Back to top
February 13, 2024
Standing Committees
Meeting summary: 

Committee Room
Granville Level
One Government Place
1700 Granville Street


Long-Term Care Builds: Impact and Approach

Department of Seniors and Long-term Care
- Tracey Barbrick, Deputy Minister
- Paula Langille, Executive Director of Infrastructure

Mountain and Meadows Care Group
- Joyce d’Entremont, CEO/Administrator

GEM Health Care Group
- Mahmood Hussain, Director of People Relations

Meeting topics: 


















Tuesday, February 13, 2024







Long-Term Care Builds: Impact and Approach








Printed and Published by Nova Scotia Hansard Reporting Services





John A. MacDonald (Chair)

Danielle Barkhouse (Vice Chair)

Chris Palmer

John White

Nolan Young

Hon. Kelly Regan

Rafah DiCostanzo

Gary Burrill

Susan Leblanc




In Attendance:


Judy Kavanagh

Legislative Committee Clerk


Gordon Hebb

Chief Legislative Counsel






Department of Seniors and Long-term Care

Tracey Barbrick

Deputy Minister


Paula Langille

Executive Director, Infrastructure


Mountains & Meadows Care Group

Joyce d’Entremont



GEM Health Care Group Limited

Mahmood Hussain

Director, People Relations









1:00 P.M.



John A. MacDonald



Danielle Barkhouse



THE CHAIR: Order. I call the meeting to order. This is the Standing Committee on Health. I’m John A. MacDonald. I’m the Chair and the MLA for Hants East.


Today we will hear from the Department of Seniors and Long-term Care, Mountains & Meadows Care Group, and GEM Health Care Group regarding Long-Term Care Builds: Impact and Approach.


Just a reminder for all phones to be put on silent. I’ll now ask each committee member to introduce themselves by stating their name and their constituency. I will start on my right with MLA Regan.


[The members introduced themselves.]


THE CHAIR: For the purposes of Hansard, I’d also like to recognize the presence of Chief Legislative Counsel Gordon Hebb and Legislative Committee Clerk Judy Kavanagh.


I’d like to welcome the witnesses. We’ll start first with introductions by your name and your department, and then we’ll figure out who’s doing opening statements. I will start to my left with Ms. Langille.


[The witnesses introduced themselves.]


THE CHAIR: Before the opening statements, I’m just going to remind - we have a 20 minute, 20 minute, 20 minute format and then I’ll wind up saying “Order.” I’m not being rude. I’ll try to get it done.


I believe Deputy Minister Barbrick has opening remarks, so I’ll let her go first. Deputy Minister Barbrick.


TRACEY BARBRICK: Thanks for the invitation to appear today and talk with you about our department’s plans for long-term care builds and the impact that those have on the province. Today I’m joined by Paula Langille, our executive director of Infrastructure. I’m also pleased to appear along with Joyce d’Entremont of Mountains & Meadows Care Group and Mahmood Hussain of GEM Health Care Group, both strong partners of the department in this work.


Ensuring that all Nova Scotians have access to health care is vitally important. As a department, our focus is on ensuring that Nova Scotians have access to care and supports as they age. This includes working with partners to build age-friendly communities, promote healthy aging, and deliver community supports, home care, and long-term care.


Not all Nova Scotians will need long-term care. Many seniors will be able to live at home independently, with the help of family and community supports like home care and programs such as the Centre of Rural Aging and Health, CORAH; and the Community Aging in Place, Advancing Better Living for Elders program, CAPABLE. Of course, some will need long-term care. We want to ensure that those who need it get the right care at the right time, close to home in the communities they have lived in.


For many years, we’ve known the need for long-term care will continue to grow because of our aging population. This isn’t a surprise, and work to add space to our long-term care system to meet this demand really should have been under way before now.


We now have a multi-year infrastructure plan to meet Nova Scotians’ long-term care needs into the future. A multi-year approach provides certainty for providers and allows the construction industry to prepare for these projects as well as other important infrastructure projects in the province. This plan includes building 5,700 new single rooms in communities across the province between now and 2032. Of this, 2,000 are spaces being added to the provincial system, increasing our ability to provide long-term care to over 10,000 people. This plan will see new nursing homes built and older long-term care facilities replaced with new modern nursing homes in all parts of the province.


This work is already under way. The first of the facilities, Villa Acadienne, opened in September, and 96 seniors are now settled in their comfortable home and staff are enjoying a new, modern workplace. Two other new homes, Kiknu in Eskasoni and the new MacLeod Mahone Bay Nursing Home, will open in the coming months. Construction is in progress on several others, and many others will break ground in the Spring. The plan, including the number and locations of the new spaces, and timing, is based on projections for population growth, current demand, and the current number of long-term care spaces in each community.


Builds are overseen by the facility owners - companies like GEM Health Care Group and Mountains & Meadows Care Group. Staff in our department work closely with the owners through this process. They are key partners of ours in the plan.


Of course, we must also have the staff in place to ensure residents receive the highest standard of care. This is also a fundamental part of the plan. We’re working with the sector to recruit and train continuing care assistants and other staff, and working together towards delivering an average of 4.1 hours of care per resident. We’re doing this through a range of investments and initiatives, and we’re seeing positive results.


Two thousand new CCAs are being supported with free tuition and books; government increased CCAs’ pay; we are providing new pathways to help CCAs advance in their careers; and we’re recruiting internationally, to name a few examples. All these initiatives are critical elements of our plan to ensure Nova Scotians who need long-term care can get the care they need now and into the future.


I look forward to today’s discussions.


THE CHAIR: Ms. d’Entremont.


JOYCE D’ENTREMONT: My name is Joyce d’Entremont, CEO of Mountains & Meadows Care Group. I’m proud to say I have been a registered nurse for 40 years this year. My experience includes 15 years of bedside nursing, mostly in critical care, VON supervisor, Public Health, hospital-based care coordinator for Yarmouth Regional Hospital, and director of nursing for the former South West Nova District Health Authority, overseeing the nursing program for Yarmouth, Digby, and Shelburne hospitals for 11 years.


In 2015, I became the CEO of Mountains & Meadows Care Group in Bridgetown, and this by far has been my best job. Mountains & Meadows Care Group oversees Mountain Lea Lodge, a 107-bed long-term care facility in Bridgetown. We also have management contracts with Villa Saint-Joseph du Lac in Yarmouth, and have recently signed a management contract with Nakile Home for Special Care in Argyle.


We also provide disability support programs funded by the Department of Community Services: The Meadows Community is an adult residential centre with 34 participants; Willow Vale Apartments, 9 participants; 27 participants that we support in the community. We also oversee Conway Workshop Association in Digby, which includes two day programs, and we oversee seven small option homes.


In 2021, Mountain Lea Lodge was one of the first long-term care facilities announced for replacement in the province. Since this time, the team at Mountain Lea Lodge has been working closely with our architect, William Nycum & Associates, and our project manager, Donna Hoar with Grey Cardinal Management Inc., to design a beautiful home for the residents whom we serve. We are now in the construction phase of this project and things are moving along quite well.


Our residents, families, and staff, including our community, are excited to see this project move forward. I’m very excited to be here today to discuss this project.


THE CHAIR: Mr. Hussain.


MAHMOOD HUSSAIN: My name is Mahmood Hussain, and I’m the director of People Relations at GEM Health Care Group. GEM Health Care Group, some people don’t know, is a Nova Scotian and now second-generation family-run business. We’ve been enhancing the lives of seniors in all of the communities we are in across Nova Scotia since 1979.


The story of GEM Health Care Group is certainly one of hard work and determination and is really an immigrant’s dream - not just in Canada but here in Nova Scotia. My father is the CEO of GEM Health Care Group, Syed Hussain. He was forced to flee his home in India in the 1940s because of partition. He and his family managed to survive and relocate to Pakistan, after which he immigrated through Germany and on to Toronto. My mother, Gloria, herself is a registered nurse. She also travelled through Europe, North America, finally landing in Ottawa and then Toronto where she was a nurse manager at Mount Sinai Hospital. They met there and married in the 1970s. After many discussions at a very tiny kitchen table in a very tiny unit in Cabbagetown, they decided they would quit their stable jobs - my dad was a senior analyst for the Metropolitan Toronto Police Service, my mother, as I mentioned, a nurse manager - and they decided they would get involved in something that was a passion for them: health care. But not just health care - caring for seniors because culturally, for both of them, that was something that was so important.


In the 1970s, there weren’t really many opportunities to just enter into health care, especially into long-term care. They did a search from Ottawa east, and one day an opportunity popped up to move to a community they had never been to, never heard of, in Amherst, Nova Scotia. They took that opportunity to pack us up and move to a small, border town. My brother wasn’t even certain that they had cable and running water. He was pleasantly surprised, but Amherst didn’t have all the trappings that downtown Toronto did.


I’m proud, though, to say that Amherst was where I was born, where I’m from. I went to school there, and even though I live in Halifax and have been living in other places since, it’s always home to me.


The first facility my parents acquired was actually the Lockhart’s Nursing Home facilities. It was a series of Victorian homes if you can imagine. At the time, this is what long-term care looked like. It was three Victorian homes, multi-levels. A nurse - rain or shine, Summer or Winter - would walk from home to home, put her parka on, go upstairs four flights, attend to all the residents, go to the next home. You can imagine - not so practical for seniors, not so practical for the practitioners and the nurses who were taking care of them. These homes, though, were replaced by the present-day Gables Lodge facility. It was the first of its kind in Nova Scotia, the first institutional health care facility and long-term care that still felt like a home. It was our first step, we say, in providing seniors the care that we continue with today.


Since then, we’ve acquired, we’ve constructed other facilities across Nova Scotia, and we like to see ourselves as leaders in transforming how health care is delivered. We operate many levels of senior care, not just long-term care, and we have about 2,500 full-time, part-time, casual Nova Scotian staff working for us at this time.


We’re here today to talk about the exciting and ambitious plans this government’s laid out for long-term care here but honestly and candidly, with Joyce sitting next to me as well, I feel I want to acknowledge my teammates at GEM, but acknowledge the health care workers, the nurses. My mother and her family, that’s 10 nurses - 10 RNs and 1 physician - all Filipinas, all hard workers, all people who came to Canada and the United States to change their socioeconomic position and really add value to the places they’ve been.


As we’re all aware, the government has announced lots of investment into long-term care, and we at GEM, we’re happy this day has come. We’re happy to be partnered in this exciting time to ensure that seniors have: the best quality; best outcomes; private rooms; private bathrooms; things in place not just for infection control, but quality of life that any of us would want in our own homes; lots of natural light; lots of recreational space.


You know, earlier I spoke about my family’s first facility, Gables Lodge. This past December, I’m proud to say we broke ground. It’s a rebuild, and it’s to serve the Cumberland area. We’ve decided, in honour of the 21st premier of Nova Scotia, to rename Gables Lodge the Roger Bacon long-term care facility. It felt fitting, given that Roger Bacon and his family have been a part and have visited that facility. Any community we’re in, someone you know, someone in your family is either at the facility, working at the facility, or will be at the facility.


GEM is a close partner, I feel, of the Department of Seniors and Long-term Care and our province, and we really look forward to continuing to build facilities with dignity and compassion, and the highest quality of life and service to seniors, as has been our mantra from Day 1.


[1:15 p.m.]


THE CHAIR: We’ll start with the questions. We’ll start with the Liberal party.


MLA Regan.


HON. KELLY REGAN: I guess first I want to say - I don’t want to speak on behalf of the committee, but I’m sure my colleagues would want to know the passing of the senior who was injured in that explosion following the snowstorm last week. I think it’s devastating news.


My first question would be around the issue of ensuring that all of the facilities that are under this department’s control - I want to make sure that we’re doing what is appropriate following weather events, whether they are a flood or a fire or a snowstorm, making sure that safety is at the top of everything that the department is doing.


I’m just wondering: What are we doing to make sure that our facilities are structurally sustainable during a time of climate change, Number 1. Number 2, what is your department doing? Are you changing your approach with long-term care homes, et cetera, to ensure that our seniors are safe, whether they’re in a long-term care home or whether they’re in a seniors’ residence?


THE CHAIR: Is that to the deputy minister, MLA Regan?


KELLY REGAN: It’s to the deputy minister, but if she wants to pass it along to Ms. Langille, that’s up to her.


THE CHAIR: Deputy Minister Barbrick.


TRACEY BARBRICK: It absolutely was a tragic circumstance in Cape Breton. I do want to clarify that wasn’t a nursing home in the province. It was housing. But I 100 per cent take your point around how we’re responding to emergencies.


I’ll start, and then my colleagues, no doubt, at the sort of facility level, and Paula as well, will have some things to add.


Every licensed nursing home or long-term care facility in the province has to have an emergency evacuation plan. We are currently in the process of working with a consultant to make sure everything is refreshed, and that we’re facing what’s realistically facing Nova Scotia for climate change reasons.


Back in the Spring, when we had the floods followed quickly by the fires, I want to say with some pride that, with our partners at the table, we actually evacuated seven nursing homes in 48 hours, and tested all of those emergency plans, and had pop-up nursing homes in the Yarmouth Nova Scotia Community College and at Acadia University. Many partners - MacLeod Group, GEM, Mountains & Meadows - helped with taking some of our more fragile clients who needed to be relocated, and those who were suitable to move into those pop-up nursing homes, we did. The sector worked together in a way that was amazing and heartwarming. So on top of good planning, there is also a sector approach to emergency response that is bar none, to my view.


The additional piece is that we’ve invested more heavily in the last couple of years, including $25 million in our capital repair fund. That fund, not too many years back, was a million dollars. It went to $10 million three years ago, and it went to $25 million last year. That’s to support the licensed long-term care facilities - when they identify needs that require refreshment or readiness for some of those things, have a way to access some of those supports. Lots of proactive things happening to make sure that we’re refreshing that continuously.


I’m going to ask if Paula wants to add some information to that. Is that enough?


THE CHAIR: MLA Regan, did you want . . .


KELLY REGAN: I think we’ve heard an adequate answer - “an adequate,” not “inadequate.” (Laughs)


Recently there were multiple announcements regarding long-term care homes over a couple of weeks. It was regarding the expansion of long-term care homes and beds. Today we had the Auditor General releasing a report - not on long-term care expansion but on another part of the health care system, or the continuum that really links into long-term care. In it, she cited a lack of due diligence when announcing the transitional care facility, et cetera, on a number of different fronts. I just want to clarify from the deputy minister: For the new builds and beds, were the proper protocols followed, was due diligence conducted, and if so, what were those things that ensured that those happened?


TRACEY BARBRICK: Maybe, if it’s okay, we’ll take the same approach. I’ll start, and if there are gaps that have Paula jumping out of her seat, we’ll add to that. There are a couple of different ways that we commission long-term care facilities in the province. One is essentially first right of refusal for a recognized facility and their operators that are in good standing. When Mountains & Meadows required replacement, we first go to Mountains & Meadows and say, Are you in for a replacement facility? In which case, of course, Joyce was.


That’s not always the case. Sometimes we’ll have facilities that are up for replacement, the infrastructure is dated, it’s time, and maybe that existing organization doesn’t want to be in the business anymore or they are for various reasons selling a business, and sometimes that changes. The policy is first right of refusal.


If we’re building net new beds, like we did in Central Zone when we ran the request for proposals almost two years ago now, there was no facility to replace. We were in desperate need of more capacity in Central Zone, so we put out an RFP. Anyone can bid on those projects - for-profit, not-for-profit, societies, whatever the case may be. It goes through a very rigorous procurement process that’s audited and overseen by Nova Scotia Procurement, and the awards are given out. GEM Health Care Group was one of the successful candidates for two facilities as a result of that.


In addition to that, part of this 11-step process to get these long-term care facilities built - it’s quite rigorous - Paula and her team are attached every step of the way, the construction itself is tendered out. It’s a competitive market for every single project. Whether it’s a non-profit, for-profit, replacement, or brand new, everything is tendered out, so that you bring the competitive nature to the business, and Procurement oversees those as well. I think that’s probably a start.


THE CHAIR: MLA Regan, do you need more?


KELLY REGAN: No, I think I’m good with that answer. That’s great. We heard in the report from the Auditor General today that the government is spending more and getting less than intended with regard to the beds at this transitional care facility. Have we seen the cost of the builds go up for long-term care: additions or new builds or replacements that are under way?


TRACEY BARBRICK: Yes, of course. Over time, both construction supply and demand, supply chain, all of that is faced with the current inflationary environment. Not so long ago, Statistics Canada released specifically a construction inflation number. It’s close to 10 per cent nationally right now, and we’re of course seeing that in this sector as well.


Maybe the piece of this business that’s different from, say, a hospital or a school is we don’t actually own this infrastructure. Our service providers own the infrastructure. We identify a facility that requires replacement, or we need net new beds. Through this 11-step process, we work very closely with the service provider to make sure that the standards are all met. The service provider actually takes the mortgage out, and the way we pay for them is over time, we pay a per diem. We pay a daily rate per bed, and a portion of that per diem is essentially the mortgage rate.


With the new facilities, about 35 per cent of the overall per diem is a mortgage rate, and 65 per cent is operating dollars. That’s the staff, the overhead, all that sort of thing. It’s a little different from hospitals and other public infrastructure because we have this arrangement where we essentially, through a per diem, pay for a portion of the mortgage until the mortgage is paid off.


THE CHAIR: MLA Regan, are you good, or do you need more?


KELLY REGAN: Yes, I’m good. Maybe I’ll switch over to the service providers now. In terms of your facilities right now, what are the issues that are facing you in terms of staffing?


THE CHAIR: Do you want me to pick which one, or do you want to pick one?


KELLY REGAN: No, whoever wants to go first can go first, just in terms of staffing.


THE CHAIR: I’m going to go ladies first. (Laughter) You’re stuck with me this way, sorry. (Interruption) Ms. d’Entremont.


JOYCE D’ENTREMONT: Staffing is something that is Canada-wide, as you folks all know. You have to keep at it constantly. You have to recruit internationally. We’re having lots of successes at Mountains & Meadows Care Group. We’ve identified one person who works two days a week just to focus on recruitment and retention, and that is working really, really well for us.


It used to be that the recruitment issues were mostly in nursing, but now they’re across the board. It’s hard to find people in environmental services, in food services. It’s across the board, so you have to think outside the box, be kind in the workplace, have a culture that’s going to bring people in instead of shutting doors and people don’t want to work with you. We’ve worked really hard at Mountains & Meadows to accept all people, love all people. Sometimes you may have somebody who’s a student at Acadia University with no car, and instead of starting at seven o’clock, they have to start at nine o’clock to work in environmental services. We are doing really well.


There’s also a recruitment/retention program to Health Association Nova Scotia funded through the department, and we’re part of that. There are many ways to recruit the CCAs. The increase in their wages has shown us great success. Paying for their tuition has - you know, we have NSCC in Middleton. The students come, they do a placement with us, and then we’re hiring all of them because, again, it’s your culture that you’re creating within your four walls. If you have a recruitment problem, there are some issues, yes, with manpower, but you also have to self-reflect and ask: Why is this nursing home up the road not having the same issues we might be having?


International, again - we’re putting a big push on international recruits. What the Nova Scotia College of Nursing just did, that certain countries can now come in and are fast-tracked to get their licence assessment - really, really helpful - prior learning, as well. As a CCA, you come in, you might work as a long-term care assistant for a bit. You get sensitized to the culture and the work, and then you start. You enrol in the Recognized Prior Learning Program, and in three years - most of them do it in two, but in three years, you can write your CCA exam.


There’s a whole menu of things that the department has supported us with that I’m seeing fruit of our labour. I’m really seeing a lot of improvements in the staffing, for sure.


THE CHAIR: Do you want to hear from Mr. Hussain also? Mr. Hussain.


MAHMOOD HUSSAIN: You know, certainly staffing is an issue and has been over the last few years. Proudly, I would say over the last decade, GEM Health Care has helped to bring in more than 500 families from across the Philippines, Asia, Central Africa. We always just saw it as a thing you do, which is to help bring your people back to where you are. Now, it’s - some places it’s a mandated policy - people need to be more diverse, equitable, and inclusive - but we always saw a benefit from it.


In the Fall, we partnered with the Province and went to the Philippines to recruit more health care workers. GEM Health Care Group has partnerships with the Government of the Philippines, one of the largest recruiters there, and the college of care training. They offer many trades - TESDA, it’s called. We work to try and get a more parity kind of training so that people could be trained almost as CCAs there and come here, so no longer does labour arbitrage of us bringing in registered nurses to clean people’s teeth, you know? Not work within their scope of work.


[1:30 p.m.]


We also partnered with the last government. We worked really hard - one of our senior staff, Tara Deveau, and I - to create now the work-and-learn program - subsidized and paid on-the-floor training for CCAs. My mother was actually the first one to teach undereducated women in Cumberland County in 1979 to become caregivers at Gables Lodge, the same facility I mentioned. We did that until - and then on into Spryfield, where we were located until the early 2000s. It was regulated away to the private colleges, but we partnered with CBBC Career College three years ago now, and we just said, You cannot have more CCAs unless single mothers who have another job and have a second job by raising kids - unless you incentivize it and actually give them the possibility, we won’t be able to train.


Now we’re proud to say that’s the model that seems to be working really well. Kudos to the province for funding that, and allowing us to create programs for retention and for staff training for the long term.


As Joyce mentioned, the work culture is a big deal. Taking care of seniors, taking care of people with mental health challenges is not easy work. Who knows really what the dollar value is to remunerate someone for doing that? But people do it because they love it, and because they love to help people. We try to make GEM a culture that recognizes the work they do, because we leverage that care and that interest - so like Joyce said, a lot of initiatives to show people that we care, that we invest in the work they do, and in the safety and the quality of work. I think that has proven to be the best return for addressing staffing issues.


KELLY REGAN: Deputy Minister Barbrick, we’ve heard that staffing is a big issue in long-term care from the unions that have appeared before this committee over recent months. Do we know what the current staffing vacancies of continuing care assistants, licensed practical nurses, and registered nurses are across long-term care?


TRACEY BARBRICK: Yes, we’ve done a lot of work in the last two years to have good clarity on the answers to those questions, which we really hadn’t had as a system before. The mandatory CCA registry, which is now fully implemented, has been a big help on that front, as well as standardized ways of collecting that information.


We know that long-term care generally has about 10 per cent vacancy across the system. That encompasses clinicians and non-clinicians, and of course, it varies significantly by facility and by geography. We continue to have some reliance on travel nurses, and those are facilities that tend to be at significantly larger vacancy numbers. With the free tuition, the wage increases and the 4.1 hours, more people on the floor to help each other - those things are all showing success. The Recognized Prior Learning Program that Joyce referenced - a couple of years ago, there were about 300 people per year who were making their way through a recognition of prior learning process who either had been educated somewhere else in a different type of program or had worked in a facility as an assistant in a different way. We actually put 700 people through that program last year.


It’s a multi-pronged approach to try to fill that workforce need, for sure.


THE CHAIR: MLA Regan with about three minutes left.


KELLY REGAN: So how much was spent on travel nurses through the long-term care facilities in 2023?


TRACEY BARBRICK: The year before last, we spent about $48 million. We’re forecasting for this year that we’re probably down around $35 million for this fiscal. That is an indication that some things are moving in the right direction.


Of course, our intent is not to be reliant on travel nurses in the long term. That’s a result of a kind of lack of attention to the continuing care workforce for too long. So we’re now playing catch-up a little bit, and we need those travel nurses to keep those nursing home rooms open, and make sure that they’re there to help take the pressure off the hospital.


We’ll use them as we need to, with hopes, of course, that we’ll be able to tail that off as quickly as we can.


KELLY REGAN: We heard there’s about a 10 per cent vacancy across the sector. Can you give us an idea of how many positions that is in each of these health care categories: nurses, LPNs, CCAs? If you don’t have that at your fingertips right now, that’s fine. If you could just send us that information, that would be good.


THE CHAIR: Deputy Minister Barbrick, do you have it or do you want to send it?


TRACEY BARBRICK: I would have to send it.


THE CHAIR: That’s great then. MLA Regan, back to you, because that was the question, correct?


KELLY REGAN: Yes. What’s that total number of people waiting to get into a long-term care facility right now?


TRACEY BARBRICK: About 2,000 people, give or take a couple. We’ve got about 175 who are waiting for a residential care facility, which is a lower level of care, and the balance of those are waiting for nursing home beds. About 75 per cent of those people would have home care while they wait.


KELLY REGAN: Those numbers - the 2,000 figure, was that factored into - and I think I heard that in your earlier remarks, but was that factored into where nursing home care beds were actually announced? Were they announced in places where they were needed?


TRACEY BARBRICK: The modeling that we did to determine where we would place replacement and net new beds really factored in a number of things. One was the condition of existing facilities. We did a province-wide engineering assessment of all of our facilities around what condition they were in. The second was population projections. The latest ones that we had that had been released by Statistics Canada . . .


THE CHAIR: Order. Sorry about that, Deputy Minister Barbrick. The next 20 minutes is for the NDP. MLA Burrill.


GARY BURRILL: Ms. Barbrick and Ms. Langille, I wanted to ask some questions about the ownership structures of the new builds. We’ve had, for a long time in Nova Scotia, a feature of the sector has been the balance between for-profit and not-for-profit parts of roughly equal for some time, 40-some per cent each. In the new builds that are at some level entrained at the moment, what is that balance between for-profit and not-for-profit facilities?


TRACEY BARBRICK: Do you mean specifically the Central Zone facilities that are being built?


GARY BURRILL: I’m thinking of the 2,500 new rooms that were proposed, those that are involving new construction. What is the balance between for-profit facilities and not-for-profit facilities, approximately - provincially?


TRACEY BARBRICK: I don’t have the breakdown with me. I’m happy to get that for you. It is primarily - of the 54 nursing homes that are being built in the province right now, the majority of those are non-profits. Our net new capacity, we’re essentially building 5,700 rooms in the province. Two thousand of those are net new, so with the 54 facilities that we’re building right now, the majority of those are not-for-profit. The additional capacity of that 2,000 net new will go from about 8,000 licensed long-term care facilities to about 10,000 long-term care rooms in the province. The majority of those are non-profit.


Because of the first right of refusal policy, the only time we go to market, so to speak, for net new beds is through a request for proposal process, and then either can bid. With that RFP in Central Zone, there are seven facilities that were successful in that. Two of those were Northwood and the others were other local businesses in the Central Zone. Of the 54 nursing homes that are being built right now, the majority of those are non-profit, but I don’t have the numbers with me.


THE CHAIR: The clerk will get you a reminder to get those numbers for us. MLA Burrill.


GARY BURRILL: The balance is not as it had been, about roughly equal. It’s more, province-wide now, the new rooms that are being opened in the new facilities being constructed, you’re saying are in the considerable majority in the private, not-for-profit sector?


TRACEY BARBRICK: Yes. Of the 54 that are being built right now, only nine of them are part of that new RFP. The rest of them are all non-profit, so of the 54 that we’re building right now, the large majority are non-profit replacements.


GARY BURRILL: I’d like to ask about the financial model, then, for the nine. You’ve spoken about how it works through the per diem, but can you explain how it works differentially - how the model differs between a for-profit long-term care facility and a not-for-profit long-term care facility? Where do you account for - where do you apply the profit part of the for-profit equation?


TRACEY BARBRICK: I’m really happy to answer this question because it is something that requires some myth busting. Joyce and Mahmood are funded exactly the same. Our per diem rate is based on operating costs - which is largely staff, food, overhead - and then the equivalent of a mortgage or space allocator or space funding. There isn’t a fixed profit line. Mahmood doesn’t have a budget with a fixed profit line, and Joyce has a budget without a fixed profit line. The funding for the per diem is exactly the same.


One thing this government put in place was the protected and unprotected envelopes. Essentially, what went in the protected envelope is food, staff, and clinical care, and if Joyce doesn’t spend all of that, I take it back from her. She doesn’t get to keep it; neither does Mahmood. In the unprotected envelope are the things like interest rates. So if Facility A gets a more competitive interest rate because they accessed some other type of borrowing - if they get a better interest rate than what the market interest rate is - that is unprotected and can be used for other things, as can maintenance and some overhead. If you fit the facility out with excellent energy efficiency and you get some savings from that, you can use that money for other things, to put it into other types of programming, other investments across the infrastructure. But there aren’t fixed profit lines anywhere and haven’t been for a long time.


GARY BURRILL: I understand that it would not be fixed, but I wonder where the provision would be. In the for-profit part of the sector, investment is not made in the hope that there would not be profit. Investment is made in the expectation that there would be profit. This is not the case in the other part of the sector, and so I’m interested in understanding where this appears in the funding model equation. Sometimes it appears in other sectors in things called management fees. The economic logic is it must appear somewhere, otherwise the for-profit part of the sector is not able to attract investment.


I think people, when they hear the discussion about the two parts of the sector, would like to understand - and I would like to understand - where does the profit come from if, in fact, both parts of the sector are on an identical model? In other words, it’s not entirely intuitive or logical.


[1:45 p.m.]


TRACEY BARBRICK: Again, I welcome this conversation because I’ve had it a lot. Certainly I will defer to my colleagues to speak from their own perspective on this, but where an owner of multiple facilities finds their efficiencies is through economies of scale. If I own four nursing homes, I can align a maintenance contract that gains efficiencies for me because I have four facilities. If I, in my own house, bring a plumber in, I’m going to pay $300 an hour for a plumber. If I own a host of facilities and can afford to have a plumber on full-time salary or part-time salary, I’m going to gain efficiencies from not having to pay that overhead for an external contract. Economies of scale is a place where that profit is largely found.


I do want to though, because it’s just by fluke that it’s Joyce with Mountains & Meadows who’s here, not by design as part of this conversation, but you would have heard

Joyce talk in her opening comments about all of the other non-profit nursing homes that she is now working with around service agreements or management contracts. The opportunity that’s found in that mirrors what is found for GEM with having multiple sites.


Joyce and some of her colleagues are starting to find really interesting, creative ways to work together for things like bulk purchasing, common accounting contracts, where they’re working closely together across the non-profit to find that kind of efficiency. That’s what we want so that if there’s costing in their funding formula, that then frees up money to invest further back into the programming. That’s what we want for them, is to be able to mirror that.


I don’t know if you’d like to hear more, but certainly, both of my colleagues would have perspectives on these things. There’s probably value in the effort to deepen your understanding on how that all works.


THE CHAIR: I’m going to start with Mr. Hussain. I assume you want both, Mr. Burrill.


MAHMOOD HUSSAIN: As Deputy Minister Barbrick said, I wouldn’t know how to do this without a certain scale. Addressing some of the labour questions earlier, when you have a facility of any size, you do need, for example, someone to keep up the maintenance of the facility. If you have a 15-bed facility or if you have a 120-bed facility, you still need a maintenance person, but obviously in the 15-bed facility, there are fewer demands. We found efficiencies by having multiple facilities. Certainly, we have facilities right next to each other. It’s the only way that it does make sense. We’ve been able to do it.


Honestly, the work effort of everyone on our staff - and I’m certain on Joyce’s staff - to be able to handle what some people might think as a full-time job, but to be able to efficiently do the accounting for multiple facilities at the same time is the only way as an operator to make it all make sense.


JOYCE D’ENTREMONT: Great discussion. We’re relatively new to having management contracts with other facilities. As I said in my opening remarks, we have one with Villa Saint-Joseph du Lac in Yarmouth, and now we have one with Nakile Home for Special Care. I have a chartered accountant on my staff. That’s a costly position, because usually you have a bookkeeper. That means that my chartered accountant can oversee the financials for Mountain Lea Lodge, Villa Saint-Joseph du Lac, Nakile, under the cloud-based accounting system, because he can do it from anywhere, plus all my DCS facilities as well.


We have a big organization. There are four year-ends now to be done. Instead of hiring a chartered accountant at every single facility, we have one who’s overseeing all the bookkeeping, all the financials, reports at the board level on that, and then we can hire bookkeepers in the facilities. That’s an example.


Another example would be HR. Instead of having HR positions at every facility, I have one at Mountain Lea Lodge, and that person is helping in overseeing some of the recruitment and policies for the other nursing homes as well. That’s kind of the efficiencies that you can find with having more than just one facility.


GARY BURRILL: Well, certainly there’s no question that economies of scale yield contained expenses in any sector. Long-term care would be no different than any other sector.


What I’m asking, though, is where is the source of profit in the for-profit sector? Are you in fact saying, Ms. Barbrick, that economies of scale allow the for-profit sector to contain expenses in a more rigorous way, and thereby the profit is provided? In other words, there must be a source of the profit itself. There is no magic in these economies. We know we can get toward that by economies of scale, but if that’s the only source, then surely there is a tremendous incentive in the for-profit sector to contain expenses.


TRACEY BARBRICK: I think the safeguards that you’re exploring are this concept of a protected envelope. The clinical staff, as it relates, for instance, to the 4.1 hours of care - you know we went to the 4.1 hours. It’s a leader in the country. That clinical envelope for both Mountains & Meadows and GEM is a protected envelope. If there are inabilities to fill positions, the money comes back from both forms of operation. There isn’t an incentive, for instance - because what I’ve heard from time to time is that people will run short nurses or short CCAs or short LPNs, because that’s where the profit comes from. It’s just not true. If they are short CCAs, LPNs, or RNs, the money comes back to us, and that money generally has been repurposed to focus on HR recruitment efforts, including all the things we’ve talked about, to some extent. There’s some funding that comes that way.


The unprotected envelope is where the efficiency can be gained. The standards are the same for all facilities. Our licensing and inspection team is in every single facility in this province at least twice a year - more if there’s reason to have any concerns. All are required to meet the same standards.


In the unprotected envelopes, for instance, if GEM - sorry to keep picking on you down there - if GEM were to retrofit all their nursing homes with heat pumps and solar panels and take that investment out of their dividends, and in exchange they operate a much more power-efficient cost for their facilities, they keep that savings and use that savings for whatever they want to. That is the issue with the protected and unprotected envelope.


That was put in two years ago. That didn’t exist before. Now that clinical envelope, as well as things like food - because we also hear a bit of myth around people are motivated to cut food budgets so they can use the money for other things - there’s annual financial statements and quarterly financial statements that come into the department. They’re reviewed by our finance team. Any gaps in the protected envelope come back to the department. So the only place they can gain efficiencies, and thereby their profit line, is from their unprotected envelope. If people find efficiencies in the way they operate, that’s an okay thing.


THE CHAIR: MLA Burrill, with about three minutes left.


GARY BURRILL: With how long, sorry?


THE CHAIR: Two and a half minutes.


GARY BURRILL: I’d like to change the subject. Thank you for exploring this. I wanted to ask about - and maybe we’ll need to come back to this a little bit later. Two minutes won’t do it for us.


I’m thinking about - with the new builds, the process for facility budgets. A person hears about - you were mentioning the 11-step process, that there’s a step there where facilities, architects, project managers put forward the budget to the department before it goes to tender. A person hears that it is not uncommon that the department wishes to have downward revisions in this budget. It’s sent back, and project managers and architects are instructed to find some savings. Can you give us some sense, first, how often this happens that facilities that are being proposed go to the department prior to tender and are sent back for downward revision?


TRACEY BARBRICK: Do you know, I’m going to turn this over to Paula because Paula and her team have their hands on every single project. She can fill you all in on that.


THE CHAIR: Ms. Langille.


PAULA LANGILLE: We have had a few organizations that have come to us with project budgets or designs that may be a little richer than we would prefer. We’ve had great conversations with our service providers about understanding the need for some of those additional spaces, some of the cost. We really have collaborative discussions with them about understanding the need for it, the rationale behind it, and asking them to look at their design to make sure it’s as efficient as possible. We’re building these buildings for 25 years, so we want to make sure the layouts are as efficient as possible.


We also recognize that these are funded by the Province. We want them to be as efficient and accountable as possible for these costs. We’ve had a few of those over the last year that we’ve had to go back and ask them to maybe value engineer a few components or provide additional rationale for the cost.


THE CHAIR: MLA Burrill, five seconds.


GARY BURRILL: Thank you very much.


THE CHAIR: I’ll go to the PC caucus. MLA White.


JOHN WHITE: I come in to these committee meetings pretty much weekly, and I always have great respect for the witnesses who come in because we are recognizing provincial issues, and we ask you for the answers. That’s what we’re looking for. I don’t want to go without saying: Mr. Hussain, I’m extremely honoured to meet you today, to hear your story about your family, coming here and making a life for yourself, and now to hear you talking about providing that same opportunity for other folks who are looking to relocate. It really actually choked me up. It was choking me up, thinking about it. I really just want to get a picture with you at break time. (Laughter) I really respect you - I do. I really do, so thank you very much for all you’re doing.


My questions are pretty much for the department. In starting, I’m just wondering, Deputy Minister Barbrick, if you’re able to help us understand the Province’s standards for the design and the space for the new long-term care facilities.


TRACEY BARBRICK: I can do that, but Paula could do it much better. (Laughter)


PAULA LANGILLE: Early on in Deputy Minister Barbrick’s remarks, we are building modern long-term facilities. That starts with our space and design documents that we have on our website, and that’s what Ms. d’Entremont and Mr. Hussain are building too. These have all single rooms.


You will see in front of you an illustration of what a typical resident room would look like. You have a single room, single bathrooms as well. Those rooms will have enough room for wardrobes, side tables. They also have a ceiling track and a ceiling lift to help residents get up and out. They’ll also have a recliner so they can sit and look out the windows or watch TV - outside of just sitting in their beds. These are modern facilities. These are all private rooms, private washrooms.


We’re also building smaller households. What that means is every household is usually a denominator of 16 or 24. It reduces the noise that you would see there. It also helps with complex and challenging behaviours. People have space to wander. There are often wandering loops for residents who like to wander. We also have large open spaces where they have common areas for their activities, their dining, social engagements that they have in the household, which is really wonderful to see. We also have ensured that these facilities are secured to help monitor egress so residents who may be exit-seeking aren’t able to get outside the facility without the staff who are nearby. We also have improved the abilities for infection prevention and control. I think the pandemic has really shone a spotlight on the need for improving some of our spaces. Having smaller households, private rooms, private bathrooms, really helped control the spread of infection throughout the facility, which is wonderful.


[2:00 p.m.]


It also improves safety standards for both the residents and the staff. Because you have more space, they have the ability to take pride in their ability to be independent, have choice in when they get up, where they go, if they want privacy. If they want to engage with others, they’re able to do that. We also, in these new standards, have a dementia-friendly design. We have a strong prevalence of those seniors who are going into long-term care who have dementia or Alzheimer’s disease. We want to make sure the design is very inviting to them and accessible for them.


We also have capped the size of the long-term care facilities. We don’t go bigger than 144. We try to reduce that in the institutional feel that we may get with some of the larger facilities. We also ensure that these are being built in residential communities. These seniors are still part of the community, so we want to make sure it stays in residential communities, which is very important. These facilities are also building community connections rooms, so you can invite the community in. It could also provide regular activities through holiday functions, local volunteers coming in - Lions Club and others - which is fantastic.


We also, outside of most of these bedrooms, have something called a memory box. It’s a great way for residents to have a sight cue for finding their room. There’s a box outside the rooms that will have mementos - things that are of personal importance to them - so they know that that is their space, which is very wonderful for some of our residents.


Also with these facilities, recognizing that we are building for the future, we are asking our operators to build them 25 per cent more efficient than the current National Energy Code of Canada for Buildings, because we do recognize that we are facing carbon taxes. This is a great way for us to start building our facilities for the future as we move forward. These are fantastic. They are a lot bigger than what we currently see. Most of these footprints, because you’re doing all single rooms, single washrooms, smaller households, the footprint is probably doubling, sometimes tripling the facilities that they’re often replacing.


The other key component that we want to make sure of is that with the smaller household it’s less travel distance for residents and also for staff, so that they’re able to be as efficient as possible when they’re caring for residents - moving to and from their rooms to activities, or dining, that sort of thing - but also for residents who are wandering, that they’re able to move to activities without having to sit down and take a rest, that sort of thing. Overall, these are going to be beautiful facilities.


With Villa Acadienne that just opened in September, it was a wonderful grand opening ceremony. The residents were thrilled. We heard opening remarks from the minister. Residents haven’t stopped smiling since they moved into the facility. We’re very looking forward to all the new facilities that will be opening in the coming years.


JOHN WHITE: You’ve answered many of my questions, but I will tell you, I spend a lot of time in long-term care facility myself. My dad’s in one. I probably know most of the residents because we spend time out in the hallway talking with them by name. It’s kind of a clutter. I do know that the community is heavily involved. I know the school visits quite often. I know that there’s one gentleman who still has AA meetings in the facility, and they have a lot of what you’re talking about. They have a courtyard that’s closed in, so you can wander around there without getting lost, you can’t go anywhere, and the building is laid out in a circle.


A lot of what you’re saying I see and I hear, and my mind is just spinning. It’s just such a positive thing for Nova Scotia and for the residents. It is a home. One of my questions here for you is: How will the design of new buildings protect residents from spreading infections? You’ve talked about it. You’ve talked about the infections.


I’m curious about this question: Wheelchair washers. I didn’t know there was such a thing, but apparently it’s like a dishwasher. Is that in the design or is that anywhere near this? Is that part of the process?


THE CHAIR: I’m going to guess that’s going to be Ms. Langille.


PAULA LANGILLE: Yes, we do have in our space and design requirements, we do list space for washing wheelchairs, so that they’re able to be washed on a regular basis. Those residents who may be wheelchair bound - and Joyce or Mahmood could speak to it better than I - it gives an opportunity to make sure that it’s really cleaned on a regular basis.


JOHN WHITE: The last thing I will say to you before my next question is positive workplaces make positive people, and a positive work environment, as Mr. Hussain was talking about, is then impacted on the residents, and this is their home. It is their home. They know them on a first name basis. I think it’s so important that you make this a positive workplace so that those folks can have good days at the near end of their life, really, is what we’re talking about. It’s so important to have such a positive environment, so I appreciate that.


My last question is: Are you able to explain the multi-year phase approach to the infrastructure, and why we’re taking this approach?


TRACEY BARBRICK: Historically with long-term care, organizations have not known when they could expect and look forward to replacement time, and how long they have to keep these facilities at what level - not that anyone would fail to maintain it at a certain point. When you’ve got facilities that are 50 to 60-plus years old in the province, it gets hard with the level of activity in those facilities to maintain them for that length of time.


It really is important for the operations that they have a sense of when they can expect to be up for discussions about renewal, for certainty for the operators and the construction industry, just with the realities of labour shortages that everybody’s working really hard to solve, and other infrastructure needs across the province. We just don’t want to be in a position that everything we tender out has one bid. That’s not a terribly competitive place to operate.


Providing certainty, both for the construction industry as well as the service providers, and families, and communities where these are very important pieces of infrastructure for all of the reasons that we’ve talked about: community access, engagement in the community. People are looking for certainty into the future. I know it would be - if you could snap your fingers and replace 54 facilities at once, that would be a wonderful thing. It’s not practical. The ability to provide certainty for the sector is really what we’re going for and why we’ve chosen to do a nine-year, multi-year plan.




NOLAN YOUNG: Previous life, I guess - I was a municipal councillor, and I would have sat on a manor board in the past. I think two governments ago, we were going to have a replacement, and the previous one, we were going to get it replaced. There was some selective amnesia. It didn’t happen; but this time it seems to be happening, and that’s exciting. (Laughter)


I guess my question is: How did you decide which facilities would be replaced?


TRACEY BARBRICK: Paula can certainly fill in gaps, but it was a pretty rigorous process that was really driven by a number of factors. One was this engineering assessment of all our inventory in the province to determine what kind of condition it was in because we really didn’t have a comprehensive view of that. Our licensing officers are in and out a lot, and they have observations, but not in a rigorous approach to assessment. So Step 1 was really assessing what we collectively have in the province between us and the service providers.


The second was looking at what capacity exists in the province by community against population growth expectations, and assessing the greatest need across the province that factors those things in. That included our existing wait-lists, as well as Statistics Canada projected growth by community in the province. All of that factored into the selection of the facilities that went out in the last batch.


Of course, we did a Central Zone RFP first. Central Zone was by far the most under-bedded, if you will, so that needed to happen chop-chop, which it did about a year and a half ago, and those projects are all moving forward. Then this last round that was announced just throughout November and December was using all of the modelling with that information to assess where the greatest needs were next.


NOLAN YOUNG: How are we doing with the projects? How are they progressing? Is there anything under construction?


PAULA LANGILLE: I’m very pleased to say that we have 12 in construction right

now, approximately probably another 10 this Spring and Summer, and a few more coming in the Fall. We have a lot of projects, as Deputy Minister Barbrick has mentioned, that are in development. We have 36 that are in development, and then the ones that we just announced in November and December will be coming on at a later date. To have 12 in active construction - two that are opening in the next coming months. We have both Kiknu up in Eskasoni and Mahone Bay opening over the next several months.


NOLAN YOUNG: What are the steps involved in the development of new long-term care projects? How long does it take to build a facility?


PAULA LANGILLE: Typically, it’s about 12 months for planning and developing the design of the long-term care facility. Once facilities break ground, then it’s about 30 months to three years, and it really depends on the size and availability of resources. There is an 11-step process that the Province works collaboratively on with our partners, like Mahmood and Joyce, because as Deputy Minister Barbrick has mentioned, we’re not the owners of these facilities. We’re not leading these projects, but we’re working with our partners as they move through the process.


Those 11 steps are for them to hire project managers, so they have qualified consultants to lead these projects. We have design firms that work through that. They develop the functional programming. When you’re going from an existing long-term care facility to a new nursing home, it’s an entirely different concept: single rooms, smaller households, infection control, all of those pieces. Then they work through finalizing the design. Once they finalize the design and the project budget, then they’re able to break ground, like Mahmood and Joyce have done these past few months.


NOLAN YOUNG: Just super quick here. You touched on it before, but how are these builds funded?


TRACEY BARBRICK: When Paula was laying out Step 5 as the functional design gets established, then the costing starts to come in - both the capital build as well as the operating dollars to fund them based on our current staffing models. There is a model that fits over that in terms of what the staffing capacity is that’s required for a facility like this to operate. That’s where it gets determined what the per diem would be. If the total build cost is X, then we know that we’re doing a 25-year deal with the provider, and then the annual budget gets established based on what that per diem is. The portion of that per diem is largely 65 per cent operating, 35 per cent build for the 25-year life of the mortgage.


We do have fixed CPI increases, so all of our service providers get annual CPI increases to reflect inflation. We don’t want to have that available budget shrink over time just by a function of inflation, so that was addressed about a year and a half ago. That establishes the budget for year-over-year for 25 years.


THE CHAIR: MLA Palmer with just under four minutes.


CHRIS PALMER: I would just like to briefly chime in on something my colleague brought up earlier in your response to emergencies or unexpected events - whether they be weather related, or something happens at the facility. I just want to give kudos to the department. We had a couple situations at Grand View Manor in Berwick over the last year. I just want, on behalf of our entire community, to commend the department and all the partners that worked with Grand View Manor at the time to basically relocate many of the people living in that facility. It was done efficiently, safely and compassionately. I just want to give kudos to the department and all the partners. Thank you for everything you did for those residents and their families.


There are a lot of happy people around Kings County and Berwick area with things coming with the new build at Grand View Manor. A question that I’m asked quite a bit - and maybe people around the table would like to know the answer to this, I know some of my residents do: What happens to existing facilities when they are replaced? People ask: What are you going to do with it? Maybe it can be repurposed for something. There’s probably a process that you go through, as far as evaluating that. Could you talk about that? Maybe I’ll invite the deputy minister to speak about that.


TRACEY BARBRICK: I might suggest two things. One, Paula can certainly lay that all - there’s fixed policy around that. Then Joyce, you have an early facility replacement coming, and I know your community is having some thoughts. If that doesn’t take too much time, it wouldn’t be a bad tag team to have that conversation.


[2:15 p.m.]


THE CHAIR: We have two minutes. Who wants to start?


PAULA LANGILLE: As Deputy Minister Barbrick said, we do have a policy. It’s about - organizations have the option to retain the building, or they can sell the building, or they can demolish the building and sell the property. Those are the three options. With those options, we do recognize that there are lots of other needs of the province currently, and those are discussions that we would have collaboratively with our colleagues at other departments and along with the operator. Joyce?


JOYCE D’ENTREMONT: What my board has done - we’ve been having ongoing discussions with housing Nova Scotia. We all know we’re in a housing crisis. The board has formed a subcommittee of the board just to look at the old facility. They’ve brought in partners - municipal government partners - to form a committee to look at the future for the old Mountain Lea Lodge that the department has been very generous in investing a lot of dollars as things were projected to - like the boiler room and flooring and new windows and a new roof, et cetera.


The building is not good to serve seniors. It’s not a good nursing home, because the space - the bathroom situation et cetera - but it could be repurposed for something else, and we’re very interested in seeing what we could do with that.


That’s where we are. We’re talking to a lot of partners right now and just deciding, and then we will bring a proposal back to government as to what we feel should be done with the building.


CHRIS PALMER: I have to apologize to my colleague, MLA Barkhouse. I think I just stole one of her questions. (Laughter) I will have one more when we come back in the next round.


THE CHAIR: The next round will be seven minutes each, and we’ll be starting with the Liberal party.


MLA DiCostanzo.


RAFAH DICOSTANZO: I’m going to start my question, if you don’t mind, regarding care plans - the actual what’s happening on the ground, whether it’s non-profit or private. What is that relationship between you two and the department - the accountability and the reporting? That’s where I’m heading.


I’ve met, actually, with Kay Jocko, I know who wrote to the minister and met with a few people. I met with the ACE Team, Advocates for the Care of the Elderly, and Kay Jocko, and I was actually stunned at the different things that she reported. You have all that information. She has complex medical issues, including that she has lost her eyesight. Her care plan is - she’s actually able - she’s not very old. She’s not senior, but because of her complex medical issues, that’s why she is at a long-term care. She’s complaining about having four or five UTIs in a very short time, bed sores, no one cutting her toenails. She has diabetes. She’s been given - her diet is not looked after at all. She gets fruit from cans - with lots of sugar, even though she’s diabetic.


What I’m trying to look for is, is there an independent audit with the goal of documenting active use of care plans in daily care for long-term care residents? Also . . .


THE CHAIR: MLA DiCostanzo, I’m just going to ask you something. I’ll pause - you had her permission to discuss this in public, yes?




THE CHAIR: I paused your time for me to ask that question, by the way.


RAFAH DICOSTANZO: No, no. The letter has gone to the department and the minister. They have all of it.


THE CHAIR: We discussed it in public, so this - I just wanted to make sure.


RAFAH DICOSTANZO: One hundred per cent.


THE CHAIR: I apologize. Thank you. MLA DiCostanzo.


RAFAH DICOSTANZO: No problem whatsoever. She’s coming to the Legislature if I want her to. She gave me the permission - 100 per cent. She’s advocating, in fact, for 8,000 members, she’s telling me. It’s not just about her. She has the ability to advocate, and she is working very hard even though she is blind.


I’d like to know the relationship in how things are done in monitoring and the accountability and the reporting between the facilities and the department. Also, the facility providing ongoing training to staff. We know there are shifts and they change constantly, and that care plan - how is that being monitored constantly, and to the medical availability of doctors and knowing these care plans?


One other issue, if I may, that wasn’t on the plan but I should add: As immigration is increasing and the population diversity is increasing, that new group is going into long-term care - even though in our culture we never did. My mother-in-law is at a long-term care here and my parents now in Ontario. I’m comparing it daily for the last year. My mother-in-law is 93 and has reverted to Italian. She cannot speak a word of English anymore. She spoke English for 50 years. How are we planning for the future, for our immigration in the staffing, and making sure these facilities have the languages of those larger community populations?


In the 1950s and 1960s, it was the Greeks, the Italians, and the Lebanese who came. How are we adjusting maybe our food plans, something toward immigrants and new immigrants who are in that category? What are you doing to their care plan in that aspect?


TRACEY BARBRICK: I’m not really sure where to start. That’s a long list. Let me start - I won’t be talking here today about any specific cases. It’s not appropriate for me to do that. In terms of care plans, the policies for service providers are all online and very public. The need to have specific care plans is well outlined there.


Our Protection of Persons in Care team and our licensing and inspection team - they’re bread and butter, if you will. They’re highly qualified health professionals, including physiotherapists, occupational therapists, pharmacists, registered nurses. That team, what they do is inspect at least twice a year every nursing home in the province and respond to complaints through the 1-800 phone line. When we have complaints, those are assessed by the Protection of Persons in Care team to see if there are any concerns there. Their twice-a-year inspection includes auditing case files around the case management plan for each person in the residence.


The new piece that we’ve put in place in the last two years that started to be onboarded and now is fully functioning in this province - one of only three provinces that have it - is the interRAI tool, International Resident Assessment Instrument for Long Term Care Facilities. The interRAI tool is a standardized set of assessments that is digital in nature and allows cases, facilities, to be compared across this country around the quality of care. It has everything from wound care to fall incidences around quality dimensions.


Nova Scotia will report that data into CIHI, the Canadian Institute for Health Information, and that will be publicly reported annually. Nova Scotia is only the third province that will have achieved that. Our service providers have all now, over the last year, onboarded and are using that. Our licensing and inspection team have access to that information so that they can audit. Those are some of the controls and checks and balances around that.


The other thing is - just for curiosity, the Ontario Minister of Long-Term Care is here with us for a couple of days. He’s been visiting some facilities in Nova Scotia because they view Nova Scotia as a national leader when it comes to long-term care. Between the 4.1 hours of care - which is more boots on the ground, it’s more clinicians in the facility. I think my partners here can talk more specifically about what that means in the facility, but if it’s okay, Chair, I would like them to have the opportunity to speak about care planning at the facility level. We have oversight and auditing responsibility, but these are actually the service providers who do this every day. I’d love them to have the chance to talk about this.


THE CHAIR: We have 40 seconds, and that would be more to the person who has the floor, which is MLA DiCostanzo.


RAFAH DICOSTANZO: I would love that, honestly. Whatever you can say in 40 seconds, my dear, go ahead.


JOYCE D’ENTREMONT: Two weeks after a resident is admitted to long-term care, we sit with the resident, their substitute decision-maker, whoever they want to bring to the table. That’s multi-disciplinary, and we have CCAs, RNs, LPNs, our physiotherapist, medical director if he’s there. We hear what their likes, their dislikes, their routines, what activities mean to them. There is . . .


THE CHAIR: Order - sorry. MLA Burrill.


GARY BURRILL: Well, I was wanting to come back to this question about the facility budgets being presented prior to tendering. You said, Ms. Langille, that this had happened in a few cases. Can you characterize then: What are some of the things that have been removed from the project proposals, or cut in response to this sending back of the original document from the department? Relatedly, how then can the government provide confidence that this is not having a negative impact on the things that are really required by residents in the new facilities being built?


TRACEY BARBRICK: Thanks for that, and Paula certainly - as I say, every one of these projects, she and her team are deeply involved. The facility design standards are on our website. They’re very public. They actually identify the requirements for a nursing home in this province, including things like square footage. Paula will speak more articulately about specific projects if need be, but generally where we’ve gone back and forth - and what my father would call sharpening your pencil - is where the limits of that standard are pushed. The standards really are with the single rooms/single bathrooms. We’re the only province in the country that has a single room/single bathroom mandate. That’s Job 1. The infectious disease piece is the other.


When service providers are outside the limits of that standard, that’s where we end up having additional discussions. While our interest might be having every facility really be a hallmark on its own, Job 1 is we’ve got people on a wait-list who need care, and we need to make sure they’re high-quality facilities that aren’t unnecessary in that effort. With replacing 54, or net new 54, nursing homes, we need to make sure that they’re built within a reasonable standard to provide good care without unnecessarily using funds that could be used, frankly, for another nursing home. It really is about best needs for the province.




SUSAN LEBLANC: That is a great segue into my question actually. I want to just ask a couple of questions about the Auditor General’s report that came out today. Last year, when all of the purchase and whatnot had taken place at the hotel on Hogan Court, a report by media on the potential adaptation of this facility expressed concerns that the facility could not be adapted to suit the needs of the intended patients because patients awaiting a bed in a long-term care facility would not be eligible for the Hogan Court facility, even though we’re hearing that the whole idea of that facility is to get people out of beds, in hospital, into a new place.


Was the department involved in the planning and site selection process to ensure that it would meet the needs of people waiting for long-term care?


TRACEY BARBRICK: The Department of Seniors and Long-term Care was not responsible for that, and we weren’t involved in the development plan at all.


SUSAN LEBLANC: Not involved in the plan, okay. Today, the Auditor General’s report found that the patient profile had indeed been revised to meet the building’s limitations. I’m wondering: Will people waiting for long-term care still be captured in this, in going into Hogan’s - for lack of a better title, Hogan Court? Are you confident that the facility will meet the unique needs of the population?


TRACEY BARBRICK: I really can’t offer any insight on that project. I haven’t actually read the report. I didn’t see it an advance. I haven’t had time yet today to read it. I will do that, but there’s not much I can offer on it today.


[2:30 p.m.]


THE CHAIR: MLA Leblanc with two minutes and 20 seconds.


SUSAN LEBLANC: This is another question around this, but I think this might be more easily answered. As of September 27, 2023, there were, as you mentioned earlier in the meeting, 2,098 individuals waiting for placement in long-term care facilities, including 387 waiting in the hospital. Really, this Hogan Court facility has been about getting the folks out of the hospital beds so that those can loosen up, but the Hogan Court facility will only have 68 beds when completed.


In your opinion, as someone who works with placement of long-term care folks, does it adequately address the need?


TRACEY BARBRICK: I actually haven’t seen the patient profile for Hogan Court, so I really can’t offer any thoughts on that.


SUSAN LEBLANC: I’m sorry to hear that, because as the Deputy Minister of Seniors and Long-term Care, it would stand to reason that your department and upper management people in your department would be working with the Department of Health and Wellness on this extremely expensive project. I find it kind of shocking that there would be no conversation. If, in fact, the people who are in the hospital are waiting for long-term care or are going into the Hogan Court facility, how come the department is not involved in those conversations?


TRACEY BARBRICK: Our job really has been, for the last two years: hustle and get net new 2,000 nursing home beds built. NSHA has been trying to manage as best they can the alternative level of care patients within their hospital walls, and Hogan Court and the transitional care unit concept that is used in some other provinces is really trying to help manage the ALC population while they’re within the hospital walls. Certainly our job is to get those nursing homes built and have as much capacity as we possibly can to receive people who need that level of care.


THE CHAIR: That is 10 minutes. MLA Palmer.


CHRIS PALMER: Deputy minister, it’s good to hear you make comments like we’re a national leader and we are recognized around the country as a national leader in long-term care. It’s good for Nova Scotians to hear that. It’s amazing to also think that past governments - they knew about this demographic tsunami that’s been coming at Nova Scotia for quite a long time, and unfortunately, I guess we’re seeing the fruits of lack of investment over the years. You mentioned in one of your comments about trying to play catch-up now.


You also talked about how important data is, and how before you wouldn’t even know basic data points for certain things. I guess one of the changes in direction, maybe, over the last little bit, is getting that data and making better policy decisions and processes. Can you talk a little bit about that, from a policy practical perspective, on why getting that data is important in this catch-up process and the investment that we need to make, please?


TRACEY BARBRICK: We’ve been in the privileged position of being asked, if there was additional capacity coming for nursing homes in this province, where did it need to be? We really had the opportunity to put out the RFP for Central Zone right off the bat. We knew what the demand was in Central Zone. Then we had a little shy of a year to do all the modelling around what the needs for the province were, which is what led to the November and December announcements, which were fed by data that we’ve never had access to before.


There was a tool put in place two years ago now called the PathWays tool. Prior to that, placement of residents into nursing homes was done literally by fax. These folks would have much hands-on experience with that. The efficiency that’s come with the PathWays tool is that the resident information, when trying to identify a match between the resident and facility and the care needs and the community needs for that person has been accelerated. Our gap time or placement time, so that we don’t have unoccupied beds, has accelerated meaningfully in the last two years because of that PathWays tool.


The interRAI tool is the other one. When we determined and were funded to provide 4.1 hours of care per person, per day, that was based on the best national intelligence there was at the time. But we didn’t actually have individualized data around one person’s needs versus another person’s needs because, as you know, if you’ve been in and around a nursing home, you see some tremendously different needs for different residents in the facility.


The intent with the interRAI tool is we’ll actually have case-managed, individual levels of data for how those needs vary, and how we actually adjust our staffing model into the future that’s data informed. Qualitative research is wonderful, but it’s not data, so the interRAI tool and the PathWays tool, just bringing long-term care into the future around digital tools - which are not always as sexy as bricks and mortar, but they’re just as important - has made us be able to operate what we have much more efficiently, and into the future will be much more informed by data.


CHRIS PALMER: Definitely sets us up for better progress and better outcomes, so thank you. I’m going to pass it on to my colleague.


THE CHAIR: MLA I’ve-Forgotten-My-Name Barkhouse. (Laughter)


DANIELLE BARKHOUSE: You haven’t, that’s a bonus.


First, I’d like to say to Ms. d’Entremont, congratulations and thank you for 40 years of service. I think that’s well deserved. (Applause) Yes. You are replacing a facility, and I’m just wondering what you’re hearing from staff, residents, and the community as you go through the process.


JOYCE D’ENTREMONT: Well, they’re super excited. I can’t say how excited the staff is. We’ve had staff focus groups. We’ve had public focus groups where we’ve explained the projects. We’ve taken their feedback. Mountain Lea Lodge is a community within a community, and when I started my job in 2015 there, I soon found out that there’s an ownership there in the community. That home is the heart. It’s the biggest employer. We have staff who have worked their entire career at Mountain Lea Lodge because they love the work and the people. I’ll often hear, I’m a Lodge Girl, I’m a Lodge Guy - such dedication.


I cannot say enough about the staff, my staff, and the staff who work across this province in long-term care. You have to love seniors, the elderly, the very frail, the most vulnerable of our society. Everybody’s excited. They cannot wait. I can tell you there is a path in the pavement going up Church Street. (Laughter) People are turning around, including myself, every day. If there’s one little thing that goes up, I hear about it.


The residents - we have resident council. We talk about the project every month. There are some residents who are actually, When are we opening? They want to hold on to be able to sleep one night in that beautiful new facility. That is the truth. We talk about it. We talk about what’s meaningful to them. They wanted a café where there’s going to be homemade muffins and coffee, just like we all like to have a coffee and have a muffin, and they’re going to see that in the new facility. I feel so privileged to be the CEO of this wonderful organization, and to see this project.


I remember the morning Paula called me. I hung up, and, you know, the department calling you on a Friday at 8:30 a.m., I thought: What the heck is going on? I hung up, and I just started crying. My husband said, What’s going on? I said, I just found out there’s an announcement today. Mountain Lea Lodge is going to be replaced. My whole day - I cried all day with excitement.


THE CHAIR: Order - sorry.


DANIELLE BARKHOUSE: I had another question. (Laughter)


THE CHAIR: Somebody did too long of a preamble, MLA Palmer. I’ll give the witnesses a chance to do their ending, if they have any closing remarks. About two minutes each maximum because we have some business. I will start with Mr. Hussain.


MAHMOOD HUSSAIN: Having been adjacent to long-term care my whole life, now working in it for some years here, and working closely with certainly the Province on the projects we’ve been selected to rebuild - the new projects we’ve been selected to do, but also to work on the day-to-day exciting and important projects, which make the facilities better places for residents and better places for staff, as a company - we’re just excited. I echo Joyce’s sentiments that it’s such a happy time for us.


Back to the immigrant story: our head office is more than half women, people of colour, immigrants whose first job is with GEM Health Care. Part of the retention model is - I tell them that if you work here, we have accountants from Wall Street, you can make more money elsewhere, but you’re here because everyone here has something to prove to ourselves, we have something to prove to our families, we have something to prove to our people back home, and have something to prove here in Nova Scotia.


Everyone who works with us is passionate about what they do. They know they’re making a difference. They know that they can call back home to Bangladesh and say their first job in Nova Scotia is with a company that’s building modern hospital-grade facilities in communities across Nova Scotia. There hasn’t been another time when that was really possible for many reasons. We are excited, and we’re excited to be a Nova Scotian company that’s doing it.


Thanks to this government, thanks to everyone here for having discussions like this under an industry that we’ve been in for 40 years, and we’re just happy that everyone else is interested and excited about it now too.


JOYCE D’ENTREMONT: I just want to thank this committee today for having me. There was a discussion earlier around the relationship with the Department of Seniors and Long-term Care. I just want to say, as CEO of Mountains & Meadows Care Group, I feel extremely supported by the department every day. We have long-term care advisers in the zones. We can pick up the phone at any time. It’s just a wonderful relationship.


The investments as well in the last two years have been just super. We have infection control practitioners now in our sites. We have long-term care assistants. The CCAs are happier because they’re getting paid more. It’s really coming together for the frail seniors that we have the privilege of caring for. I just want to thank government as well for the investments that have been made in long-term care.


I often say long-term care is a specialty, no different from critical care or emergency nursing or renal or perioperative. It is a specialty, and it’s time that we all recognize it as a specialty. You need to be specially educated to be able to work in long-term care. I just want to thank this committee. It’s been a great privilege for me today, and you’ve all made me feel so welcome.


TRACEY BARBRICK: Thank you very much for having us today. These are important conversations. I need Nova Scotian seniors to have confidence in this system. I think of my father, my mother, my in-laws and all of the seniors in my life for whom I will participate in their care in the future years. It’s critical to me that they have confidence in modern infrastructure that provides dignity and privacy, staff who care, and facilities that are adequately supported to provide excellent care into the future. That’s really important to me personally, so thanks for the chance to talk about it today.


THE CHAIR: Do you want to say anything, Ms. Langille, before I let everybody go? We do have a bit of committee business - however, the witnesses are excused. I’m expecting you’d like to take a two-minute recess. We’re in recess for two minutes. Be back at 2:46 p.m. in your seats, please.


[2:44 p.m. The committee recessed.]


[2:48 p.m. The committee reconvened.]


THE CHAIR: Order. I’m calling the meeting back to order.


We have a couple of items on the agenda that I just want to bring up. I sent an email out just so everybody would realize - so they’d catch it.


For our witnesses on March 19th - because the House is sitting, it’s now a morning meeting. We’d requested Dr. Audain. Dr. Audain may be in surgery. If he’s in surgery, he’s saying that Dr. Hawker would be there. They just want to make sure that everybody’s cool with that. Perfect. That’s done.


Correspondence: January 18, 2024, we received an email that everybody in the committee has received from Deputy Minister Byron Rafuse - from his office - regarding participation on this.


KELLY REGAN: We are not talking about homelessness, which of course resides with the Department of Community Services. We are talking about affordable housing, and the links between health outcomes and the lack of safe affordable housing. I have to say that I think that if the deputy minister is not qualified and does not have information available to be able to discuss these, that is concerning to me. It should be concerning to this committee and to Nova Scotians. That’s part of his job.


I think he should be at this committee, and I think if he doesn’t have that information and he’s not qualified, he should get qualified and get that information.


THE CHAIR: I’m just going to ask the question: Is everybody in agreement that he will be receiving an email letting him know that he or somebody in his department will be in attendance? Everyone in agreement? Don’t need a motion - everybody’s in agreement. Thank you.


Next item, January 24, 2024, letter from the Department of Health and Wellness and Nova Scotia Health Authority in response to the request for information from the December 12th meeting on ER Closures and Doctor Retention. Do we have any questions? MLA Regan.


KELLY REGAN: On the second page, we have - sorry, the first page - the number of physicians who have reduced their practices. It’s only from April to December 2023, and that wasn’t what I asked for. I asked how many had left. I didn’t intend it to be for just a short period. I actually wanted the information from the point when this government took over. To me, it’s an incomplete record.


THE CHAIR: Just a question because I can’t remember: Is it a possibility that we just forgot to tell them the range and we just need to get them to it? I’m just asking for clarity.


KELLY REGAN: The question did not give a range. They’ve arbitrarily added a range in there, and that was not what we were going for.


THE CHAIR: Your request was really from September 2021? I guess then, if everybody’s in agreement, we’ll just follow up on it? Seeing no “no’s,” that’s it for this one.


Next item, January 24, 2024, letter from the Minister of Health and Wellness, and the CEOs of the IWK Health Centre and the Nova Scotia Health Authority in response to a request for information made at the December 12th meeting arising from discussions at the October 19th meeting of Mental Health Supports for First Nation Communities. Any questions or comments on that one? Looking - none.


February 7, 2024, letter from Sandra Mullen, President of the Nova Scotia Government and General Employees Union, regarding inclusion in meetings on issues affecting NSGEU members. Any comments, discussion on that? MLA Burrill.


GARY BURRILL: I move that we receive this very reasonable criticism in Sandra Mullen’s correspondence, and we undertake as a committee to rectify it in the future.


THE CHAIR: I wasn’t looking up when he did the motion, so MLA Leblanc, I’ll let you - even latitude outside the motion, in case your hand was up first.


SUSAN LEBLANC: This is actually speaking to the motion. I just wanted to know from the clerk if NSGEU has received their invitation for the meeting that they are going to be a witness at yet. Does the clerk maybe know when that invitation would go out?


THE CHAIR: Ms. Kavanagh.


JUDY KAVANAGH: I’d have to look at our list of topics. It’s not one of the ones that I’ve put out feelers for yet for our future meetings.


SUSAN LEBLANC: I think it’s later down on the list. Anyway, I agree with my colleague that we should undertake to rectify the situation, but we have in a way, because the NSGEU will be coming to a meeting in this agenda session, for lack of a better description. However, I do think his point is well taken that when we are choosing witnesses, we should maybe have a list of who’s been when so that we have that at our fingertips in case there’s a question of who would be the best witness to come to a certain topic.


THE CHAIR: I’m confused because the only motion that - just one second.


SUSAN LEBLANC: I’m just speaking to the motion.


THE CHAIR: I understand. We’re good, but the motion from MLA Burrill the way I understood it was to take it, notify them, and work on doing it better. There was no request to have a list of other people who were at their . . .


SUSAN LEBLANC: That’s not what I said.


THE CHAIR: Okay, all right. Just to be clear, MLA Burrill, your motion is to receive it, let them know we’ve received it, and attempt to do better on future meetings? MLA Burrill - and then I’ll get to you, MLA Palmer.


GARY BURRILL: I would assume that the letting them know we had received it part had already been taken care of. So my motion is just that we receive the correspondence and undertake to address the problem in future that the letter points out.


THE CHAIR: Okay, thank you.


NOLAN YOUNG: I’m just confused a bit by this motion - lots of moving parts here. Is the motion saying - is the pretence of this that the NSGEU is inviting themselves as witnesses?


THE CHAIR: No. The understanding of the motion for me is - and the mover will correct me because he just helped me figure it out - we’re receiving the letter, and as we do future topic selections, we will take their comment into account when we’re picking witnesses. Correct, MLA Burrill? That’s the intent of the motion. I guess it would probably be good, even though it’s not, is to let them know that, by the way, they are for future ones, so they know that. (Interruptions) Which one?


CHRIS PALMER: I appreciate my colleague, the motion. I’m just not sure what really it’s supposed to do. Whenever we have an opportunity to have topic selection, every single one of us around this table - each caucus can put whichever witnesses they want to put forward. Isn’t the opportunity for all of us to do that without a motion now anyway? I just don’t see the - whenever we select topics, we all have the opportunity to put whatever witnesses we want into that, so I’m just . . .


THE CHAIR: I would submit that it is a good reminder. It doesn’t tie this one or future to do anything. For me, I believe that’s your intent, MLA Burrill, right? It is. It’s a reminder as to when we’re doing it.


JOHN WHITE: I actually agree with the testament of the letter, to be honest with you. It’s an oversight by all members at this committee. If we missed them, we missed them. My question is: Is it standard practice to reply back to say that we received your letter, and we’ll try to do better? Is that a standard practice?


THE CHAIR: Actually, MLA Burrill corrected me when I misunderstood. They’ve already been told we got the letter. All MLA Burrill was saying is we put it on file and we’re officially saying: On future ones, we’re going to look better at different witnesses for everything, not just this. Correct, MLA Burrill? MLA Burrill is nodding, since I didn’t give him the microphone.


NOLAN YOUNG: I really apologize. I don’t mean to be digging into the weeds of this at all, but when the committee is taking witnesses into account, we’re always looking at the various witnesses who would be applicable to whatever topic that we’re going to discuss. It just seems odd to say: Make sure you consider - we consider everybody. I just don’t understand the motion. I would just accept this for information. It just seems it’s the practice of the committee regardless. It’s not that I’m against anything, just procedurally I’m confused.


THE CHAIR: MLA Burrill, did you want to speak to anything on this, since it’s your motion? I keep speaking for you, which I really shouldn’t.


GARY BURRILL: I think the point of the motion is plain. I said twice what it was. I’m happy to say it a third time if the Chair would like me to.


THE CHAIR: We’ve got it twice. It’s all good.


GARY BURRILL: I’m prepared for us to have the question.




NOLAN YOUNG: You can’t just be prepared for the question when we’re still in discussion of this. Any time we have various witnesses - this is the first time I’ve seen a letter like this come through any of the committees that I happen to be part of. Perhaps the clerk can speak if this is a normal practice of things in the past. It’s just something that stands out because it’s outside of the procedures of most committees.


THE CHAIR: Order. Clerk. Ms. Kavanagh.


JUDY KAVANAGH: He’s right, it’s not a formality that’s normally used in standing committees.


NOLAN YOUNG: I’d like to amend the motion that we accept this in the same manner we accept other correspondence, which really, we shouldn’t even need a motion, but we’re just reverting back to the normal practice of the committee.


THE CHAIR: Legislative Counsel has said that in any amendment we vote against the motion. It’s the same impact as the modification. Ready for the question?


All those in favour? Contrary minded? Thank you.


The motion is defeated.


[3:00 p.m.]


It’s the time of adjournment.


GARY BURRILL: I believe the motion was in a tie.


THE CHAIR: How is that?


SUSAN LEBLANC: The Chair didn’t vote.


THE CHAIR: I did vote nay. I always vote. Trust me.


We got through the business, too, which is nice.


We will be meeting again on Tuesday, March 19, 2024, between 9:00 a.m. and 11:00 a.m. on Impacts of the Labour Shortage on the Health Care System, with witnesses Nova Scotia Nurses’ Union, Doctors Nova Scotia, Nova Scotia Health Authority, the Office of Healthcare Professionals Recruitment, and Nova Scotia Paramedics Union - IUOE Local 727.


We are adjourned.


[The committee adjourned at 3:00 p.m.]