’re having today around the recommendations of the Auditor General and ensuring that the department is looking at their own processes based on the recommendations of it. As I said, the $7 billion is a lot of money. We just want to make sure that that money is being spent in a way that - of course, I know the department; we’ve had a good relationship with them for years. You’re doing your best to support seniors, but there are recommendations coming from the Auditor General to look at how those contracts are being issued. We want to ensure that if contracts can be tendered, that process takes place.

I do want to ask a question in regard to the construction, getting away from the numbers, and it goes to trades. We’ve seen it at home. You see a lot of construction happening not only in long-term care. In 2021, we announced Carefield Manor, which is under construction. There are a few others that were under construction that were announced in the previous government. There are some that are back to the drawing board based on costs. The costs came in too high. Part of that is the fact that trades - there’s a high demand for it. Are you confident in your construction and in your outlook that you’ll be able to keep the timelines based on what we’re seeing on the ground when it comes to trades? Which is great; everybody’s working, but it also plays a big part in your overall costs of your infrastructure.

THE CHAIR: Deputy Minister MacEachern.

LORA MACEACHERN: We’ll turn that one over to Paula Langille.

THE CHAIR: Ms. Langille.

PAULA LANGILLE: As I mentioned earlier, my team works very diligently with all of these service providers, from the design all the way through to occupancy. We work with them very collaboratively and ensure that they have a cost-effective design, they’re doing all measures possible to ensure that there is efficiency from a staff flow. You have to consider that when you’ll building new facilities. They’re not just apartment buildings. Staff have to move. Residents have to have care and be treated. There is a complex process that is involved. We work with them very diligently to ensure that we’re getting the most cost-effective design and inputs out there.

When the service providers do go to tendering, which is the public process for them to secure a contractor, there may be escalation of costs. We are facing that, as I mentioned earlier, because we are building so many things - schools and hospitals and housing and everything - that there may not be opportunities. We would diligently work with service providers to look at what they’re proposing, ensure that if there are any opportunities for value engineering to bring their costs down, any opportunity - did they open to a full tender? Are there other parties that might be involved?

We do work very closely with all of our services providers so we know exactly what measures have been taken, what suggestions have been presented, and what other success we are seeing with other projects that could be applied to those projects.

We are confident, as the deputy minister mentioned - we have good solid budget health. There may be a few one-offs, and we do work with those providers on a regular basis to try to keep the projects moving and being successful.

DEREK MOMBOURQUETTE: Earlier last week, CUPE announced that long-term care workers in Dartmouth and Hammonds Plains planned are going on strike. These facilities are two of 52 - nearly 5,000 staff who are considering job action.

Just a couple of questions - when does that contract expire?

LORA MACEACHERN: Labour Relations, another department of government, is responsible for that work. We can refer that question to them.

DEREK MOMBOURQUETTE: How much time do we have left?

THE CHAIR: Six minutes.

DEREK MOMBOURQUETTE: The Department of Growth and Development acts as the financer for nursing home providers across the province. One of the questions I have around that: What are the risks that the government assumes by financing these projects themselves?

LORA MACEACHERN: Just wondering - would you want to answer that? I’ll refer that one.

ROBERT BOURGEOIS: The financing is done out of the Department of Growth and Development. They would enter into construction or development agreements with the service providers and would have quite detailed criteria in regard to all of that. One of the things that they do also provide in the risk - if DGD is not being paid, then there’s communication between DGD and SLTC, right. Ultimately, SLTC is paying per diems to the service providers, of which a portion is for the funding of the projects. So there’s that, from a protection perspective as well.

DEREK MOMBOURQUETTE: You’ve said these are 25-year mortgages. Do you have provisions in place if you have to extend beyond that timeline for the mortgage?

ROBERT BOURGEOIS: To date, my understanding is that we haven’t had to extend or we haven’t had to default or write off a mortgage. They’ve all been paid. They’ve all been paid to date. That is, I think, the symbolism of the sector itself - the importance of them being in the province and working toward and building the long-term care sector and wanting to be here and work with Nova Scotians. We’ve had good relationships with service providers and with operators in general. To date - yes, there is risk, but to date, risk hasn’t materialized in that way.

THE CHAIR: MLA Mombourquette with three minutes.

DEREK MOMBOURQUETTE: I will ask this question. I think it’s one of the greatest examples. I was there for the opening of the long-term care facility in Eskasoni, there the day former Premier McNeil announced construction, along with the federal government at the time. It’s really a beautiful facility in that community. In your work in the design process, are you looking at that? Are you looking at the culturally sensitive parts - the individuality of communities when you’re looking at some of these builds?

THE CHAIR: Deputy Minister MacEachern.

LORA MACEACHERN: I haven’t had the opportunity to see that facility just yet in my three months at the department, but very much looking forward to that. Maybe Paula will be able to speak to that in just a little bit more detail on how we take those considerations.

THE CHAIR: Ms. Langille.

PAULA LANGILLE: I’ve been there for the opening of the Eskasoni Kiknu facility, as it’s called. It’s a beautiful home. They’re incorporating the community, the culture, and everything like that. We have another build that’s going to be in partnership with Akoma as well, and Northwood, that is going to bring in that Africentric component as well to the facilities. We do have a number of other builds that are happening in French communities.

[10:30 a.m.]

As I mentioned, these long-term care facilities are core components of those communities. They’re jobs where our seniors live. We want to make sure that their community is reflected in those buildings. We do allow for that community connection. It could be from some of the art that is displayed, some of the activities that are done in each of those facilities. We want these to be welcoming environments and there’s space for them to be able to do ceilidhs or a variety of other community culture pieces that are very important to those seniors and to those community members.

DEREK MOMBOURQUETTE: I don’t know if I have enough time for another question or not. That pretty much concludes the questions that I do have. I will say that these are important conversations to have. As I said, these are substantial builds right across the province. This is the committee where we take the recommendations from the Auditor General. We appreciate the work that people do within the department. As I said, being here as long as I have, I’ve seen it first-hand. I have a deep respect for the Office of the Auditor General as well. This is a very important committee.

I don’t have much time left, so I’ll just say to all of the folks working in our long-term care sector, we all see first-hand how much love and support they put into supporting our family members each and every day. I think I speak on behalf of committee members, regardless of political stripe. It’s really important work that’s done with a lot of care, love, empathy, and compassion. Thank you for the opportunity to ask a few questions today. We will continue to ask questions ensuring that this kind of money being spent on something so important that we want as much opportunity for open bids and open competition.

THE CHAIR: Now we will move to MLA Burns.

RICK BURNS: I think we all know the important work that this department does. It affects everybody in the province. We all age. It’s great to see we have a department that’s so thoughtfully and carefully considering the needs of Nova Scotians as they age, by both helping them age in place and having a place to transition.

The topic at hand: We’re discussing the AG Report. I want to ask about the recommendations. There’s been some discussion about recommendations that have been completed. There are a number of recommendations. Can you share the recommendations that have been completed, the ones that are slated to be completed, and the timelines that you’re looking at as far as progressing through those recommendations?

THE CHAIR: Deputy Minister MacEachern.

LORA MACEACHERN: I’m happy to provide an overview. We’ve completed six of the 10 recommendations so far. We’re really pleased with that. The Auditor General’s Report came out in September. As you know, we’re only in early November. Six of the 10 have been completed. I’ll outline what those are. The first recommendation around the Government Records Act - as we said, all of the thousands of records have been transferred from the Department of Health and Wellness over to Seniors and Long-term Care now. A records management policy is in place and staff are being trained on that policy. Recommendation 1.1 is complete.

I would also move to some of the later recommendations that are complete - very important ones that are all around monitoring of the construction process, which we’ve talked about a lot today. Recommendation 1.6, which is the recommendation around strengthening the monitoring of the builds, about ensuring that the mortgage payout commences - that it’s clear when it commences upon occupation by the provider. We have made that clarification. Three months is now the time. Within three months of occupancy, the mortgage needs to be repaid. That recommendation is complete.

Recommendation 1.7 is complete as well. That was a recommendation around reviewing contracts that service providers enter into to make sure that they’re providing good value for the service provider themselves and for Nova Scotians generally. That recommendation is now complete as well. We have changed our process, and the review of those contracts is under way and will continue going forward.

Recommendation 1.8 is also complete. That is the recommendation around ensuring that we obtain submissions from service providers for approval and that we ensure that they’re adhering to the approval process. We have made changes to our process documents and we’ve added six new critical gates that the service provider, in doing their construction process, must follow in order to get to the next stage. They have to satisfy completion with that stage before they’re able to move to the next stage. It’s a really important change in terms of monitoring that we have undertaken. Recommendation 1.8 is done.

Recommendation 1.9 is complete as well. That’s about requiring facilities to procure through RFP - if they’ve gone through RFP, to ensure that they’ve followed all steps in the process. Our documents have been changed and that is now complete as well. Of course, Recommendation 1.10: we’ve talked about that. That’s the website. We’re happy to have a much more interactive website dashboard that people can click on and easily see what’s happening in their community and the status of their projects.

Those are the six that we’ve completed. We talked about the couple that are still under way. That would be, for example, the Auditor General’s Office had recommended that we do a review of the small group that are the smaller long-term care facilities owned by the Nova Scotia Health Authority. It’s just a small group, but we are working now with the Nova Scotia Health Authority and the Department of Public Works to make sure that those few are assessed as well. That would be one example of one that’s still under way. We have dates set out in our response to the Auditor General’s Report about when they will be completed, and it’s not far off.

RICK BURNS: I’m hearing progress is being made quickly. We’re at six of 10 recommendations that we’ve moved through already. Can you give me a sense of how you were able to move through those so quickly? What factors went into affecting the timelines of getting us where we’re at right now? You have some dates planned and laid out as well. Maybe if you could take us through that.

LORA MACEACHERN: I think it speaks to the fact that we take the Auditor General’s recommendations really seriously, and the dedication of the team. As I said in my opening comments, I’m very pleased to have the opportunity to work with this team. It’s only been a couple of months for me, but they’re very dedicated. As I said, when they receive recommendations, they take them closely at hand and execute on those. We have clarity in terms of what it is the Auditor General recommended. We took that and made immediate action.

I also think it speaks to the importance of the work. We really do have a mandate of making sure that Nova Scotian seniors are able to live in dignity and have the right care when they need it. The entire team is committed to that. We have a minister who’s incredibly committed to that. We’re making it happen for Nova Scotian seniors.

RICK BURNS: The Auditor General’s report says that the department conducted reasonable projections for future demand for nursing homes. Can you explain the process in those projections, where they are, and how you’re going to account for those numbers as the department grows?

LORA MACEACHERN: We very much can, but I think Paula Langille will be able to answer that question.

THE CHAIR: Ms. Langille.

PAULA LANGILLE: It’s a great question and it’s something that we do take very seriously, as the deputy minister mentioned. We know that the senior population is about 22 percent. We know it’s increasing to 25 percent. Building all of these buildings is one step of moving toward there, but we needed to ensure, to build the buildings, that we are building them in the right communities, that we’re building the right size - all of those components. We work together with our data group to sort of look at the population projections by age and by county. We also then looked at the wait-list, so we have an idea of where we’re seeing the demand in those areas, and also looking at the number of facilities we already have in some of those communities.

That was sort of the core fundamental to determine where we would need projected demand on a go-forward basis. We want to address the needs we have now, but also then into the future. Those are some of the key components that we did.

The Office of the Auditor General did commend us on our process - that methodology that we used for looking at the projections of where those beds should be needed. We’re quite pleased that they recognize the work we’ve undertaken to ensure that we are projecting correctly.

RICK BURNS: Thank you. I appreciate the work you’re doing. I’m going to hand my questions over to MLA Wong.

THE CHAIR: MLA Wong with four minutes.

HON. BRIAN WONG: Thank you for the work you do for helping seniors stay in their homes as long as possible and the work you’re doing in our long-term care facilities.

I have a couple of questions. When the department was created, one of the mandated items was to determine exactly how many nursing home beds you had. My understanding is that it was very difficult to come with that number. I’m just wondering if you could explain to us why.

THE CHAIR: Deputy Minister McEachern.

LORA MCEACHERN: I’m going to turn it over - do you think Paula would be best? Okay.

THE CHAIR: Ms. Langille.

PAULA LANGILLE: When this department was formed, we had a very manual process to determine where the beds were and how many were open. When this department was formed, we undertook a variety of measures to call each individual facility - emails, texts - engagements to ensure we had a clear count of how many beds we had and how many were closed. As the deputy minister and Associate Deputy Minister Huntington mentioned, we had 400 closed. That was not where we wanted to be. We needed those beds open. We needed them to move forward.

In addition to the work that was done on the workforce side, we also then implemented an e-solution so that we have a platform that doesn’t rely on manual inputs from licence information from a spreadsheet that might be held by one of the care coordinators at the health authority. This is an electronic system that is very timely and accurate to show us exactly how many beds.

We know that we have 8,497 beds in the system, where before we said, “Oh, it’s about 8,000, and 400 of those are closed.” We know exactly how many beds we have in the system. We know if they’re closed and for what reasons. That’s very timely for us to have that up-to-date information for us in our planning as we move forward.

BRIAN WONG: A few years ago - and I know you had touched on the CCA track and how we’re able to provide a pathway for CCAs to go beyond if they want - we had a time when we had a really difficult time retaining the CCAs who were already in the system. Two years ago, my sister-in-law moved from Calgary to Nova Scotia because all of a sudden Nova Scotia became more competitive and was able to offer an incentive.

I would say that if every CCA loves and cares for their clients as much as she does, we’re in good shape. I’ll guarantee it.

Could you explain some of the things that happened to also retain the CCAs we had in the system at the time, and what you did for recruitment?

THE CHAIR: With a minute and a half, Ms. Huntington.

JANET LYNN HUNTINGTON: I could talk for about two hours on this topic. I’m very passionate about it.

What Minister Adams said to us when we first started working together in the department was “Please make sure that whatever you do, you rebuild sector pride in Nova Scotia.” That was kind of the message she gave to us. Every initiative that we have taken over the last number of years is to ensure that Nova Scotians have access to the care they need, when and where they need it, by highly trained, skilled staff in a way that makes them want to come to work every day.

We made investments - I mean, we’re talking about 5,700 new long-term care beds in Nova Scotia. People want to work in new modern facilities. That’s wonderful. We’re doing that. We’re also looking at things like workplace health and safety - how do you make sure that people are safe in the workplace? We have the lowest injury rates in long-term care and home care right now since 1997. That’s a credit to the sector. We have workforce initiatives that help them come to work, stay at work. We’ve created those pathways that we talked about earlier: the CCA to LPN pathway. It’s not just about that; it’s making sure that they know that whatever they want to do, if they want to be a CCA - maybe they want to take a more advanced role in a CCA. We have, for the first time in Nova Scotia’s history, RN authorized prescribers working in continuing care.

I talk about them often because we initiated that, because the sector called me one day and said, “Do you know that there are RN-APs that work in acute?” Why do they not work in long-term care? That’s a great question. Why do they not work in VON? Great question.

THE CHAIR: I’m going to have to call order now. I know you want to talk for two hours. (Laughter) It’s great, but unfortunately, that is all the time we have left for questions. I’m going to invite Deputy Minister MacEachern, or if you want to invite someone else to make closing remarks, go ahead.

[10:45 a.m.]

LORA MACEACHERN: I just wanted to extend a sincere thanks to the committee. We really appreciate your time, your attention, and your questions today. As we’ve all spoken to, this is extremely important work. It’s a significant investment in the future for Nova Scotia seniors. We’re happy to be a part of it and happy for the support. Thank you for your time today.

THE CHAIR: I think we can say goodbye to our witnesses. We have a bit of committee business to do, so thank you very much for being here and we’ll see you again. Let’s take a one-minute recess.

[10:46 a.m. The committee recessed.]

[10:48 a.m. The committee reconvened.]

THE CHAIR: Order, please. I’m going to call the meeting back to order. We have some committee business to take care of. Firstly, there’s some correspondence. The Department of Education and Early Childhood Development have followed up with some information from the October 15^th meeting as requested. I’m wondering if there is any discussion on that information that was sent. Great.

Secondly, we need an endorsement of the Auditor General’s recommendations for the report that we just discussed, Planning and Acquiring Nursing Home Beds. Is there anyone who will make a motion, please, to endorse the recommendations? MLA Burns.

RICK BURNS: I’ll make a motion. I move that the Public Accounts Committee formally accept and endorse the recommendations contained in the 2025 Report of the Auditor General, Planning and Acquiring Nursing Home Beds, that have been accepted by the audited departments or agencies, and ask that those departments and agencies commit to and take responsibility for timely implementations of the recommendations accepted by those departments and agencies.

THE CHAIR: There’s a motion on the floor. Is there any discussion?

All those in favour? Contrary minded? Thank you.

The motion is carried.

Thirdly, we have - I want to put this to the committee. In September, the vice-chair and I travelled to Saskatchewan along with the Auditor General and members of the Office of the Clerk. We attended the CCPAC conference in Regina. There is some information that we would like to share with the committee at some point, but also, Nova Scotia is hosting the same conference next year in August. There is some discussion and planning to take place. We’ve already begun planning it.

Because there are some holes in our meeting schedule - namely November 19^th and 26^th - I was wondering if we could use one of those vacant dates to have a meeting. It would be an in camera meeting and it would be relative to the learning that we did in Regina, and also looking forward to next year’s conference.

I am proposing that we either use November 19^th or 26^th to have that discussion, and I want to open the floor for discussion on that.

MLA Taggart.

TOM TAGGART: Did you want a motion?

THE CHAIR: Well, I mean - agreement to hold a meeting. Is there any discussion on it? (Interruption) Good idea? Thank you.

Do we need a motion? And it doesn’t matter which date we schedule it? Okay. I’ll just ask the clerk to schedule that and let us know.

Next on the agenda is the December meeting schedule. The committee typically recesses over the holidays. For scheduling purposes, we need to decide how late we would like to meet into December. Will the last meeting before the Christmas holiday be December 10^th or December 17^th? Any discussion on that?

MLA Wong.

BRIAN WONG: It is a busy season for all of us. We have lots of events. If we don’t have anything to discuss on the agenda, I would suggest that maybe we have one in December and then move on from there - so potentially cancel maybe the 10^th and the 17^th and following that.

THE CHAIR: I’m hearing from the clerk that nothing is booked for the 10^th or the 17^th. Is it okay with the committee that we meet on whatever the Wednesday before the 10^th is - the 3^rd? See, I can do math. Then we’ll reconvene in January. Is that acceptable or is there any discussion on that? (Interruption)

We don’t have anything currently scheduled for December 10^th or 17^th, but we could, because we will have a subcommittee meeting between now and then and we’ll have new topics coming up on the schedule. (Interruptions) You’re fine with it? MLA Lachance, any thoughts? Okay.

That means December 3^rd will be our last meeting and we’ll reconvene in January. Thank you very much.

Our next meeting date is November 12, 2025, and the witnesses are the Department of Growth and Development and Adsum for Women and Children regarding Rent Supplements and the Canada Housing Benefit.

I think if there is no further business, we will adjourn the meeting. Thank you very much, everyone.

[The committee adjourned at 10:53 a.m.]