HANSARD
Printed and Published by Nova Scotia Hansard Reporting Services
COMMUNITY SERVICES COMMITTEE
Ms. Marilyn More (Chairman)
Mr. William Langille
Mr. Mark Parent
Mr. Gary Hines
Mr. Jerry Pye
Mr. Gordon Gosse
Mr. Russell MacKinnon
Mr. Stephen McNeil
Mr. Leo Glavine
[Mr. Gary Hines was replaced by Mr. Brooke Taylor.]
In Attendance:
Ms. Mora Stevens
Legislative Committee Coordinator
Ms. Diana Whalen
MLA, Halifax Clayton Park
WITNESSES
Department of Health
Ms. Cheryl Doiron
Deputy Minister
Mr. Keith Menzies
Executive Director of Continuing Care
Ms. Kathy Greenwood
Director of Service and Business Support
YWCA
Ms. Brenda Sanderson
President
Ms. Sue Wolstenholme
Executive Director of Operations
ALIGN="CENTER">[Page 1]
HALIFAX, THURSDAY, NOVEMBER 25, 2004
STANDING COMMITTEE ON COMMUNITY SERVICES
1:00 P.M.
CHAIRMAN
Ms. Marilyn More
MADAM CHAIRMAN: I'd like to call the Standing Committee on Community Services to order. It is unusual for us to start without representatives from all three Parties here but because of the serious and heavy nature of the topics on the agenda today, I think we should at least start with introductions and the presentation and, hopefully, the members from the Government Party will be along shortly.
I'm Marilyn More, chairman of the standing committee and I think perhaps we'll start with the introduction of committee members, then we're just going to discuss a brief procedural issue, and then I'll invite the deputy minister to introduce herself and her staff. So, Gordie, would you like to start.
[The committee members introduced themselves.]
MADAM CHAIRMAN: I do want to ask the committee just how you want to reallocate the time for our meeting today. It's officially scheduled for two hours, although there was some discussion that we might run a little over time in order to accommodate the YWCA on today's agenda. As you'll hear a little later, their situation has been a bit relieved by some emergency funding that came through this week, so they might not need a full hour. Would you like to go for perhaps an hour and a half on home care, and then the half hour with the possibility of spreading it out a little longer for the YWCA, or would you like to do it another way?
MR. LEO GLAVINE: Certainly an hour and a half would be my preference, as a minimal for a very important topic.
MADAM CHAIRMAN: So do we have consensus then that we'll spend an hour and a half on home care?
[Page 2]
MR. RUSSELL MACKINNON: Why don't we see how it plays out. We'll try for that, but if there are still some pressing issues on home care, we may need . . .
MR. GLAVINE: Madam Chairman, does the meeting have to conclude at 3:00 p.m.?
MADAM CHAIRMAN: No. Mark, do you want to add something to that?
MR. MARK PARENT: Yes. Sorry for being late, but our caucus has a meeting with the Premier that was changed from 1:00 p.m. - he's meeting us at 3:00 p.m. - so we have to leave at 3:00 p.m. It's not something that we scheduled but it was something that was scheduled and then they changed it deliberately from 1:00 p.m. to 3:00 p.m. because we said we wanted to be at this meeting. So if we could finish by 3:00 p.m., it would be deeply appreciated.
MADAM CHAIRMAN: Might I suggest then that we'll see where we are at 2:30 p.m. but we'll attempt to be finished two rounds of questioning by then, if at all possible. I ask people to be fairly brief, because we did promise the YWCA and they do have representatives coming, so we have to save some time for them. Is there agreement on that?
Okay, thank you.
Sorry for the delay. Ms. Doiron, would you like to introduce your staff.
MS. CHERYL DOIRON: I would be pleased to do that. Today, as you know, we were requested to be here to talk about home care and we would agree with the comments that you've been making that this is a very important area of care and service to the people of this province. I've come mainly to be present to support my staff here and to answer any questions that may be helpful for me to answer, but I'm going to have staff do the presentation and probably address most of your questions.
I would like to introduce Kathy Greenwood, who is our Director of Service and Business Support within the Department of Health, and I think many of you may have met Keith Menzies before, who is the Executive Director of Continuing Care and he will be starting with the presentation. Although he will talk a bit generally about the Continuing Care area in his presentation, it will be mostly focused on home care itself, since that was your topic. So we'll just get underway, if that's all right with you.
MADAM CHAIRMAN: Thank you very much. Go ahead.
MR. KEITH MENZIES: Recognizing your time constraints, I have a number of overheads but I'll walk through them fairly quickly for you so that we can move to the questions.
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We are pleased to be here to talk about home care. It is a vital part of the Continuing Care branch and the services that we provide. What I would like to, very quickly, walk through with you this afternoon is, first of all, the context of home care within the Continuing Care branch, talk a little bit about home care programs, in-home support programs, some of the budgets and how funding has grown over the past few years, and talk about some of our challenges and the future directions, which may help frame some of your questions or help respond to some of your questions.
The context of home care services is a part of the Continuing Care branch, it is one service in the continuum of services offered through Continuing Care at the Department of Health. The following services are provided through the department's Continuing Care branch, through our single-entry access approach to service delivery. It is about home care when home care is no longer appropriate for families, we are talking about then moving people through the system into the appropriate long-term care settings and, of course, we also have responsibility for the Adult Protection Act or the protection of vulnerable adults. So we will concentrate primarily on home care.
One of the projects that we've undertaken this past year is to look at the Continuing Care branch and begin a renewal process to prepare us for future directions and future changing needs and all of the challenges that we know we will be faced with in the Department of Health as our population continues to age, as we all continue to age. We've recently completed this vision statement in terms of the Continuing Care branch and how we serve or see ourselves serving people into the future. It is a statement of the future and where we hope to be in the near future.
We see ourselves supporting and caring for Nova Scotians. We are leaders and partners in the health system, supporting continuing care in the communities of Nova Scotia. We are responsive to the changing health needs of Nova Scotians. We are catalysts and facilitators in the planning of community-based continuing care services. We are a critical component of an integrated service delivery system. We promote and embrace the independence and autonomy of Nova Scotians.
In order to try to achieve the role of the department regarding continuing care, we are reorganizing the branch somewhat in terms of focusing on four key areas. I'll start at the right instead of the left. Monitoring and evaluating or the accountability mechanisms. We know we have work to do in looking at how we do that now and how we should be doing it in the future. It's not only licensing functions, it is also about evaluating our programs and redesigning them and building them to meet the needs of Nova Scotians.
We will be having staff focus on the area of standards and policy. The home care policies were implemented in 1995, we need to do a good evaluation on them and look at changing them or developing them more fully to meet the needs of Nova Scotians that we serve.
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The area of system planning and liaising. This sector is one of the areas that I think we all know will have to respond to the needs of a population as it continues to age and as we have more and more seniors in the province. The function in that area is to look at those system changes, what we need to build in terms of home care programs, new programs or expand existing ones, what we need to do in terms of residential kinds of care like nursing homes, to develop that whole planning process around that, so it's inclusive and has all of our partners at the table so that we build from the community base and are there to respond to Nova Scotians' needs.
Right now the largest area, of course, where most of our staff work, is in that direct service and support piece, where all of our care coordinators function in carrying out assessments of clients within the districts. We are structuring that part of our organization so that it mirrors or parallels the nine district health authorities. Right now we have more of a regionalized structure, but it's time for us to evolve to that district structure and to be able to begin to integrate our programs more fully with each of the districts as they develop overall programs.
The role of the Department of Health, and by extension the Continuing Care branch, is certainly identified here in the bullets: to set the strategic direction for continuing care services; to set those policies and standards; to ensure availability of quality services for the population; to oversee and manage the whole funding of the system; to monitor, evaluate and report on performance, not only of our providers but also of the system. Are we putting money in the right places? The programs that we build for the future, do they really achieve the outcomes that we think we are expecting, or are there better ways? Those are the key functions, I think, of any government branch.
One of the areas where we are involved in Continuing Care more fully than some other government branches within the Department of Health is that we are still involved very much in that whole care coordination activity, which employs approximately 300 of our staff across the province, in terms of doing the care assessments of clients as they come forward in the system and managing that whole wait list and helping people move through the system into nursing homes as appropriate.
[1:15 p.m.]
That's a huge function that takes up many of our resources within the branch and I'm sure you know from working in organizations that unless you really structure and commit resources dedicated to specific functions, we will tend to find that operations will take up all of our resource. That is certainly where we have seen the branch over the last few years, we are seeing this restructuring as an opportunity to move forward on many fronts, at the same time, and still achieve the outcomes that we think are important.
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So within that context, everything we do in home care is part of that overall continuing care context. So I think I would start by saying the definition, or the mission defined for home care is that it is there to deliver an array of services to assist Nova Scotians of all ages who have assessed unmet needs in order that they achieve and maintain their maximum independence while living in their own homes and in the community. All of our services through home care are designed to enable that mission. More specifically, the services we have, we defined as being nursing care. That's the professional nursing care provided by RNs and LPNs is either provided through the acute program where people are discharged from hospital or perhaps we enable patients to go home without being actually admitted to hospital. It's the acute IV antibiotics, the kinds of acute programs and it's short term. It may be two or three weeks that somebody receives home care treatment from RNs and LPNs for an acute condition.
We also have nursing provision or nursing services on a more extended basis for people who are living at home but need that ongoing nursing intervention and can manage at home quite well with that kind of support.
Many of our programs and services relate to home supports, enabling people to stay in their home by providing personal care to them, by providing essential housekeeping in order that their houses are safe for them to continue to live and manage, to provide meal services and support, the kind of nutritional needs of people living at home. Certainly for many family caregivers, the whole area of providing respite staff, staff to provide respite services so that the family members who are providing care and providing a great deal of support to family members in the homes do have an opportunity to step out and take care of regular normal activities that we all have to do in terms of our daily lives and know that the family member they are caring for has someone there to look out for them.
Certainly the Home Oxygen Program is another part of our service and those tend to be the primary areas where our services are provided at this time.
I will talk for a minute about the client fees. In terms of the professional nursing care provided by nurses and LPNs, there are no fees, whether it's a chronic program, you are having nursing visits over an extended period of time, or if it is an acute substitution kind of program, there is no fee for the individual to avail that program. There are fees for the home support kind of services and those are based on income and family size. It's a sliding scale, the higher the income the more you pay. Anybody who has a family income of less than $18,785 would not pay any fees at all for the home support services they would receive.
To give you a sense of the number of clients we work with at any point in time, as of November 6th, this is the information from November 6th, a snapshot of how many clients we have receiving home care services across the province, 11,639 as of that date. It also gives an indication of the health district and where the services are being provided. Over the course of a year, we probably provide services to 23,000 to 25,000 people but many of them are in
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the program for short periods of time and at any point in time we are probably serving around 11,000 to 14,000 people.
The age distribution of our clients also is an indicator of need and particularly of seniors' needs. Fully 79 per cent of the clients we have in the program right now are 65 years of age or older and of the 11,000 clients we have in the system right now, 69 per cent of them are women.
I will talk for a couple of minutes about our provider agencies and how we work with them. The professional nursing services provided by RNs and LPNs are provided in two ways. First of all, the VON provide, through their 11 branches around the province, much of the direct nursing care, nursing services that we have in place. However, in Cape Breton, Antigonish area and the Eastern Shore here in Capital District, we do employ the direct caregivers ourselves, still. They are employees of the Continuing Care branch. They are in the homes doing the care the VON are doing in many other parts of the province.
Along with that, in terms of the home support services, the meal preparation, personal care and essential housekeeping, those are carried out by 20 home support agencies across the province. The largest one is here in metro, of course, with Northwood Home Care being a major player. I meant to look before I came and I forgot, I'm not sure which agency is the smallest but it is one of the rural agencies. You can see that the number of direct service hours is quite variable, depending on the size of the agency.
The In Home Support Program. This program came over to the Department of Health from Community Services in 2000. It is a program that initially had been run by municipal units. In the provincial-municipal exchange in 1995 it became a provincial program. It was initially administered on behalf of the Department of Health by Community Services and in 2000 it came over to the Department of Health. It's a program that provides some funding directly to the client so they manage their own care. It has been closed since 2000. We have not yet developed a new program in this area. It is one of the initiatives we want to undertake. We currently have 450 clients in that program and the budget is $6.6 million. The amount of money any one client receives varies based on that individual's particular needs.
In terms of the dollars that are spent on these programs, if we look at the nursing care provided by RNs and LPNs, you will see that we have, over the last three years, slight increase in volume in terms of numbers of clients and a considerable increase in the numbers of visits. The budget and the actual costs relating to that direct nursing component have increased from $25.4 million in 2002-03 and we are forecasting for this year about $29 million. One of the factors I will point out here, while there may only be 400 more clients, the numbers of visits have increased over that two-year period by 60,000 visits and those visits generate additional costs. If you are going to the clients' homes more frequently, you are incurring the costs around transportation and travel time.
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In our home support area, we have approximately 8,800 clients. It's been down as low as 8,600 and we are projecting 8,700 for this year so there hasn't been a huge change in the number of clients we are serving and the volume of direct service hours has not increased significantly either. The budget is basically the same as, well, we spent $59.9 million in 2002-03. We spent actually $58.6 million, you will see at the bottom of the overhead there, in 2003-04. The reason it is showing to be a lower amount is that some of the agencies had surpluses that then came back to the department so it reduced our overall expenditure. Then this year we are forecasting spending approximately $60 million.
This overhead simply gives you an indication of which services are being drawn on most. You can see that the personal care time, direct service hours, make up nearly half of the overall budget or utilization. Nutritional support is 20 per cent. Community resource is assisting people to appointments or to activities, a very small amount there. The essential housekeeping services are about 12 per cent of that budget. Family relief or the respite programs are 22 per cent. The identified palliative care is only 0.2 per cent and when I say identified palliative care, if many of the clients are receiving personal care support, we may not identify it always as palliative care and it may be, so that number may be a little bit off. I know we have other kinds of services that take up about 16,000 hours; those are the kinds of issues like teaching staff and teaching time.
Within the In-Home Support Program, where that program is closed, we've seen a slight decrease in the number of clients in that program and the financial costs with it have dropped somewhat, as well, over the last two years.
With the Home Oxygen Program, the number of clients has not changed, there has been an increase in the cost related to the last contract on those services in 2003-04 but we're basically projecting a straight line costing for this current year.
There are a number of smaller initiatives that we support as well through the Continuing Care branch. One of them is the palliative care project in Northern, on which we are spending approximately $41 million. You may recall a couple of years ago that the Arthritis Society was providing some community-based rehab services through our Home Care Program and I think our commitment to them at the time was about $320,000 a year. They chose to remove themselves from that service delivery and we have transitioned that resource on that service to the district health authorities, and we've actually increased the money there somewhat from $320,000 to $450,000 and the commitment we have from the DHAs is that they will use that resource specifically to build community-based rehab in their district. It's a program that needs further attention but we have maintained what was there and extended it slightly.
Establishing the Red Cross health equipment loan program has been about $900,000. We support the Family Caregivers Association operation to the tune of $190,000. We are supporting and contributing - the department is contributing - towards the adult day programs
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runs by Northwood and VON by $350,000. There is a home care program operated by Antigonish called Hospital in the Home and that, again, is coming out of the home care budget and we are investing about $300,000 a year in education of continuing care assistants, recognizing a need for that resource. We also support Chebucto Links, which is again a family caregiver kind of support organization here in Halifax.
The challenges that we know we have on a higher scale, a broader scale are that we know that the demand for services is going to continually increase with the aging of the population. We know that the recruitment and retention of home support agencies staff is a major, major issue, not only in home care but in all health professions, but it is an issue for us. We are also well aware that as we move forward there will continue to be greater expectations of what home care does provide.
I do want to spend the last few minutes - I only have two more overheads to go through. I want to talk for a couple of minutes about the future direction of Continuing Care. In our business plan this year, we have identified that we will begin work in looking at the strategic framework for Continuing Care services across this province. That we will develop a process, a project involving providers, involving the district health authorities and certainly involving the public in terms of looking at the future vision or the future needs for Continuing Care services across this province. That will develop for us a strategic plan for Continuing Care services to respond to changing needs and it will be done in conjunction with stakeholders, partners and the public.
We will build on the work that is currently being done by the Senior Citizens' Secretariat in terms of the Task Force on Aging that is currently being done. Recognizing that they were going out to do that work, we did not want to go out and consult at the same time and what we've done is link our project to theirs. So as they've done their consultation, we're saying to the public, we'll be back to talk more specifically about services; theirs will be very broad and general strategic framework kinds of issues, ours will become more specific around service delivery.
So we see this strategic framework in forming our strategic planning for Continuing Care in terms of the services we provide as well as what the district health authorities provide, it will increase our opportunities for health promotion and efforts and will enable us to provide better resources to address health care needs on the promotion side and wellness side to hopefully delay or eliminate need for some of the supportive services that we currently provide.
[1:30 p.m.]
The last item I will just cover on this is that the whole purpose behind this strategic framework and the approach we will take is that it will be a collaborative process, it will be based on integration of Continuing Care as part of the overall delivery of health services in
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this province. We want to ensure that we are developing and establishing shared values and purpose for these programs so that we work collectively, that we will establish concrete objectives, share in that leadership and it then puts us in a better position to develop base lines for accountability for the actual delivery, are we actually doing the things that we say we will do.
So with that, I'll stop and we're more than pleased to try to answer questions.
MADAM CHAIRMAN: Thank you, Mr. Menzies. In the meantime we've been joined by two other members, Mark Parent who is from Kings North and Brooke Taylor from Colchester-Musquodoboit Valley. I did neglect to introduce Diana Whalen from Halifax Clayton Park, who is going to replace one of the Liberal members later in the meeting.
MR. PARENT: I apologize, Madam Chairman, for being late but I ran into Brooke and he was so enthused about President Bush coming and his letter to him that I couldn't get him to stop talking about it.
MADAM CHAIRMAN: I think for the sake of getting in two rounds of questions, I might ask each member to just ask one question in round one and then we'll go through again.
MR. MACKINNON: That would be impossible considering the complexity of some of these issues.
MADAM CHAIRMAN: Well, we want to make sure everybody gets their fair allocation of time. We only have an hour.
MR. MACKINNON: Would it be better to allocate each member five minutes?
MADAM CHAIRMAN: Well, we could if you would like to do it that way.
MR. MACKINNON: That would be better.
MADAM CHAIRMAN: Okay. Let's do the five minutes. So far I have Gordie Gosse, Russell MacKinnon, Mark Parent and Stephen McNeil. Gordie.
MR. GORDON GOSSE: Thank you for coming and doing the presentation today. When we were looking at the presentation there was a concern that I had with the recruitment of home care, CCA, I guess, and the two options of that program. What you were saying, one is acute, which is a short-term program, and the other one is the chronic care needs. The two are different, the chronic care needs would be a longer program than the short. I'm just wondering, what is being done to address the poor pay and working conditions of home support workers in order to stop the serious problem with recruitment? I'm just wondering
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what your department is doing, for example, why aren't agencies being required to guarantee hours of work for those people in home care?
MR. MENZIES: That's certainly an issue that I think is becoming a question in the current round of negotiations with the collective agreements. What has happened over the last several years, I believe about five years ago many of the agencies were not only paying different levels of salaries, different hourly rates, what we have seen in the past couple of rounds of negotiations is that we have come to a standardized salary rate, it's currently $12.63 an hour for home support agency workers, which is very close to what people are paid in the long-term care sector of $12.93, I believe. So we are reaching that parity. We have established, I think, parity for home support workers across the province as we have for the long-term care sector and now we're seeing a move towards all of those providers being paid at the same level, the same hourly rate.
The issue around guaranteed hours is one that I think is going to be at the table in this round of bargaining. It's certainly one that we have a great interest in ensuring that we have or are able to retain staff in this very vital role.
MR. GOSSE: The other issue that I have on that is in the Community Services Department, a lot of single mothers were strongly directed to take the CCA program, at that time it was PCW, I think it became the CCA program. Their caseworkers and employment support workers told a lot of single parents in my area of Cape Breton, take this course, there's a lot of employment in this course, and they were kind of strongly directed in that area of employment at that time. Then the problems arise with the inconsistency with the hours, problems with child care, being single parents and stuff like that. That is why a lot of them left the in-home support and went to, like you say, Northwood Manor here in Halifax, because it was a more stable environment, guaranteed work and I think that is why you saw a lot of the outward migration.
Again, the double-edged sword is if they didn't get enough hours and it wasn't supporting the single parents, they had to quit and then, again, they were penalized. I know in specific cases in Cape Breton Nova, they were penalized for six weeks from Community Services for leaving that job and not getting the hours. I'm just wondering your opinion on that, please.
MR. MENZIES: Certainly, this is a major concern to us in terms of developing a strong base of employees. Those are some of the issues that we know will be part of the negotiations in looking at how you meet the need of that individual to have a guarantee, or some commitment to the work, to pay, in order for them to stay in the sector. We're well aware that that is a factor that is causing people to leave.
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Some of the solutions are through that collective bargaining process and one of the concerns I would have is that because of the way collective agreements are established right now, there are certain protections in the collective agreements for individuals, in terms of being able to choose hours, based on the fact that they aren't guaranteed. To then introduce a guaranteed hour of some kind without addressing that part of it, so we can then assign staff more effectively, will then create a greater problem for us or for the whole sector.
As that goes forward, one of the things I would expect the agencies to be looking for is some trade-off, in terms of if we move to a guaranteed hours kind of thing, then we have to be able to assign the work differently than we have in the past. That is an issue that I think will be at the table in bargaining.
MR. GOSSE: Job descriptions . . .
MR. MENZIES: Job descriptions but also in terms of how work is assigned.
MADAM CHAIRMAN: Russell.
MR. MACKINNON: My first question is with regard to the Home Care Program. Does the Home Care Program currently pay physicians to be available for home care and if so, how much are they paid?
MR. MENZIES: People are able to access their physicians through their usual route. We do not have physicians as part of home care - am I right, Kathy?
MS. KATHY GREENWOOD: The program itself does not pay family physicians, for instance. However, if a provider is required to get direction or advice during an acute phase, they have the ability to have the dialogue with the family physician. And there is a fee related to that.
MR. MACKINNON: Who pays that, home care?
MS. DOIRON: That would actually be billed through the normal medical system for fee for service.
MR. MACKINNON: I'm told that they're compensated to the extent of $150 an hour for this service. Is that correct?
MS. GREENWOOD: I can't speak specifically today to the actual figure.
MR. MENZIES: As I said, the billing would be through MSI, through the Medical Services Insurance and I don't have those figures either.
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MR. MACKINNON: With regard to Home Care Nova Scotia, the number of clients and so on, how many are on the waiting list presently?
MS. GREENWOOD: Across the province?
MR. MACKINNON: Yes.
MS. GREENWOOD: I can't give you the exact figure, it varies in different districts.
MR. MACKINNON: Will you give an undertaking to the committee that you will provide that information?
MS. GREENWOOD: Yes, we can provide that.
MR. MACKINNON: On a county by county basis, if possible.
MR. MENZIES: District by district.
MS. GREENWOOD: Could I ask for clarification? Are you asking for home support, nursing or both?
MR. MACKINNON: You can give both. How long does it take to be assessed, on average?
MR. MENZIES: The home care assessment?
MR. MACKINNON: Yes.
MS. GREENWOOD: We have standards in place across the province and priorities for assessments. When an intake is received at our 1-800 number, it's determined by priority level, there's a screening tool that is used, and based on that information a timeline is determined.
MR. MACKINNON: But you didn't answer my question. Approximately, what's the average?
MS. GREENWOOD: The standard would vary from a 24-hour response to perhaps two to three weeks.
MS. DOIRON: The other service that is provided in some communities now as well is home care relationship with the emergency department in the area; certainly, that's one of the provisions in Halifax. So home care will enter into the emergency department at the
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invitation of the hospitals so that in many cases then there's an opportunity to prevent admission to hospital, by escalating the speed at which home care can be provided.
MR. MACKINNON: Can you confirm whether there has been a reduction in the amount of time available for each home care visit and what is being done by the department to ensure that quality of care is not being compromised?
MS. GREENWOOD: Can you repeat the first part of that question?
MR. MACKINNON: Can you confirm if there has been reduction in time available for each home care visit?
MS. GREENWOOD: I'm not aware that there has been a reduction in time available for each visit.
MR. MACKINNON: Can you confirm that that is not the case?
MR. MENZIES: Based on every assessment that is done on a client, services will be put in place. There are times when those services may not be deemed as necessary anymore, so there will be, from time to time for clients, some reduction in services. But it's client by client specific, it's not a standard, if you will, that we've reduced the number of hours available for home care visits.
MR. MACKINNON: I noticed you made reference to the Home Oxygen Program, but the department does not provide any support for portable oxygen. Why not? In other words, we're talking about making Nova Scotians healthier and some individuals, if they could exit their home and take a stroll, a walk, or go visit their doctor, the mall, church, or whatever, they can't do that because this program doesn't support them in that initiative. It is contradictory to what the other departments in government are saying.
MS. GREENWOOD: I think you've raised a good point but at the moment our eligibility for the Home Oxygen Program does not provide that. It is something that we will be looking at in the future.
MR. MACKINNON: I'll go for a second round.
MADAM CHAIRMAN: Next we have Mark Parent.
MR. PARENT: I appreciate the opportunity to talk about this program because it's so important that we help our seniors and others stay in their homes as long as possible. The question that I have had and the issues that I have had to deal with in my riding, deal with scheduling. I know there has been a change in scheduling, the scheduling was done previously by the local VON chapter and it was moved into Halifax. In that transition, as in
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any transition, of course, there are wrinkles to be worked out. So I'm wondering if you would talk a little about scheduling and what you've done to make sure that it works smoothly and properly.
MR. MENZIES: Certainly, the VON organization has undertaken a number of changes, including centralizing some of the support functions like scheduling and their intake lines. As in any reorganization or change in the way you deliver service, there are issues that develop. As we have been made aware of these issues and concerns, we've negotiated and discussed them with VON. I think at lot of those issues are being resolved, that we don't have the same difficulties, or they don't have the same difficulties in scheduling that they had initially when they moved forward into this new system.
MR. PARENT: My colleague was asking about oxygen and the support for home oxygen. I'm curious, and maybe it falls under EMO and you have no responsibility for it, but when you have power outages, what happens to those people, do you have a list? Do you liaise with EMO? What is the procedure there?
MR. MENZIES: Kathy, you can correct me if I'm wrong. My understanding is that anybody receiving home care services is expected to have an alternative plan in place, or a support plan in place, in case of emergency. When people are on home oxygen, if they need assistance, at this time they will go to the emergency departments to be cared for there.
MR. PARENT: You gave a snapshot of a year in terms of the breakdown of the rising costs, but what has been the fastest rising cost? What has been the biggest cost pressure that you have had to deal with?
[1:45 p.m.]
MS. DOIRON: I would suggest that there are two factors that have been driving our home care costs. One is that probably in the last five years - Keith, I think you went back about three years in your slide - there has been substantial increased funding to home care to be able to increase the volume of home care. I don't think that we are yet at the maximum provision that would be feasible for home care in this province and at this point any progression to kind of continue to fulfill that to the greatest extent possible is more based on the supply-demand issue with staffing, but there was considerable advancement made in the increase in home care provisions during the last five years and so that did have an impact on cost.
The second issue that has a substantial impact on cost, of course, is the ongoing negotiations of most of the individuals who are employed in the service, regardless of whether they are employed by the department or contracted by one of the providers, the Department of Health included. So in those arenas, then of course the collective bargaining agreements have an impact on substantial cost increases.
[Page 15]
MR. PARENT: One last question. What is the role of the federal government in funding home care? Do they have any role at all?
MR. MENZIES: They have no role at all in that.
MR. PARENT: So it falls totally to the province.
MR. MENZIES: It falls to the province.
MS. DOIRON: The Canada Health Act, as you know, only covers hospital and physician care. The federal government has encouraged the development of alternate forms of care and often they have provided some dollars for developmental work, but of course as soon as it gets into an operational mode, then all of the costs have reverted to the provinces and obviously the subject of discussions at the federal-provincial meetings in the past year, or two or three years, has very much surrounded that in terms of the pressure that that has placed on provinces and certainly we appreciate having the opportunity for the developmental work that has to be done and actually it's, I guess, a better form of service in many ways for the provision of care and support to people and it's more economical in many ways.
But we feel that we have not maximized community-based care through the Department of Health. We are constantly now exploring and have a very good partnership with the Department of Community Services so we can jointly move forward in many of the community-based programs where we serve many of the same clients.
MR. PARENT: Thank you.
MADAM CHAIRMAN: Thank you. Next I have Stephen and then just so you are prepared, we have Jerry, Leo, Brooke and then myself. Stephen.
MR. STEPHEN MCNEIL: Thank you for coming in today. You mentioned in your presentation you have 20 home support agencies that are providing services. You set the standard?
MR. MENZIES: The department sets the standard.
MR. MCNEIL: Is it a province-wide standard or is that standard different depending on which district you are in?
MR. MENZIES: It is a province-wide standard.
MR. MCNEIL: So whether you live in the Annapolis district or in Cape Breton, you should be provided the same level of service.
[Page 16]
MR. MENZIES: Exactly.
MR. MCNEIL: What happens if a client has a complaint about the service they are receiving? Who do they go to?
MS. GREENWOOD: If a client has an issue with the type of service that is being provided to them they have several avenues. One, of course, would be the agency that is providing the service and then the care coordinator who has done the assessment would be informed of that as well.
MR. MCNEIL: What role does the department have in terms of a complaint? Do you have any? For example, if a constituent is having a problem with the service provider who is giving the service, they cannot resolve it, it really appears that the service provider is self-policing. They really hold the hammer here. If a constituent of mine has nowhere to turn other than to say, accept the level service they are not happy with or be removed from the program, which they are being removed from the program, when someone is taken out of the program, who in the Department of Health do they turn to? Who will respond and listen to them?
MS. GREENWOOD: We have an appeal process related to program issues which that would fall under. We also have a format where issues are brought forward in terms of complaints. We have an auditor who would investigate those particular complaints so that the forum would be that not only would the agency have an ability to comment on the situation but the client and family would as well. So these cases are reviewed through that process.
MR. MCNEIL: At the point that the client sees there is just absolutely no way that the service being provided will work for them, is there any other option for them to have another service provider?
MS. GREENWOOD: It would depend upon the area of the province. If there is only one . . .
MR. MCNEIL: It doesn't matter where I live in Nova Scotia, you just told me, I would be having the same access to the same level of service from one end of the province to the other. So it really shouldn't matter where I live.
MS. DOIRON: If there is a complaint that is investigated and goes through the appropriate processes and if, in fact, the agency is found to be meeting a standard, there are times when this can come down to, I think, a relationship issue or issues that sometimes have to be resolved by changing not just the agency based on standards but sometimes changing the specific caregiver, if that's a possible thing to do and those kinds of adjustments can sometimes take place.
[Page 17]
MR. MCNEIL: One of the problems - and I will speak to the ones in my constituency - they have a problem with who do they turn to. Who is going to mediate that? To suggest that they are going to call their service provider and somehow be critical of somebody who is providing them a particular in-home service and then have them replaced, that's not easy to do. Many of them who are calling are in a vulnerable position. They feel . . .
MS. DOIRON: I think Kathy just explained that the appeal process is managed through the department so it is essentially the Department of Health that steps in at that point and basically would apply the appropriate review to standards of care delivery as well as assessment of the situation and listening to all parties try to come to what is the best resolution for the care of the individual and if, in fact, it is a standard of care or a relationship issue, try to resolve that in a way that is going to be most constructive for the reception of patient care. There are occasional cases where the department may suggest that it's not reasonable to continue sending staff into certain kinds of situations where potentially they can even be at risk and from time to time that will occur. I don't know what the situations are and we don't want to get into that here, but I think the mechanisms are there and they are there up to the level of intervention by the department to make those assessments.
MR. MCNEIL: One thing I would like to receive a copy of is the level of standards or the standards that you are requiring these providers to provide but one of the biggest issues that was raised by the member for Kings North was around the number of people who come into a client's home. There is absolutely no minimum number. You could have a different person every day of the month coming into your home. That is a grave concern for seniors in Nova Scotia. Is there any thought given to where there is a certain number of home providers that would be dealing with each specific constituent?
MR. MENZIES: Certainly for most of the agencies this is a major concern to them as well. There are times when there will be far too many people going into a home. It will never be a position where it will be the same person all the time, just by the nature of the work; employment conditions for anybody, they are not always there. All of the agencies try very hard to be more consistent about that. Occasionally we wind up in situations where there are far too many going in and we will ask agencies to take a good look at that and find out why that's happening with that client and what they can do to resolve it. But it is a concern and I'm not sure what the answer is in terms of how you consistently provide it. If you look at a nursing home, for example, the care there . . .
MR. MCNEIL: If you have a certain level of standard of service you are being provided, you are the one who should be dictating to the service providers on what you want, not the service providers dictating to you what they are going to give you.
MR. MENZIES: But we also have to be reasonable in what we dictate. So if we put a standard like no more than five people can go into this person's home and the agencies can't do that simply because of the human resource issues around them, we sent an untenable
[Page 18]
standard for them and what is the recourse then? It is a matter of moving towards a reasonable number and that will vary.
MADAM CHAIRMAN: I'm sorry, we have to move on to the next questioner. Jerry.
MR. JERRY PYE: Madam Chairman, as you can see, there are many people who are chomping at the bit to ask a lot of questions around this particular issue. I want to say that because of the time constraints we will never get to the nub of a lot of very real and serious issues with respect to home care, in-home supports and that umbrella in which we cover.
First of all, I want to say to Ms. Greenwood, it's a pleasure to see a face to the names of the individuals with whom I have had conversations over the last few years on issues around home care. You're the only one as a witness there that I have not actually met personally but had many phone conversations with. The concern that I have is that sometimes you have to question the sanity of government with respect to the development of policy. The very real policy issue that I'm talking about here right now is the notion that government ought to extract from people, because they can't give a 24-hour notification of leaving their home care services behind, that there be a $50 fine, the very people who need the home care services, the very people who can't afford the home care services are the ones who are expected to pay a fine.
I don't know the logic of that, maybe you can explain the logic of how you came up with that, because it really is something uniquely different to me. Also, I would like to know just how much money you have made in this fiscal year, because it was during the 2004-05 budget that this policy was brought forward by the Department of Health, to take money from individuals who were giving notice of less than 24 hours for service.
I want to tell you that I actually had received calls from individuals this Summer who had cancelled Summer outings as a result of this policy, who did not, because they were disabled individuals, get the opportunity to take that trip or that venture that they normally would have. Now, I guess my question to you is, who came up with this scheme and are you, in fact, earning any money on it or off-setting some of the costs?
MR. MENZIES: I don't know who came up with the scheme, it was a budget initiative, so I can't give you a name. What I can tell you is that when we meet with the home support agencies, one of the issues that the staff have faced in many of these home support agencies is going to the door and there is no one home or going to the door and having a family member say, we don't need you today. There are many reasons why that can happen and there are a whole list of exceptions in that policy and that's quite all right. If somebody has gone off to the hospital, if somebody has had a major incident of some kind where they simply can't be available, they've gone to the hospital or whatever else has happened, this fee is not charged.
[Page 19]
What we're simply trying to do and to have people understand is that this is a valuable resource. If the home support agency has scheduled time with you and they go to the door and you're not there, that's not only an inconvenience for that staff person, that means somebody else didn't get care that day who may be on the wait list. It's that kind of issue that brought us to that policy. We will find out for you and come back to you with how much we've made off of that and my sense is - well, I should say I don't think we've seen very much at all, if anything. It was not done as a fundraising issue, it was done in terms of having people very aware that if you're going to cancel - and people have the right to do that - please give us sufficient notice to reassign those staff, that's what the purpose of it was.
MR. PYE: But I also think that it should be reciprocal as well by the fact that you know if the caregiver or the provider of the service cannot meet with the client and often the case is reversed, the client doesn't receive notification nor does the client have the opportunity to send a bill off to the Department of Health with respect to this issue.
The other area surrounding this very issue is another area - there are so many that I really would like to have a day with you to discuss it but that's not possible - but this one particular issue is another very dehumanizing issue with respect to a tool that you use called minimum data set. The minimum data set is a tool that's used to evaluate and assess the level
of services being provided to people. I have not met one client out there who has not had a reduction in services as a result of the minimum data set.
[2:00 p.m.]
Madam Chairman, I have to tell you that I want to take a quote from my letter to the honourable minister with respect to this and I want you to hear exactly what I've said in the event that you haven't seen the letter. I said: Despite what might be said about the validity of this process as a tool used to evaluate the need of a person receiving care, to the disabled person it is insulting, degrading, humiliating and, simply put, not a very dignified way of doing an assessment. Without sounding crass, this method of assessment could not have been conceived by any person with a disability.
Now, there are needs for this assessment, and I do acknowledge. But it's not around persons with physical disabilities or debilitating physical disabilities. There may be some need for a minimum data set, as I understand it, for persons with intellectual disabilities, and even then I would question the kind of tool that you're using to make an assessment to provide services to individuals.
MADAM CHAIRMAN: Mr. Menzies, there is only time, unfortunately, for a very short answer.
MR. MENZIES: This question merits a very long answer.
[Page 20]
MADAM CHAIRMAN: I know.
MR. MENZIES: I guess what I would say is that we will certainly take your concerns under advisement in terms of looking at that, but I want to assure you, the assessment tool is simply that, it is an instrument to enable our staff to better assess care needs, the tool itself, the assessment itself does not dictate what those care needs are. If we have work to do with our staff around that issue, we will certainly undertake that and we will certainly follow up on that. I understand people's concerns about it.
MR. PYE: Thank you very much.
MADAM CHAIRMAN: Leo.
MR. GLAVINE: First of all, thank you for being here today and it is a big topic and I guess a worrisome one in that many more Nova Scotians are going to be needing to access, of course, home care in the future and we do need to improve the system and get it right.
I would have to say that most of the calls that come to my office are around the inconsistent delivery. By this I mean the number of people who are in and out of homes in the course of a month, in the course of a six-month period. In fact, I directed one eventually to write a four-page letter to Mr. Menzies. But I hear from about eight people consistently. One of them puts it in these terms, I don't want my mother undressing in front of every other person in Kings County. That's how often the turnover is in some situations. I would like for you, Mr. Menzies, to at least give us an idea of where you may be going with this.
When we went around the province last year on the health care round table - and we'll be issuing that report next week - we heard both from people inside of the delivery and outside of the delivery that the DHAs would do a better job in administering home care. We heard that from both the practitioners and those receiving home care. How do you respond to that?
MR. MENZIES: If we talk about the district health authorities and the intended role they play and will play, certainly my department has said on many occasions, the department's role is not in direct service delivery, which to a degree we are now because of the way we're structured. The commitment is still there that at some point these services will become the responsibility of the district health authorities, so it's certainly on our agenda to move in that direction. We haven't been able to up to this point.
MR. GLAVINE: So, long term then, that may be in fact . . .
MR. MENZIES: Yes.
[Page 21]
MR. GLAVINE: I hear, for example, that even that sense of geography is totally misplaced at times. My most recent call was from a lady who told me on several occasions a person with an appointment at nine o'clock in Middleton and the provider is also going to be doing an appointment 45 minutes later in East Dalhousie. Now, there's got to be something terribly wrong with that kind of scheduling, absolutely. In fact, that's missing the mark, really, in delivery.
MS. DOIRON: That' s exactly why from both points of view that Keith and his staff have undertaken a reorganization internally and also aligning the service delivery out in the system with the districts. So it will do two things, it will change the district response and the opportunity for people to get from one place to another. It will also, at a time when it's appropriate to do the hand-off to the districts, have things put in a structure that will make that much easier.
MR. GLAVINE: Thank you. Probably just one other?
MADAM CHAIRMAN: No, sorry, there are only five seconds left.
Brooke.
MR. BROOKE TAYLOR: I'd like to thank our guests for coming in. A lot of these concerns certainly have a common thread right across the province. I wanted to speak a little bit about essential housekeeping. I know that perhaps in terms of priorities, nursing care may be fundamentally given more priority but on essential housekeeping, I had a call from two senior citizens recently claiming that they were only entitled to one hour every two weeks. Now, I don't know if that's a standard or if that's a result of the data test that was carried out. I do know that both of these elderly people are receiving some nursing care and the husband is very concerned about his wife because she, in fact, is trying to do the housekeeping and like I said, she's receiving some nursing care, she's quite elderly. I know you have to have a limit but I'm wondering if there is an evaluation or process in place, if that's something that is in the mix, so to speak?
MS. GREENWOOD: Certainly, as individual situations change, clients have every ability to call their care coordinator and have a reassessment based on those needs that are changing. Clearly, they would look at what are the needs that maybe have varied in the last month or so.
MR. TAYLOR: That has been done and in fact, their MLA has called the home care coordinator and has been told that the one hour is what they're entitled to.
MR. MENZIES: That's the standard.
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MS. DOIRON: There are a couple of comments I would like to make in relation to that. The whole issue of providing home care services, homemaking services, has been one that has been debated heavily over the last several years or more. We went through a basic transition, I think, in the system, at least in Canada and if not beyond, where there was a debate around the level of dependencies that may have been created by sending people in to do things that maybe individuals should do for themselves.
Many of us in the health care system - and I happen to be one - suggest that that is not the case and in fact, unless we provide adequate in-home support services, that we will end up with more of these people in emergency departments than in other kinds of facilities. I think that the research has now caught up with that and so it's bearing out to suggest that yes, that is indeed the case and it's much more effective to provide that, which is yes, costly, but a lower cost service than some of the alternatives. So it's a position that we support in the department and I think there is room, if we had enough resources, to move further in advancing some of the allotments of time around those services. It is an issue of concern for us, I don't think we have that totally resolved yet.
MR. TAYLOR: I'm heartened to hear that because sometimes it kind of gets moved down the pecking order when you're talking about the various components of home care. As well, I noted with interest when you showed the gender breakdown relative to home care. I'm wondering, is that in proportion to our demographics, that males may die earlier, for example, or is there another reason for that?
[2:09 p.m. Mr. Mark Parent took the Chair.]
MR. MENZIES: I could give you a very subjective answer and from what I understand, for the most part many men are cared for by their wives and when they pass away, it's the women who need the care at that point and it's provided by the system. That's some of the reality, I think. I don't know how much research there is to substantiate that.
MR. TAYLOR: Well, I'm a living example of that. Do I have time for one more quick one?
MR. CHAIRMAN: Yes, one more minute.
MR. TAYLOR: The honourable member for Dartmouth North raised a concern regarding the client sometimes not being available when the home care worker arrives and, of course, that does happen, as he alluded to in the vice versa. I'm wondering, in the name of fairness, if the department or those appropriate are looking at some type of a notification, a better notification system on both ends, rather than the fines and penalties because there isn't any, the reverse onus isn't there.
[Page 23]
I, and I'm sure every member around this table, has heard from constituents who said, I was really looking forward to respite and for whatever reason the home care provider didn't show up. At least from my experience it doesn't happen frequently, but it does happen from time to time and sometimes, if it's a family member, they have a doctor's appointment or they're going to go get groceries, and it really puts them behind the eight ball. What I would suggest, rather than those penalties, maybe we should look at - from both sides of the equation - some type of notification system that would work perhaps better than whatever we have now. And with the penalty, I have the same concerns, I have to say.
MS. DOIRON: I think that's a reasonable suggestion. We will take that away and look at it.
MR. CHAIRMAN: Marilyn.
MS. MARILYN MORE: As you can imagine, we don't often get the phone calls that talk about all the good things that are happening in home care. People contact us when they're desperate, when they're being sent home from hospital, flat on their back and no home care available.
I had been dealing with one particular family situation, trying to get their homemaker and personal care service re-established after it was cancelled - and we don't need to get into all that. It took me 10 months of active advocacy on behalf of this individual who was in the advanced stages of MS, to get her much-needed daily support re-established through home care. I actually brought it up in the Legislature and I issued a news release on it because this individual actually chose to move to Abbotsford, British Columbia, in order to get the much-needed support she needed. She died within a couple of weeks of arriving in British Columbia.
I want to learn something from this. I don't want to see this repeated anywhere else in this province. So I'm wondering, has the department ever considered putting in an ombudsperson to deal with the situations that don't get resolved at the lower level of your operation in terms of home care, so that there can be a speedy resolution to the situations where there is a difference of opinion between the family who require the service and your department officials making the decisions?
MR. MENZIES: We haven't considered that but we certainly will now. I think that probably is a very effective way for us to try to manage these few situations as they occur, and to have one person become the person who helps them navigate through that system makes a lot of sense.
[Page 24]
MS. MORE: I think that would bring a lot of relief to people who feel that they're just beating their heads against a wall, don't understand the system, are constantly every week dealing with different officials from the department. I think this might be a way to resolve some of that.
Just quickly, several years ago I took part in a three-day workshop on home care. We were told at the time that from the department's point of view, the first level of support was always assessed as the family, whether they lived in the home, in the community, or elsewhere, they had the first responsibility for looking after someone either in the acute or the regular system. The second line of support for the family would be services in the community, often volunteers and that kind of thing, and also neighbours and friends. Then, if there were any gaps left in serving these people, home care would kick in. Has that changed or is that still the approach taken?
MS. DOIRON: Basically, I think, what we're doing at this point in time is not necessarily going through that elimination process and regardless of what has been said about the assessment tool or the approach to it, is to try to get to the assessment that truly allows us to assess what kind of support the person needs. If, in fact, that support is nursing support, we don't expect family or community members to be providing that.
[2:15 p.m.]
I think it is determined based on the kinds of needs the individual has and who is the appropriate, competent kind of support to deliver that. If it's simply family or care support of a generalized nature and they do have family and/or community folks who can respond, then obviously we would take that into consideration. By the time now that we're getting involved - and most of the people are looking for our services or, if the acute care system or some other part of the system is recommending that we do an assessment - many or most of those clients would be individuals who actually require a higher level of care.
One of the things that I will add, too, that applies to a number of the questions and issues that have been posed here is the development that has been going on over the approximately last four years in the department, to try to manage something that grew up from municipalities, that basically came from Community Services to Health.
I know that when I came to this province four and a half years ago, trying to understand the home care budget, every office had developed their own way of accounting for statistics and finances and there was no way to actually be able to roll things up in a way that made sense on a provincial basis. We have dealt with that, but we are still in the process and some of the reordering and the restructuring of the department and the system is based on getting us further and further down that road, to be able to define, to share, to be able to actually monitor the kinds of standards we think should be there. I think it's fair to say that
[Page 25]
we don't think they're exactly where they should be but we have made a lot of progress and we will make more over the next couple of years.
MR. CHAIRMAN: Thank you very much. We only have about 13 minutes so we will go into some very short, quick questions, if possible, to be fair to our guests from the YWCA. Russell will take the first part. Marilyn, do you want to come back or just stay there?
MS. MORE: I'll stay here, actually.
MR. CHAIRMAN: Russell.
MR. MACKINNON: The deputy minister has indicated there is a greater need for home care, correct?
MS. DOIRON: Correct.
MR. MACKINNON: But yet in the last two fiscal years you have underspent your budget.
MS. DOIRON: That's right.
MR. MACKINNON: Two years ago you underspent by $4.3 million, last year you underspent by $8.9 million. Given the fact that you've recognized this genuine need and we have a waiting list, why is the department not doing everything it can to help these people?
MS. DOIRON: I believe that we are. If the requirement is for care and we need caregivers, as I mentioned, the major issue that's a problem for all of us is, again, the supply and demand issue in terms of the care providers. However, where we can make an influence, we have been adding seats to nursing schools in this province, we have a nursing strategy that has been fairly successful. Those kinds of things are feeding all of the care delivery places, whether it's acute care, home care, or other places where we need to employ people.
What we have been pleased about in home care is that the budget that has been provided to home care has not been reduced, based on the fact that we haven't been able to fill all the positions. I think there's a recognition that we do need to fill those positions and once we're able to do that, probably get another increase to kind of keep moving that forward. So I won't go into a lot of detail but I think there are a whole number of initiatives that we have been employing to try to continue to move that forward.
MR. MACKINNON: But not fully utilized.
MS. DOIRON: But we still are not fully utilized, no.
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MR. CHAIRMAN: Thank you. We will now turn to Gordie Gosse.
MR. GOSSE: I'm not going to get into great detail, Mark asked for a short one, I'll just give you a real quick one. A constituent of mine was cut off with no warning, with no care, not informed of the appeal process and wound up in hospital. What my question is, what is the standard timeline of providing care with safety for employees until the issue is resolved?
MS. GREENWOOD: Obviously I can't speak to specific cases, but clearly, each client of home care is required to have a back-up plan so that they should be able to be self-sufficient in terms of having their care looked after in the community.
MR. GOSSE: Some of these clients have dementia and different illnesses that are pretty severe, I don't know where their back-up plan would come from.
MR. CHAIRMAN: Anyone want to respond further?
MR. MENZIES: I think certainly when services are withdrawn it is my understanding that people are advised of the appeal process so if you would like to give us the name of that situation, maybe we can go back and look at what happened, not here today but afterwards. We will go back and find out what happened that the person or family wasn't aware of the appeal process.
MS. DOIRON: I would also suggest that when Kathy mentions that there needs to be an emergency plan, it was really developed for that purpose. We all know some of the emergencies we've had in this province that would make it challenging to get to all of the home care visits at times. There has to be a contingency as to what is required, regardless of whether it's an individual with dementia, an acute care requirement, or whatever it might be.
It's that extent of response that we try to put in place, not simply something that would be carried on for a long period. I think that what happens in many situations, what becomes the back-up plan for many situations that we collectively can't or don't cover in some other way, it becomes the emergency department door of acute care facilities. It's important for us to kind of continue to work with the districts and it's one of the motivators for us to hand this over to the districts because we feel that kind of thing can be dealt with more effectively at the local level, and hopefully, we will get there.
MR. CHAIRMAN: Thank you. I'm going to have to ask for the answers to be a touch shorter just because I have five more people and that will be the end of it. Diana, if you would like to ask your question.
MS. DIANA WHALEN: I'm very sorry I only have such a short time because this is a huge issue and I do hope the committee will invite you back to speak perhaps for an
[Page 27]
afternoon on this subject, because I think there are many MLAs who would like to listen in and have questions. I'm going to pick up a few of the threads that have been put out there today.
Clearly, the client that I have been calling you about for the last few months is not alone, I think every MLA has clients who call who are desperate. When services are removed and discontinued because of any sort of dispute between a client and the caregiver, I want to know why the department doesn't have an emergency plan? You have unspent money in your account, I can' t believe it, $8 million last year unspent and I ask the minister's office what your emergency plan is because the person I'm talking about had care removed September 23rd and I don't think that their back-up plan was intended to carry them two months without care. I think that they are certainly ready to go through snowstorms or hurricanes but not two months without care.
I think it's awful that when you appeal to the Minister of Health, we're told the Minister of Health doesn't have any power to reinstate care. I think that's a failure on the part of the department not to have any back-up plans. I think we have put all of our store in the service delivery agreement that we have with VON or with whatever other provider, and I'm told there are no options beyond that. I think that that's wrong and irresponsible of the Department of Health and the Government of Nova Scotia.
I guess I would like to know - I think the ombudsman is a great idea but we need to know - that when care is interrupted, the people with serious health problems have a back-up. I would like to know what plans you have, I saw the strategic planning and all the rest of it. People who require care are tired of being consulted about it, they want to know what other plans you have, what options you can offer. The option I was given was, you accept services on the conditions provided by the VON or you lose service and you make your own plans.
MR. CHAIRMAN: Diane. Thank you very much.
MS. WHALEN: That's a good question.
MR. CHAIRMAN: That's a very good question, it's just time is of the essence for us right now. So a very quick answer please and thank you.
MR. MENZIES: I certainly appreciate and understand your concerns. The idea of an ombudsman is an avenue we will explore. The concern here though that we also have to be aware of is that quite often when services are withdrawn, it's because of risks identified by that care provider. That is our obligation, to live within the occupational health and safety laws of this province and the provider's obligation. When those issues are there, I think, working through an ombudsman's office or whatever to try to resolve those is probably the best bet. We cannot force a provider to make their staff go into a situation that they feel is
[Page 28]
unsafe or they consider themselves to be unsafe. That's a liability issue, we do deal with it from time to time . . .
MS. WHALEN: I think it should be clarified we're talking about verbal abuse.
MR. CHAIRMAN: Excuse me, five people and four minutes.
MR. MENZIES: Anyway, we will certainly look at the ombudsman's office as an avenue, we will look to resolve these issues more fully and easily for clients. I'll leave it at that.
MR. CHAIRMAN: Thank you very much, sorry to rush you. Jerry.
MR. PYE: Mr. Chairman, these short snappers make me feel as though I'm on some kind of a television game show rather than before the Community Services Committee. My question is this and there may be more, but I know at least there are two components to the delivery of good home care services: one, that being the standards; two, that being the training program, like care workers. So my question to you is rather brief but I do know that it would require a great deal more discussion than what we're going to get here now in this couple of minutes, so my question to you is what standards are currently in place for home care and what training is being provided to home care workers at this time?
MR. MENZIES: The requirement that we have at this time is that home care workers working for our agencies have to have the continuing care assistant designation. They have to have taken the course to become a continuing care assistant. They may have received training as a home support worker and have that certification, which will also meet that CCA need, or they may have worked in a nursing home as a personal care worker and can take additional training to become that continuing care assistant. But we do require all staff in home care to have that training.
MR. PYE: Is there required upgrading training as well, and you ignored the standards section.
MR. MENZIES: I didn't ignore the standards, I thought you were talking about a standard towards staffing and training, but the standards are there in terms of the expectations from the agencies and certainly we can share those with you.
MR. CHAIRMAN: If the honourable member is frustrated about the time, we could encroach upon the time for the YWCA if you would like to make that motion and take more time for home care. You seemed to express some concern that you're being pressured. (Interruption) They're outside. I just offer that as an option if that's what you would like.
MR. MCNEIL: Give everybody a chance to ask one more question.
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MR. CHAIRMAN: Okay, I was just responding to the frustration expressed by Mr. Pye.
Mr. Glavine.
MR. GLAVINE: Yes, I understand that the contract with VON is for an alternate service arrangement and I was wondering if you could provide the committee with a copy of that contract, please.
MR. MENZIES: Yes, we can provide you with that.
MR. GLAVINE: Okay, thank you, I'll be quick.
MR. CHAIRMAN: Marilyn, if you would like to ask your question.
MS. MORE: Yes, I'm concerned about the transition from hospital to home with appropriate home care services in place. Two or three years ago I remember being told that in order to have that happen the patient had to actually request home care as they were going through the emergency room, and while they were in hospital that could be arranged so it would be in place when they got home. I'm not sure how many patients actually know when they're going through triage and everything that they're going to end up in hospital and require home care. So do you track how many patients requiring home care actually have that service in place when they go home?
MS. GREENWOOD: Certainly, we are aware of how many referrals we have in the hospital. I'm not sure if we could give you the figures of those who would in terms of being a preventive measure and knowing that they would need home care when they went home, but obviously we would like to know that because if we can anticipate those services prior to clients being admitted to the hospital, it's a lot better. However, at the other end, we can ensure, necessarily that the service that they think they need when they're coming through the door will be the service that they need at the end of their treatment in hospital.
MS. MORE: You don't know if 50 per cent of people are going home who require home care services and don't have it. How do you know where to expand and what to do if you don't track it?
MS. GREENWOOD: We do know, I'm sorry, maybe I misunderstood your question. We certainly know how many people are leaving the hospital and have the home care services when they leave the hospital.
MS. MORE: So what percentage is it?
MS. GREENWOOD: I would have to get that information for you.
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MS. MORE: Could you provide it, because I think that gap in service might be quite critical to people's recovery.
[2:30 p.m.]
MS. DOIRON: I would like to clarify though that it is not a requirement for the person coming in to have to request or know that knowledge. Certainly, when giving their information and if they can provide information that's helpful in planning their care that's very good. But we also expect that the staff, the discharge planners and the home care people who liaise with the acute care facilities would be on top of kind of reviewing the patients who may be the candidates who would need to be followed up.
MS. MORE: I'm just quoting what I was told was sort of the worst-case scenario, perhaps three years ago - I'm sure it has improved since then - and they were told that they should have thought of that when they were in the emergency department, which is unbelievable.
MR. CHAIRMAN: Brooke.
MR. TAYLOR: Mr. Chairman, I would just like to make a very quick comment and then a short question. The comment is this, you've certainly raised a lot of concerns here today and we don't want to lose sight of the fact that our home care workers, the nurses, the personal care workers, all the different employees who make up that valuable service are doing just a great, great job, from my perspective, and I think other members would agree. They go at all hours, in all kinds of weather, 24/7, and we can't lose sight of that fact. It's something like the linemen when you're criticizing Nova Scotia Power, you lose sight of the fact that the employees on the ground are doing a really, really, good job under very, very difficult circumstances. So I wanted to say that.
As well, the income threshold of $18,785, I know everything comes with a fee, funding is critical, no matter what service you're trying to provide, but from time to time we do get complaints. A household income of $18,785 isn't a lot of money and most provincial programs - and I'll probably get slapped on the wrist for saying this - do have a higher threshold for other services that may not be deemed as necessary or essential - they're necessary but not as essential.
I know you have a difficult task trying to juggle the figures to make this whole scheme work and I think it has certainly evolved positively for the most part. But I do hope when we're evaluating policies that we take another look at that threshold because I don't know how the people are doing it and there are some people paying, as you folks know, and they're paying for that very essential service that they must have. It's life and death.
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MR. CHAIRMAN: With the committee's permission, the member for Halifax Clayton Park substituted for the member for Annapolis and took his second question, but would the committee indulge Mr. McNeil to ask a quick question, would that be agreeable?
It is agreed.
MR. MCNEIL: Thanks very much. I just wanted to show a gentler, kinder side to me. (Laughter) There was a pilot project for self-managed attendant care that was put in by the previous Liberal Government, which has shown to be very effective, not only saving the government money but providing a better quality of life for persons with disabilities. Considering the recent money that has been announced coming from Ottawa, I want to know, is this program on the agenda to be implemented as a full program as opposed to the pilot project it was?
MR. MENZIES: I can tell you that we've actually spent a full day with a group of people who are in that project so that we could understand it more fully and are certainly impressed with how it works for them. Their real commitment is that this is the best way for certain groups of people, not for everybody but for certain groups, and we will be looking to that kind of a project and assessing how we can move it forward as part of our regular business planning process as well. I have to tell you that I'm just totally impressed with those people in terms of how they're managing their own care needs, their independence, their autonomy, how important it is to them and they speak passionately of it. It was really quite good.
MR. MCNEIL: That's great to hear, thanks very much.
MR. CHAIRMAN: Thank you very much to our witnesses. We appreciate you coming and speaking about this important issue. I echo what Brooke said, I'm sure all the committee members do, that we do, in spite of our concerns, appreciate what goes on at the ground with the workers and the services that they provide. So thank you very much for appearing before us. Are there any closing comments you would like to make?
MR. MENZIES: Thank you for having us. You certainly made your concerns known and we will respond to the issues we said we would. We certainly appreciate hearing those concerns again and they will help us in future planning as well. Thank you.
MR. CHAIRMAN: Now, in the interest of time, can we be back here in two minutes, because we want to give the YWCA as much time as possible. So two minutes, please and thank you.
[2:35 p.m. The committee recessed.]
[2:37 p.m. The committee reconvened.]
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MR. CHAIRMAN: If I could call the committee back to order, please and thank you, we'll get started. (Interruptions) You'll get longer to speak now. Actually, you may not get much longer. We welcome our guests, and sorry that we have so little time, but we would like you to introduce yourselves and then, very briefly, if you could - we've already been introduced to the subject - if you want to add anything, then we'll go right into a round of questions.
MS. BRENDA SANDERSON: My name is Brenda Sanderson, and I'm President of the Board of Directors of the YWCA.
MS. SUE WOLSTENHOLME: My name is Sue Wolstenholme, and I'm Executive Director of Operations of the YWCA.
MS. SANDERSON: Just briefly, by background, thank you for making the time today to hear from us. It has been an eventful week for the YWCA. As I'm sure most of you know, this week the YWCA received an additional $100,000 from the province. What that money will do is actually secure the beds for our housing program until April 1st. So while it's work that's been going on for almost a year, and I would be remiss if I didn't acknowledge a number of people around this table but also our volunteers and our staff who worked very hard to get there, it's really an amount of money that allows us to focus on the future.
We have a lot of work to do between now and April 1st. That work really focuses on building a sustainable future for the YWCA, and working with the Department of Community Services to establish a sustainable funding agreement for our housing program. Hand-in-hand with that, what the YWCA is doing is assessing all of our operations to build a sustainable business model overall, and part of that is working through an RFP process to leverage our building at Barrington Street, which is our biggest asset. So currently we have expressions of interest from private partners, and our finance team and a task force to the board is reviewing those expressions of interest to see which are feasible. From there we will move to a community consultation round to get input from the community on best options, and expect a recommendation to come to the board early in the new year. That's really where we are today.
MR. CHAIRMAN: Did you have anything you wanted to add, Sue?
MS. WOLSTENHOLME: No.
MR. CHAIRMAN: We'll call upon Diana Whalen first, and you have five minutes.
MS. WHALEN: Five minutes, thank you very much. I just wanted to clarify for the record, as well, if I could, Ms. Sanderson, the $100,000 is not a grant, is it?
MS. SANDERSON: It is not, no. It's a one-time investment in the association.
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MS. WHALEN: And yet it was determined that that money was in fact a shortfall in earlier funding, was it not?
MS. SANDERSON: The review of the funding of our housing program done by the finance team within Community Services identified an $83,000 shortfall in funding to September 1, 2004.
MS. WHALEN: So this made up for that and gave a little bit additionally.
MS. SANDERSON: Right.
MS. WHALEN: If I understand you correctly, there has been no change then in the amount you can charge for your beds or people staying at your facility on a nightly basis, the per diem that you receive.
MS. SANDERSON: Right. There's been no per diem change. Currently what we have, both with the correspondence that came with the money we received this week and at a meeting in October that we had with the deputy minister, is a commitment to work towards a change in that agreement for the April 1st new budget year.
MS. WHALEN: Again for the members of the committee, can you just tell us the dollar amount you get per night from Community Services, the per diem rate?
MS. SANDERSON: Certainly. What we have is a nightly, weekly and monthly rate. Our nightly rate is $45, our monthly rate is $535, so that works out to be about $18 a night. Currently we're seeing a shift in our residents staying longer, so while we see an increase in our bed nights, and in fact this year we'll provide almost double what we did in 2002, the overall revenue from that is actually going down, because people are staying longer so they're taking advantage of a monthly rate.
MS. WHALEN: I had the opportunity to come and visit your centre last week to just see for myself what you're doing. It's very different than a shelter, and I think it's important that the committee understand how you differ from what would just be the nightly shelters that are available. Could you tell them, perhaps briefly?
MS. SANDERSON: Sure. The rooms that the YWCA offers to women in Halifax are unique. While the public might see us as a shelter, in fact we talk about our program as a residence for women. We have 26 beds in total, and of those 26 beds, 16 are designated, a minimum of 16, for women in transition, women who might otherwise be homeless, but we also accept students, we accept women just looking for affordable housing who might be travellers, whether they're coming in from out of town and need to stay in metro, or travellers from anywhere in the country who just trust the YWCA as a safe place.
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For the women in transition who take advantage of our services, they have private rooms. They can come and go 24 hours a day, which makes us unique of all the housing programs. When they're in the building and taking advantage of programming that might be there and accessing support services, they're just one of the women in the building. So it is very much about creating a women's centre as opposed to stigmatizing our clients by grouping them together.
MS. WHALEN: I'd like to know a little bit about the second stage. I guess I'm looking at where there's a gap in service here in Halifax. I had the opportunity to go to the launch of the Purple Ribbon Campaign, housing was mentioned again there as a reason why women may stay in abusive situations and so on, because we don't have a way to provide affordable housing. Many of the women you see are there in transition, and you need another place to move them, maybe before they're fully independent. Are there places available for that interim step?
MS. SANDERSON: Currently a lot of the women who stay with us are using the YWCA as that step. So we see, when we track who stays with us and ask them where they spent their previous night, if they're a new resident, a lot of those women actually spent their previous night in a shelter. So they're making the transition from crisis to an interim step, to being out on their own in the community. What we've identified with community consultation, and in fact in November we had 20 women show up who are in what we would call supportive housing, a need for, as women make that next step, housing that would allow them to live independently but perhaps access some services. When I say live independently, they would pay rent, they would be responsible for their own living arrangements, but they might want some on-site programming to allow them to take that next step into the community.
[2:45 p.m.]
MS. WHALEN: If I could ask just one more question about the funding again, to go back to that. If your monthly rate is equivalent to $18 a night for the people you are helping in that interim step, can you tell me what Community Services would be paying, say, for a night at Adsum House, a single night at Adsum or any of the other shelters that are more emergency?
MS. SANDERSON: The service we looked at that would be the most comparable to what the YWCA offered is Barry House and they receive an $85 a night per diem.
MS. WHALEN: So the difference is between $18 a night, or just shy of $18 a night, and $85 a night.
MS. SANDERSON: Right. And Barry House does not have a monthly rate or a weekly rate.
[Page 35]
MS. WHALEN: And the crisis you have just come through is a result of not getting enough money on a nightly basis to cover your costs, really, to provide this very important service.
MS. SANDERSON: Certainly we recognize that there are underlying sustainable issues across the organization but this is a key one that we were able to identify, yes.
MS. WHALEN: Thank you very much.
MR. CHAIRMAN: Marilyn.
MS. MORE: With your permission, I want to use the YWCA as sort of an example of what is happening to community organizations in this day and age who are providing services for government departments. I think it points to the lack of long-term planning for the sustainability of the sector. I understand that the low per diems is one problem and when was the last time your per diem rates were raised?
MS. WOLSTENHOLME: I think it was about two and half years ago.
MS. MORE: Okay, in that per diem rate, the extent of support in outreach service that you provide the clients and the transition program, is that reflected or is it more just to cover their basic accommodations and food?
MS. WOLSTENHOLME: That's a difficult question to answer because the people who negotiated the rate are no longer around. Some of the services that we do provide, we have had funded through different sources so part of our funding from the United Way in the past has established the advocacy office which is the two-hour-a-day office in the residence staffed by our housing manager to provide residents with assistance in working their way through the myriad services that they need to go through in order to become more independent and maybe eventually find their own . . .
MS. MORE: So you have had to supplement, then, the funding that comes from the department for those very clients.
MS. WOLSTENHOLME: We supplemented that and we also provide free space to the MCIS, Metro Crisis Intervention Service, and in turn they provide counselling to our residents.
MS. MORE: Okay. The other concern I have, it strikes me that this near crisis - you were very close to actually closing that program - seems to be the route that many organizations have had to go to. They have been in deliberations with the department. There has been delay, no decisions made until they reach a point where the organization has had to give them a deadline to say that we have to lay off staff or close the program or whatever.
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Then the department responds. I would be interested to know if you even have a rough idea of the extent of time that your board and staff and volunteers and others put into avoiding having to close that program. It must have taken an immense amount of time that could have gone into regular programming and fundraising for other things.
MS. WOLSTENHOLME: Weeks and weeks of combined time.
MS. SANDERSON: Without a doubt, it's been a strain on the association. I track my time personally, just so I know where I have been spending my day. Some weeks, on average, I was spending 40 hours over and above my workday towards YWCA business and a lot of that would have been focused on resolving this issue.
MS. MORE: That's amazing. Is there any sort of plan of action? Did the department give you any support through this or did they give you reasonable timelines or be upfront or clear about the information they wanted? It strikes me it sort of jerked from one mini crisis to another to another which used up even more valuable time from your staff and board members. I mean is there a clear process for appealing or going after emergency or one-time funding? Did you know upfront what to expect or how to go about it?
MS. SANDERSON: No, this is work that started, literally, a year ago. What has been a sharp learning curve and a surprising learning curve, I think, for our board members is that there is not a clear process. To go back to your point about what does the per diem rate cover, not only is there not a process by which to negotiate compensation and do regular checks and balances of is that appropriate for the level of services, there does not seem to be clearly articulated criteria of who might qualify and who doesn't qualify. So while part of our process was to communicate with the department the amount of additional cost that the agency had to absorb since our last increase, there was not a process by which to have that evaluated.
MS. MORE: So it's fair to say that from organization to organization, you don't know who's being treated fairly and what the transparent process is. You can only judge by what happened to your organization and your involvement . . .
MS. SANDERSON: It was a topic that actually came up at our last eastern regional meeting for the YWCA, to look out, within our national network, to see which provinces might have provincial standards relative to their housing programs and which ones don't. We discovered a mixed result where some provinces do, some don't. The benefit we have of being part of a national organization is we can look to those who do and learn from them.
MS. MORE: And where did Nova Scotia rate in that discussion?
MS. SANDERSON: Nova Scotia doesn't have (Interruptions)
[Page 37]
MS. WOLSTENHOLME: That's been made very clear. There is no standard for evaluating.
MS. MORE: So people doing something similar in other provinces might have had an easier process.
MS. SANDERSON: Exactly.
MR. CHAIRMAN: Leo.
MR. GLAVINE: You had talked about the fact that there's been an increase in usership from 2002 to now. Could you give some idea, over the year, how that may ebb and flow and the kind of percentages that are there, just a general kind of framework, really?
MS. SANDERSON: This is really from my awareness of how our occupancy works. It's interesting that early in the month, of any given month, we might have a lower occupancy, and that tends to be because as people come in and then might find housing, a longer-term solution, they will leave and transition to that for the first of the month. So if I'm moving into an apartment, it makes sense that I'm moving out of the YWCA at that point in time. The same sort of thing we found last year at Christmastime, this time of year, where our occupancy in the Fall had been quite high, over the holiday season a number of our residents were able to reconnect with their families or their support systems and find a solution, so they weren't coming back to the YWCA. So there's those kinds of things that affect our residency.
In the Summer months, our occupancy tends to be much higher for women who have the ability to pay, women who might be travellers who are looking for affordable housing solutions. Otherwise, we tend to have higher occupancy from women who might be clients of Community Services.
MR. GLAVINE: Do some tend to stay for some considerable period of time? In other words, the relationship between the service you are providing and the fact that homelessness or getting a place within one's budget is, in fact, a real dilemma for so many of your clients.
MS. SANDERSON: We'd certainly see it as a dilemma that our clients are facing. We don't link it to a specific category of client, but what we know is that our residents are staying longer, our average stay is now approximately four months, and that our residents are getting younger. So it's an interesting change in the dynamic of who the women are we're serving and the kinds of supports that we should be looking and planning to be able to provide for them.
MR. CHAIRMAN: Brooke.
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MR. TAYLOR: Thank you to our guests for coming in. I just wondered, did you say earlier that the United Way had decreased their funding, or did I mishear that?
MS. WOLSTENHOLME: It's not that they decreased their funding, they just changed the programs that they're funding now.
MR. TAYLOR: Could you explain that further?
MS. SANDERSON: I could speak to that. The United Way's funding is a zero-based funding approach. So you do not receive ongoing funding on an annualized basis, you apply each year. The United Way distributes their funding based on decisions of funding panel volunteers. Each year you have a different group approaching the agencies that are applying, so that may change. They look at across-the-community needs and make their decisions based on a best fit with their mission. So something that's funded this year might not be funded next year.
MR. TAYLOR: Mr. Chairman, I'm a little unclear. So it's a funding panel that actually submits the request for funding to the UW, is that it?
MS. SANDERSON: No. What it is is we submit a funding request based on four impact areas that the United Way has identified to fund the programs in, and then it's a funding panel that assesses which applications are the best fit with those impact areas.
MR. TAYLOR: So, for example, in terms of the overall funding United Way put into the YWCA for 2002 versus 2003, do you have a couple of years, so we could kind of put a face on those numbers. If there's a decrease, what does it amount to in dollars?
MS. SANDERSON: I'll give you an idea of how that funding can go up and down. In the United Way's 2002 budget year, we would have received almost $100,000 in funding. In their 2003 year, we received $30,000. In their 2004 year, we'll receive $66,000. So it's a very volatile funding mix, and it's not something that you would plan year to year to be able to base programming around.
MR. TAYLOR: I do apologize, Mr. Chairman, I'm not really clear on this. I would think that just based on my very limited experience with the YWCA, would that be, at the very least, perplexing to the members of the YWCA, the directors?
MS. SANDERSON: It would be very difficult. We actually worked very closely with the United Way to assess, given the change between 2002 and 2003, where our programming could better meet their funding criteria. I think the measure of going from $30,000 to $66,000 is an indicator of the outcome of that.
MR. TAYLOR: I can appreciate that. That's fine, then, Mr. Chairman, for now.
[Page 39]
MR. CHAIRMAN: Stephen.
MR. MCNEIL: Thank you for coming in today. You had mentioned that it was a $100,000 grant that you received to get you through this fiscal year, correct?
MS. SANDERSON: It's a one-time - and I'm just quoting from the correspondence - investment in the association.
MR. MCNEIL: I guess it begs the question of what happens next year? If you're $100,000 short this year, was there any suggestion from the department, was there any commitment from the department to support you next year?
MS. SANDERSON: What we have is a commitment to work together to establish a sustainable funding model. I think an indicator of moving forward is that we're actually working right now to schedule the next meeting with the department and the regional director to start us on that process.
MR. MCNEIL: Is there a deadline? I guess we arrived at your deadline here, that you were going to close the door. Have you set a deadline to the department on when you need to have that funding formula in place before you proceed with next year?
MS. SANDERSON: And that would go back to the beginning of these negotiations. When we first started talking with the department about this, we said we needed to get resolution and that without resolution as early as November 1st, by April 1, 2005 this program would be at risk. Certainly the investment we got this week allows us to navigate between now and April 1st, but without a sustainable funding agreement for April 1st, it would be at risk, yes.
MR. CHAIRMAN: I was absolutely shocked - just a quick comment, if I may be allowed - that you would go from $100,000 from the United Way to $30,000 in one year's time. Did they offer any rationale for that?
MS. SANDERSON: The United Way has a process with funding panel volunteers, and we do meet with them in advance of getting a decision. Like any other organization, though, we were actually surprised to find out that there's not a formal appeal process either. But I do think that we did get positive results out of that communication. They identified some ways that we could actually build our internal organization to create a stronger case. While it was a shock, it certainly netted out with a stronger organization and a better financial result the following year.
MR. CHAIRMAN: That's a $70,000 difference. We've come to the end of our time. Does anyone want to ask a quick closing question? Well, thank you very much for appearing. We appreciate you coming here, and wish you much success and stable funding.
[Page 40]
Before we go, our next meeting, Marilyn, is in January, I understand. Just a very quick question. We have on the list the future small unlicensed seniors' homes, with Keith Menzies back again. Do you want to stay with that, or do you want to jump to the Children's Aid Societies as our next one and then come back to Keith Menzies after that? It's up to you, it really doesn't matter.
MS. MORE: Could I make a suggestion?
MR. CHAIRMAN: Yes, please do.
MS. MORE: I think in January we're going to be meeting with the deputy ministers as a follow-up on our forum.
MR. CHAIRMAN: Yes, but that's in addition to our regular meeting, isn't it?
MS. MORE: Yes. I think we should deal with the Children's Aid Societies because the governance renewal is happening currently.
MR. CHAIRMAN: It would be very timely.
MS. MORE: And I think it would be very timely to deal with that in January.
MR. CHAIRMAN: Would people agree with that, that our January meeting would on be on Children's Aid Societies, and then in February we would come back to the - is there agreement?
It is agreed.
We stand adjourned.
[The committee adjourned at 3:00 p.m.]
