HALIFAX, FRIDAY, APRIL 24, 2015

 

COMMITTEE OF THE WHOLE ON SUPPLY

 

12:06 P.M.

 

CHAIRMAN

Ms. Margaret Miller

 

            MADAM CHAIRMAN: The Committee of the Whole on Supply will come to order.

 

The honourable Government House Leader.

 

            HON. MICHEL SAMSON: Madam Chairman, would you please continue with the estimates for the Department of Health and Wellness.

 

            MADAM CHAIRMAN: We will start with the NDP caucus, with 48 minutes remaining in their time.

 

The honourable member for Chester-St. Margaret's.

 

            HON. DENISE PETERSON-RAFUSE: Good afternoon to the minister and his staff. I'm going to initially focus on some things in my constituency that the minister is familiar with.

 

            The first one is Shoreham Village, a senior citizens' complex. Shoreham Village, to explain, is set up as a nursing home and also apartments. Some of those apartments are subsidized through the Department of Community Services. With regard to Shoreham Village, very quickly after it was built a number of years ago, there was not enough space. Rooms were designed for one person to live in. They're very small rooms, and very quickly the capacity was filled and they were required to have two people per room.

 

You can imagine, after years of living in your own home and having the space in your own home as a senior, that what's available to you in the community - there's not very many senior citizens' homes; that's the only one in the Chester area - the issue is that you're going into a home, and a room that should have been for one person. There's a great lack of privacy for those who live there.

 

            There have been many issues over the years. I will say that the staff are incredible at Shoreham Village. I know many of the staff who work there and how dedicated they are to their jobs. There's a lot of pressure, as we know, because of our aging society and the number of seniors. The caseload is very heavy because, as we're living longer, the care level has tripled in terms of what we expected the nurses to carry a number of years ago. That's moving along very quickly.

 

            Then the whole issue of dementia and Alzheimer's - they do have an Alzheimer's wing, but there have been a lot of problems over there. They've had mould issues in the facility that they've had to renovate. They've had issues with running out of water. There's a very long list.

 

            Shoreham Village was one of the complexes or long-term care facilities that was identified by the NDP Government as needing a rebuild. I cannot stress enough, minister, the seriousness of a rebuild for that complex. I know that you have many struggles with the Health and Wellness budget. However, before and during the election not only the Liberal candidate but the Liberal Party itself came out very loudly and publicly in my community to say that they would commit to any of the capital projects that were going to be done by the NDP. It was very, very loud and clear.

 

            The staff and the nurses at Shoreham Village were also told that, and the community was told that. So there has been a great expectation that there will be a rebuild.

 

Am I understanding that that is now off the table? I asked the minister about it last year in estimates and didn't get a clear answer. It was one of those "we're working on it and going toward that direction." I would like to have an absolute yes or no, like in QP today. I believe it is a no, unfortunately.

 

My concern - and family members' concerns, and those living there - is the condition of the home. I know that the administration and the CEO work very hard within the facility and what she has to work with. I know the staff does that also, and their board of directors, but it doesn't take away from the fact that we are allowing our seniors to live in a facility that could even be deemed unsafe at times because of the amount of mould - we don't know what is between other walls there - people living in small little rooms. Where is their independence?

 

There is a long list of issues with respect to Shoreham Village, and people are coming to me to ask what is going on, because a promise was made. There was a circulation of a paper by your candidate in that area saying, we are committing that the date was the same date, 2016.

 

We're now in 2015. If that rebuild was going to take place, there would be consultation with the community, with the family members, and with the residents to decide whether or not the particular location where the home is now would be suitable or if the rebuild would take place in another location - not just renovations. In some areas, it would be a total rebuild.

 

What I'm trying to express to you, Mr. Minister, is the human element. I can tell you right now that I would not want to live my senior years in a complex that doesn't allow me to have independence because of the small size, or a complex that desperately needs to be rebuilt because of the water issues, the mould issues. That does not take away from the value of the staff and how hard they have to work under those conditions; it's how our seniors have to live under those conditions, and it's extremely disappointing that a Party could tell people right to their face, yes, we are going to do this.

 

            I know what will happen. I will be told that the government did not believe or understand the conditions of the province when they came in. I'll say two things about that. One, we do know that the deficit was basically created by your own government paying off the pension plan in a year rather than over the 12 years that we were going to amortize it. That's fact. We know that.

 

The problem - and we faced many issues such as you did when you came into government - was that past governments neglected to look at the fact and calculate the numbers, that our Public Service were growing older, and that many more people would be retiring around the same time. So there was not enough in that pension plan to cover those retirements. It was identified as a $600-million gap. We made the decision, the same as anybody who purchases a house, to amortize that over 12 years so that we would be able to make sure that we could invest into rebuilding homes for our seniors, would be able to increase income assistance for the most vulnerable people in our society, and could keep the film and television industry going, which creates an investment of 396 per cent.

 

            It is about priorities. I believe very strongly that our priorities came with the people and that our decisions were made based on the people. A decision to pay that off over a 12-year period was a decision to ensure that there was still food on the table, the same as anyone amortizes a mortgage. You may have all the money to pay out your mortgage, but once you do it, you won't have enough money to bring up your children or put food on the table, so you have to make those decisions. They are not easy decisions. It's nice if you have the money to pay it all off at once, but when you do not, you make a common-sense decision, and that common-sense decision comes down to people and their lives.

 

This is what is not happening at Shoreham Village. We have seniors living under tough conditions and we have staff working under very tough conditions. What makes it worse is that there was a public promise to rebuild Shoreham Village - a very public promise. I know that sometimes it's difficult to keep those promises, but if you can't keep them, then it shouldn't have been made to those poor seniors and their families.

 

I would like to ask the minister if he can tell me a couple of things. This is going to be a two-part question: (1) is Shoreham going to be rebuilt under the time frame that was committed by you and the members of your Party during the election? And (2), there have been great issues at Shoreham with respect to a mortgage that was taken out over a 50-year period and the apartments are not receiving any dollars for maintenance, which comes from Community Services. There has been a fight back and forth between Community Services and Health and Wellness in terms of the dollars into the apartments.

 

            What I have been told by the board many times over is that Health and Wellness and the Department of Community Services need to get together with a meeting with both boards - the apartment board and the senior citizen board and the CEO. This is a meeting they've been trying to organize for well over a year and a half. So I'm asking the minister to give direction to his staff that that meeting take place, which would include if he would like to be there himself, but also myself, because it has been a year and a half and it's not going anywhere. What is happening is the apartment complex is becoming a slum apartment for our seniors. I can take the minister there and show him exactly what the conditions of the apartments are.

 

            Those are my two starting questions. Is Shoreham going to be rebuilt, as promised? If it is, can I be provided with the exact dates of when the process will started and be finished?

 

Would the minister also confirm to me that his department will organize a meeting before the end of summer with the Department of Health and Wellness and the Department of Community Services staff, both boards, and myself? Thank you, Madam Chairman.

 

            HON. LEO GLAVINE: I thank the honourable member for that question and for raising a very important issue when it comes to the replacement of nursing homes. We have a very strong evaluation, a very strong assessment of the conditions of all nursing homes in the province. There are some that are definitely in that top 10 that we need to get at. As the member opposite knows, we have made no announcements. We have some that need replacement in a number of members' ridings on both sides of the House.

 

            It's an issue that I can assure the member I do not put weight on in terms of political references that the member has raised here. I see it as a seniors' need issue - those who are already in a nursing home and those who will come to Shoreham or any of our facilities across the province.

 

            My first commitment, after going to a number of nursing homes - and I added a number additionally this winter when I made a shortened version, but over a three-month period, I went across the province to deal with seniors' issues. When we talk about seniors in our province, there are a number of issues, but there are way more powerful and positive stories about how seniors are living in our province, both in terms of nursing homes, those that spend time in hospital, and those - the vast majority of Nova Scotians - who live in their homes in their elder years. We all know that's where the vast majority of our seniors want to remain.

 

            At the present time in our province, we have about 7,060 nursing home beds. For the member's reference - maybe she does already know this - that is the highest number per capita in the country. We're not about to add nursing home beds. But she is right in saying there are some like Shoreham that need a very significant upgrade or full replacement. There are some that are on the list that can go through an upgrade. There are some I have visited that, as we know, as need for more nursing home beds came along - especially since the year 2000 - there was an addition of a number of beds. If we go across the province, it's interesting to see that you go into a home and there are three very different styles, three different degrees of modernity of the home as it currently exists.

 

            In fact, there really are a few homes that are in the top 10 that could have a partial build or could go through an extensive renovation project. We're all familiar with renovation projects on public buildings that turn a 50-year-old building into a very modern complex. We have to look at the structure of a building and see what is possible in a particular area.

 

            The first commitment that I made in terms of a nursing home in the province - and I've already stated this publicly, but it is to look at a replacement for Bethany. The Sisters of St. Martha currently have a nursing home/infirmary on the third floor of their very old, aging, decrepit, in need of repair complex in Antigonish. That's the first area. In fact, we've had to make some special provisions, being on the third floor of the complex.

 

            We have spent a lot of hours in the department finding what will be the best way to get that development off the ground. The sisters have a number of requirements in relation to their congregation, and they are very, very - I guess perhaps I would use the term "challenging" - when you meet with them. They reference canon law. They bring out all the stops, but in the end we realize that the Sisters of St. Martha's numbers - like religious congregations around the world - have been in decline. We must stop, pause, and remember the phenomenal contribution that the Sisters of St. Martha and other congregations have made to the Province of Nova Scotia.

 

            That's the first order of business for this minister and this government. We're very close to announcing how that build will be done for the sisters, and I believe we'll find that is a very interesting manner in which we will address their needs as a congregation. We will have a nursing home in Antigonish for the sisters that will meet the congregation's needs, as well as community needs, so we're looking forward to that in the very, very near future.

 

            As the member pointed out, governments - her government, the government before, probably it wasn't - I guess we go back about a decade to the John Hamm Government, in terms of having a little bit more fiscal latitude. I know in one of those years, when I was first here in the Legislature - I'd say around 2003-04 - they had an additional $400 million to $500 million in revenue just from the royalties of the Sable Offshore Energy Project. That gave them a tremendous amount of money to do things as a government. That's what every government truly would like to do when they come to office, while they're in office, is to be able to have some fiscal opportunity to say here's a program, here's a facility, or here's a plan to upgrade a number of facilities in our province.

 

The last two or three governments have really not had that kind of ability. When we look at the current need of taking 11 nursing homes - and I believe it's one, maybe two residential facilities - through a modern update or a complete rebuild, we know that we're probably in the neighbourhood of $300 million to $400 million. Having that money quickly accessible for any government with the fiscal realities that our province faced - and as we're finding out almost every day, other jurisdictions across Canada are now going through the same kind of very significant challenges.

 

            When the Province of Alberta - who has been a great contributor of wealth to our province, through those who have gone out to ply their trades in communities across Alberta but continue to live here in Nova Scotia - are looking at taking $6 billion or $7 billion from their budget, we already know that it will be hospitals, health services, education, and probably community services - the three big areas that all governments have to respond to in as full a manner as possible.

 

We've put together a plan to look at how we can have those capital dollars for rebuilds that have been currently identified. While the member opposite perhaps thought that we were thinking that some of those were on the list for political purposes, we know that the review the department did was very vigorous. It was a very sound review. In fact, there's a scoring process when a team will go into a nursing home to take a look at the current state and status of that home. Without question, when Shoreham went through the rigorous process by the department to take a look at the needs there, it scored very high in terms of the need for replacement.

 

            I've been down to Shoreham since becoming minister and have had the opportunity to look at the complex there. One does not have to be a building inspector or part of a construction company to realize that that facility, like a number of others across the province, has deficiencies. As the member pointed out, when we take a look at what our seniors should have, and the goal - it will take successive governments to reach the final goal of having a private room for each of our citizens who spend the last years of their life in a nursing home. It truly does become their room.

 

I have visited a number of Nova Scotians who now call that room their home, and they have truly made it very homey as well. I wish I had more time in my role and in my job, because it does open up the door to go and sit with a senior in their room and hear from them first-hand what they experience each and every day.

 

            The other part about having that individual room is very much one of the big areas that nursing homes often face, and that is infection control. I've been in a number of nursing homes where infection control has been an issue and continues to be an issue. It's only because - again, as the member opposite said - we have staff who are committed and conscientious in making sure that the environment, no matter how old the home is, is in as fine a condition as they can make it, to give those who are in our nursing homes the greatest care and the greatest dignity possible.

 

            When I met with the board - and I'll have to confer for a moment with the deputy minister, because he was with me on that tour. Were members of both boards present that day, or was it just the nursing home board?

 

So I met with the nursing home board, and it was an opportunity to hear from them first-hand. A number have been on the board for some time, and they are strong advocates of the need for replacing Shoreham. We have a schedule - and as the member pointed out, it also wasn't - nothing really quick was going to happen there. If the last government were involved and started a process for replacement, they soon realized that there were challenges to overcome around the mortgage and some other elements as a first step.

 

            In May, there will be a meeting of DCS and the Department of Health and Wellness, as well as Housing Nova Scotia. There are some issues that need to be cleared up before the rebuild will get underway for Shoreham, and I think the member is keenly aware of some of those issues. That's going to address what I see as one of those blockers that has been around for a while there, and the board certainly spoke to those issues.

 

In wrapping up some general comments around nursing homes, I would say that Shoreham remains in the top 11 priority group. As the member is perhaps aware, in the last major bill that we did in the province, about 11 homes were announced all at one time. We will not be picking off one at a time to build. We're working on a financial plan that will allow for those that are most in need of a renovation or total replacement to go out and to be addressed at one time.

 

            That has taken a while, as I said earlier. Having the kind of fiscal capacity for the province to take it on is a very significant challenge for us, but we feel we're very close to the plan. It has been worked on for a while now, and we've overcome the logistics of a number of the homes that are on the list. That's where I will leave my comments for now, in relation to Shoreham.

 

            MS. PETERSON-RAFUSE: I want to point out that the mortgage issue at Shoreham has nothing to do with the rebuild. I want that to be on the record. The mortgage issue is holding up any funding to the apartments that are in horrible shape.

 

I would also like to be invited to that meeting. I used to sit on the board of directors for Shoreham Village, so I want to be a part of that meeting. I have been supporting both the senior citizens' board and the apartment board, and they're at loggerheads. There needs to be a restorative collaborative approach.

 

            As former Minister of Community Services, we had signed off on approximately $350,000 to help out with maintenance and repair at the apartments, which look like slum apartments presently. That money was not accepted because of the issues and trying to get the departments together. There has been correspondence from the Minister of Community Services in terms of those dollars. We don't want to lose that $350,000 that was signed off by myself. That would be an awful shame.

 

            Minister, you mentioned the political reference, and I can't help but do that, because the sincerity from your Party to seniors - I have been brought up to have a great deal of respect for our seniors and what they do. I would never make them think that they were going to get a new home if I didn't know that I could provide a new home to them, and within that period of time that the commitment was made - it was very public and it was very clear. It was written down on paper, so it wasn't even a verbal commitment that somebody could say they misinterpreted or that the communications were misunderstood. The people in my constituency know that, and the people know that the seniors there are living under those conditions.

 

            I would challenge you or anyone in your department to pack up a little suitcase and go there and try to live in those very small rooms that are almost like closets for a couple of months, and see how you fare. Give it a try, because that's what our seniors are doing.

 

I'm standing here to fight for those seniors and their rights, because they have worked so hard to make the province that we have today. When you make a commitment of that level - and their families were so excited, and they were so excited, and the staff were so excited - and then turn around and say, oh, we have a different plan now, that's plainly and blatantly unfair to our senior population.

 

            I know my time is going, and I'd like to - an easy answer is to know how much is in the budget for Shoreham Village, and you should be able to identify what the budget is, please and thank you. I also want to quickly talk about home care and the fear that the home care workers have with the path this government is taking toward privatization. I know it intimately. My family has to utilize home care for my parents, and I do know how fearful those home care workers are.

 

So my second question is, is the minister going to guarantee in writing to all our home care workers in the province that their jobs will be secure under his mandate - his government's mandate - and will they continue to be paid at least the pay level that they receive today?

 

That's three questions: the budget for Shoreham, and the letter of commitment that home care workers' jobs are not going to change in terms of their salary. So those are the questions that I have, minister.

 

MR. GLAVINE: We have our chief financial officer looking up the budget figure, and in terms of the details, letters are to be sent out 30 days after the budget has passed.

 

One of the other questions that the member has asked here is to deal with home care. The home care issue is of great concern to me and to all of the 12,000 Nova Scotians who receive home care, home support. Over the course of any year, about 25,000 Nova Scotians receive home care. Currently there are five private providers in the province, and that's private delivery and publicly funded. There are 20 others that are not for profit, and in some ways that's really part of our challenge and our conundrum.

 

I was speaking with the former Minister of Health and Wellness yesterday. I'm very open about this in terms of what it's costing the province. I asked him if he was concerned about this when he was Minister of Health and Wellness. When the highest-paid nurse is receiving $40.05 an hour, and we're paying $90.65 an hour for that care, it is a huge problem. By extrapolating from this, this goes all the way down through to the LPNs and the CNAs. We have enormous inconsistency across the province in terms of the cost of delivering home support, home care, and that what's we have to change.

 

We know that we also have a few gaps in terms of geography, where home care is not as strong as it needs to be because part of that continuing care refresh is getting to that point where we know that every Nova Scotian who wants home care is able to receive it - unless it's somebody needing 24/7, 365 - quite intensive care, which our nursing homes provide, then home-first home care, nursing care in the home.

 

We know that array of medical services in our homes is expanding. It is the home that we will look at first and foremost. Therefore the care providers in the home are an absolutely integral part of making sure that we have an extremely strong service. We know the demands that are there now. We have wait-lists in some of our areas. Working through the old districts into compiling data into the management zone, which we're now starting to do, we actually have some of the old districts that have no wait-list at all. We have some districts that have made terrific improvement, and we have some others where the numbers on the list and the hours required have gone up some in the past year. In fact, as we know, VON provides the majority of our home care in the province, and they've had to rely on some subcontracts with private deliverers in order to get all the required work done.

 

            We need to be very careful when we're talking about private versus public when it comes to home care, because we have high-quality care being delivered by both. There are some individuals in that income level where they're able to get public care and private care at the same time. We have some providers that do both - they do both public pay for home care and also private to the same person, and sometimes, again, those can be at different rates, as some of us know or have experienced.

 

            What I can tell the member opposite is that those who are providing home care in our province will be providing home care a year from now, two years from now, and into the future, as long as they wish to have service. What I can state categorically is that, like our restructuring of health care, we are using Nova Scotians to design the system. We did not bring in any consultants when it went to the restructuring, and we will not do that for home care in terms of setting the system up.

 

We know that we have workers here currently - and I'm sure my area is no different than other parts of the province, where we have a number of community colleges. We also have places like PeopleWorx, who each and every year put out a class of CCAs who do a great deal of the home support.

 

As far as consulting and setting it up, we have the abilities in our province, and we will not be bringing in workers from other provinces. There is absolutely no need. We have workers here in the province who will continue to be part of delivering home care and nursing home care. Also, those who will come out of classes this year will get their first employment in our province. Again, they're the ones - in fact, it's very interesting that over the last 12 months, as we've started to talk about this area, I've had those emails, I've had those CCAs and LPNs come to my office and outline where they see improvements that can be made. A number of MLAs have held community meetings, and at those meetings, when asked, why are you rearranging home care - on one occasion, I know very well, the MLA turned to the home care providers in front of him and said, you can give me that answer and you can also give me the solution. Many went on to describe some of the inefficiencies that I've talked about here in the House, both in Question Period and in estimates.

 

            I know the demand that's coming. You don't have to be visionary. You just have to look at demographics, and demographics are driving many things in our province, especially around health care. Demographics are going to push us to the limit in terms of home care. Many will be able to pay for it privately, because they have made provision through their planning, through their retirement planning, through insurance programs, but many Nova Scotians will rely upon government.

 

            I'm pleased to say that in the last fiscal year, $197 million went to home care - home support, actually - in our province. We put $30 million in last year and $3 million more this year. Now we need to look at the accountability of those dollars, but I think also the accountability around - whether it's scheduling - the number of providers who will go into a home.

 

            If there is one thing that I have heard over and over again as minister, or as MLA - they would say, is there any way you can have fewer providers coming in to look after my mother? She has to keep retraining and giving the little outline of how I like to have my care done each and every morning, or if it's the tuck-in, whatever it is. By the time you're 80 or 90 - or we have some that are centenarians who are receiving home care - I think established patterns and ways of doing things are very much entrenched, and they like to have that consistent care each and every day.

 

In many ways I'm talking about the quality of care and also the cost of care because, as my deputy minister reminds me, they're part of the same coin, the same issue, and we will address both in our plan for home care.

 

            MADAM CHAIRMAN: The honourable member for Hants West.

 

            MR. CHUCK PORTER: I'm pleased to have an opportunity this afternoon to ask a few questions of the minister. I'm sure there will be nothing in my line of questions that he wouldn't expect to be coming his way, actually - half a dozen things or so, and I'll bounce around a little bit.

 

            I want to talk a bit about dialysis, something he's very familiar with. Recently the report was completed, and it dictates that, as was planned in the past, it will go to Kentville at some point. Berwick will move there also, and others will travel to Kentville in an effort to receive their dialysis treatment.

 

Having said that, it has been the same battle for some years. As the minister would certainly be aware, we lobbied for a long time for the Hants Community Hospital. He has explained very well about the needs base that you have to have to set up a satellite dialysis. There are some questions around that that we may get into a little bit, but I'm curious just to start the day off here with, is there a time frame for when the Kentville system will be up and running fully in the Valley?

 

            MR. GLAVINE: I want to welcome the member for Hants West to the debate on estimates. I know that he has had a very strong interest with the general requirements of health care in his riding, and not just because he is a former paramedic. I have been with him when we have announced a CAPP doctor. We have talked about the number of doctors also needed in his area. I know Windsor, in particular, has been the beneficiary of a couple of new doctors - in fact, there was a group trying to get one of them to Kingston, since that's where he grew up, but he has chosen to work in a collaborative practice in Windsor. I've had a number of conversations with the member around health care issues.

 

            In relation to dialysis, we know that with an aging population, with the high percentage of diabetics that we have in our province, predicting a high demand on dialysis is an easy connection. Just this week I had the opportunity to meet with our staff at Health and Wellness who gave me an overview of the provincial renal program. It's always insightful to hear them speak.

 

            I won't depart from the member's question for very long, but one of the areas that I was quite intrigued by when I found out what happens in one of the better jurisdictions - and that is currently about 17 per cent in our province. It seems to be a little bit of a holding pattern, but about 17 per cent are doing home dialysis. We look at the Province of British Columbia, who have made a really strong effort around home dialysis - putting in place all of the education, all of the safety measures that need to be part of that home delivery system - and they're at a rate that is almost twice ours.

           

We have a gap there, in my view. I believe that the more work we can do in the home in terms of a whole array of health services - it's a better day for the patient. It takes some pressures off our health care system, and I believe those two working in parallel give us the opportunity for really strong outcomes, both in terms of patient satisfaction and in terms of the cost delivery. Here we're talking about a life-sustaining health service, one we need to do and do well.

 

            As part of the renal program, the major emphasis has been on making sure that regional hospitals - and our regional hospitals are well positioned geographically. It's the one area, when I take a look at a map of the province and see the location of our regional hospitals - they are in a good range of communities that can look after an immediate, significant number of people, as well as embrace the geographic area around them.

 

            The rolling out of a full renal program to get it in our regional hospitals has taken some time, obviously. The next site is Kentville, and a big part of that build, based on the figure in the budget - and I think we have that available here - so there is a figure in terms of that first phase that we will see phase one of this particular work. It will be a 12-bed. I think we were originally looking at 10, but it will be a 12-bed satellite dialysis unit connected to the Valley Regional Hospital. That final figure is actually before the Treasury Board, so I had better hold on to that for the time being.

 

            I know we're very close to getting that project underway. As the member opposite pointed out correctly, it will embrace the dialysis that is currently done at Berwick. But as we all know - and this is one of the challenges that I went through, as you know - why couldn't you have smaller dialysis units? Why couldn't we have one in Middleton, for example, or Digby, and have patients looked after closer to home?

 

            We know there has to be that medical backup, that whole medical team, if we're doing hemodialysis and peritoneal as well at the one site. I've been fortunate to learn a bit from our wonderful clinical team that works out of the Dickson Centre, and of course recently open, I would say, probably as modern or maybe the most modern site in Canada at the moment is wonderfully placed where there used to be a Tim Hortons. So it's very easy to walk in off the street at the Infirmary site.

 

            I would encourage the member, if he has that 15 minutes - he can no longer get a coffee, but he can go in and see what I would suspect is the most modern dialysis unit in the country at the moment. In fact, member, it is such an absolutely state-of-the-art facility that I'm afraid that some who go there may not want to do home dialysis. But it's much bigger than just the number of units there that are providing the dialysis Monday/Wednesday/Friday or Tuesday/Thursday/Saturday. It's also a centre for some of the repair work and the education programs. It really is a marvellous location, and I would encourage anybody to have a look.

 

            One of the issues now is that we're also looking at stage-gating all of these projects so that stage one, the design, is being finished up; stage two will start that first construction work, and it's to be fully operational sometime in late 2017 or early 2018. That is the plan for that project.

 

            MR. PORTER: I thank the minister for the answer and the detail he has provided; 2017-18 is still a ways away, so a lot won't change for these folks over the next couple of years. As the minister would know, travel is their biggest issue - how am I going to get there? Those are the calls I take: how am I going to get there? Not that all of these people are seniors, but a number of them are getting up there in age. At times they are able to get fairly regular travel when the weather is good, but when the weather gets a little nasty, people get nervous on the roads. That creates another issue, but it is always about the travel.

 

I think when you look at the idea we had around Hants Community Hospital, the next question would be, is there another mechanism? If we can't have a satellite unit set up at the hospital, is there a mechanism that we can look at by way of that logistical part of travel? We've got somewhere between 35 to 40 pretty consistently, unfortunately, going to dialysis either toward Halifax or toward Berwick. At some point that number might change a little bit, but probably not. It hasn't changed a whole lot over the years. Is there a way, or has any thought been given to the idea - they all gather at Hants Community and there are three that are going in the morning and three that are going in the afternoon, whatever that schedule might look like?

 

I should go back a little bit. The foundation had offered to put money up. There was community fundraising, as you're well aware. We've talked about that. Are there any ideas around partnerships with the community for travel to ease that extra burden? If they had to go to Kentville - it's only a half an hour, we'll say - from the Windsor hospital, is there something we could look at by way of some logistical-type travel that could work, up and back? I know that they go for a number of hours. Do you think the hospital or the department would be willing to work something like that in, knowing the numbers?

 

            If it were one or two it would be different, perhaps, or maybe even half a dozen, but we're talking a pretty significant number that remains consistent - which, as I said, is unfortunate, but when I talk to the folks who are in this positon, that's their biggest concern: how am I going to continue to get there? And of course for some, the cost has - Rick LaPierre has been travelling for 16 or 17 years now, it must be, and you can just imagine the cost that goes along with that. I mean, credit cards, remortgaging of homes, the price of gas - all those things are a factor, let alone his health in general continues to go down.

 

            On behalf of those people that I do talk to from my communities that I represent, who do have the need for dialysis and who do travel, is there some consideration that could be given to an idea like that when Kentville does come online, and consistently look at, are you going west or are you coming east? I know that's a big question, and there are a lot of people and things change over the course of years, but the number seems to somehow remain close. We would love to see that go down - obviously we all would - and maybe someday it will.

 

I'll leave it at that, and maybe you could speak to that, minister, if you would, please?

 

            MR. GLAVINE: To the member for Hants West, I know this is an issue that he has put some thought into and consideration about, if there is in fact a way of addressing it so that we could have some kind of consistent support. There are always different levels of income of these people. Some can handle it fine, without any problems, but for others it is a tremendous burden.

 

            Some areas of the province - and I know the area where the Premier lives, and Trans County Transportation has done probably the premiere job, if you wish, in the province, in terms of those who will come into the Dickson Centre for treatment and having them collected from Annapolis County, possibly even Digby, picking up one or two in the Kingston/Greenwood area and having that service so that they're getting their treatment all on the same day. They do the Monday/Wednesday/Friday routine for the most part.

 

They're able to bring them as a group, which creates savings for them, but also because of the special nature of the dialysis patient, that they're coming three times a week, 52 weeks of the year, they've been able to use a bit of a levelling mechanism for the cost of those patients being transported as a not-for-profit organization. I believe a call to a lady by the name of Debbie Decker - she won't mind me giving out her name - who has assisted my office many times. I believe she has also helped do some advisory for some of the other transit companies and shuttle services around the province. Actually, as the member would know, some of our provincial grants to support these small transit shuttle services are there in place. That would probably be an avenue to take a look at, first off.

 

            I see the dialysis patient as a very special patient in terms of their need. Like the member opposite, I've been in that very challenging situation of having a couple of constituents who speak about the travel - not always the cost, but how the travel takes its toll on them when they're leaving the Valley at 6:00 a.m., coming for four to five hours of dialysis, and the trip back home, and this is three days a week. I'll tell you, I get a little shivery when I speak about it, because I've had a few people who perhaps gave up to a degree in keeping their health going, because the travel after a number of years is so demanding.

 

            A number of governments over the past decade have really said, look, we need a full dialysis unit in the Valley. South Shore is now in the early stages of design as well. If we get our regional hospitals equipped first and also get a higher percentage into home dialysis, then - and I know it's sometime in the future, but smaller satellite sites are the ones that would get the next consideration. And it's the renal program that would make that kind of decision.

 

            The renal program is another example of a provincial program, and it needs to be delivered from Sydney to Yarmouth and Amherst to Bridgewater with the same high standards. This is why we can't necessarily put two chairs here, three chairs, until we get the full dialysis units into our regional hospitals, but it's the question of transportation cost.

 

            Whether or not something like the BTO program - and it's one where I'm prepared to look at its utilization. It goes for transportation and board for cancer patients. It hadn't been improved in about 14 years. We've upped the amount of support there considerably, and whether or not something along that line can be taken a look at over a period of time - we know exactly the number of dialysis patients we have in the province, and where they're geographically located.

 

It's a great question that the member opposite asks, because it is quite a burden for some people, and whether or not foundations - the special grants that go to the small transit and shuttle companies. It may merit that kind of more intensive look, and it's one that I've noticed that the deputy minister has made a note on, and one that we will keep on our radar.

 

            MR. PORTER: I thank you very much for that answer. That's something we'll certainly look into. Maybe there is some work we can put into that with our volunteer board and committee out home that has been raising money and would have liked to have seen it there. It gives us something to think about and a little more detail to look into, and we'll move toward that.

 

            I've got a lot to cover, and an hour goes by pretty quickly, so I'm going to try to get to a couple of other things here. Just briefly, I want to talk about the physical plant. I've driven where our hospital is. You've been there. The emergency entrance, the roadway into that, is just incredible. It's probably like a lot of other roads - it has been a hard winter - a lot of holes in it, so people are starting to call and ask, who is responsible for this? Well, there is a clinic up back, as you know, and they are partly, but on the upper end.

 

            We put a call in to your EA - who has been very helpful, as always - this week again. I'm just curious, since I am here, how does that work? Is there a separate budget line item in your department or does it actually go somewhere else where it is part of the infrastructure, we'll call it? Maybe it's a Transportation and Infrastructure Renewal thing? I don't know, but we're curious about that. What is the mechanism to get that done? Is it all in - I don't want to call it the "Capital Health budget," because it isn't, it's all one now,  but I'm kind of curious about how we might be able to get it fixed. What is our resource? What is our method to get that done? Who do we go to?

 

            MR. GLAVINE: That's a first-time question that I've had, both in the House and in the department. I've certainly been at a few hospital sites where I would have liked to call the Minister of Transportation and Infrastructure Renewal to find out exactly where the areas of responsibility are, because there are obviously some covered off by the hospital site.

 

            What I would advise the member to do here is - there is now a VP of operations within the new central zone, and I would suggest corresponding and getting it on the record that the Windsor hospital does need some remediation, at least - not a full new project or anything, but rather that there are some safety concerns. I would suggest that, and I would be pleased to get a follow-up on how that was handled.

 

            MR. PORTER: Thank you, minister. I'll certainly do that. Hopefully we'll get some remediation done there, because that is really what it needs.

 

            Again, I want to talk about a few different things. I'm just going to bounce around a little bit. One of those I'll start with is the one district health authority. It would be no surprise to anyone who has been around this House for a while - I've been here nine years, and one of the first things I did when I came into this place was begin lobbying for one district health authority. Having come from EHS, where there were 52 operators at the time, or different companies, having been part of bringing that down to one very efficient - one internationally recognized as very well-run, as you know, and in my opinion as good as anyone else in the world, and maybe better than a lot, too. So there are a lot of benefits to that, and I am not afraid to stand here in my place and say thank God that's done. We need it to be there, and we've needed it to be there for a long time.

 

            I have questioned every minister, even in our own government - because I was in the governing Party when we came in - and there were a couple of different Health Ministers in those days and all the way up through. So I am pleased to see that, because I lived through that as a paramedic going from one district to another, where you would find even the simplest things that were so different and that never should have been, by way of equipment and purchasing and all those things. It should be interesting to see how this all works out now that we've actually reached that point. I can only hope that it has even a portion of the benefit that it has had in the EHS world and for the medics on the street. It does make a huge difference. I'm looking forward to seeing how that now plays out in the longer term, and I do hope there's a huge benefit there.

 

            On that, I've also talked a lot in this House and in my place about the single-entry system when it comes to placing folks in long-term care. I have called that a failure more than once in this House. We've had our challenges with that. Again, I think part of that goes back to my experience working on the street and remembering a day when someone was in the hospital, perhaps - and I'll use my own hospital and Unit 500. If they needed a long-term care facility, the doctor would just pick up the phone and say, we're sending Mr. So-and-So over to Dykeland Lodge or to the Elms or wherever. It was a pretty simple process, and it seemed to work well.

 

            I'm sure there were probably people from other areas not really delving into it, and unknowingly, there were probably people who came from other areas who were in those homes at that time too. I don't know what the numbers would have been.

 

            I hate to say that families have gotten used to it, but I think they've gotten used to this 100-kilometre circle where families will end up. In talking to a lot of them, they appreciate the fact that there is a place their family member can go and be cared for. That is first and foremost to them, and it really comes back to the next question: how do I get back home? What does that process look like? I think sometimes before, when we were dealing with different district health authorities - I hope this challenge gets a little bit different as well, and finds a way back.

 

            I have heard you talk an awful lot in the past 18 months about changing the way this whole thing operates right from the wait-list and what the wait-list truly is, what those numbers really are and what they're not - those who are just waiting, who do feel that at some point they will be ready - and I think that is a good assessment as well. We really need to know what those numbers are. I also spoke many times about how we would call Capital Health and we could never get an answer about where Mr. and Mrs. So-and-So were on the list.

 

There was a time when we were able to do that, and it was helpful because the families took some comfort in that - you know, there are maybe four or five on the list, so they knew they were somewhere. We've been challenged to try to find them an answer, and it's pretty discouraging for those families, because they don't know what's next. Of course, when they're on places like Unit 500 where they're getting good care - but we all know the cost of being in hospital versus being in a long-term care facility. We know that there is a huge difference.

 

            Once they've made that decision, those folks are happy to get to their destination, whether it be the Elms or Haliburton Place or what have you, after some of them have spent quite a bit of time there - some have been there a very long time, and other times they have been there a relatively short period of time, and there are obvious reasons why. We all know, unfortunately, how a bed becomes available in the long-term care facility, so a lot of that does depend on that. The true wait number is important.

 

So I'll start with, maybe after some of that, are you working on one list and categorizing people differently? What does that really look like in your mind, as minister of the department? How will that change the focus of how folks are placed, or will it?

 

            MR. GLAVINE: Thank you, Madam Chairman. The member for Hants West covered a lot of ground on that introduction to his question - in fact, quite similar to how I handle my time on the floor in the House here on occasion.

 

I first want to acknowledge that the member was unequivocal from day one here in the House that we could gain a number of advantages by going to a provincial health authority. His influence on his Party was very strong, very sound, looking at reducing down to three, as he looked at in the last few years.

 

For us, when we looked at EHS and some other provincial programs in existence run by the department, one of the hallmarks that really convinced us was to take a system like emergency care and have 52 providers. I know from my own area that some of the drivers on those vehicles that left the funeral home, they were probably sound on first aid and not a lot more than that. The outcry that came about to change that model of emergency delivery is one that I remember. I wasn't following all of the detail around that particular issue as it was unfolding, but it was one that I was certainly familiar with in my community, and we know where we've arrived today.

 

            What took place was that the cost of the service, the investment made, became secondary in terms of how the quality blossomed, in that there had to be a standard of care because the standard of training had to be a certain level. As the member rightly says, we don't need to take a backseat to anybody when it comes to the delivery of emergency care in our province. I would venture to say that with a population of almost one million people, saving a life is a daily occurrence somewhere in the province due to the interventions of our highly-qualified emergency service. In fact, in that regard I can only see more advancement of their scope of practice and their role in the total health care delivery system for our province.

 

I'll just end off by saying that I think in terms of what we've seen in a few pilot projects of our paramedics actually doing home care - when we think of Long Island and Brier Island, where the paramedic service there would do follow-up when a person came home from hospital or a senior was identified in those communities as going through some health issues. There was the paramedic team that responded and became part of a daily visit to check in, whether it was checking on vitals or whatever it may have been, medications and so forth. They were doing that.

 

            One of the areas that I think every member of the House was very familiar with, in terms of the nursing home list - that's the primary question the member was asking me, one of the areas that I had a strong personal interest in, when given the privilege of being the Health and Wellness Minister here in the province, where I felt we could make some foundational and fundamental changes that would get us to a place where we might be able to tell somebody where you are on the list. We had such a long wait-list that it was a pretty discouraging report to a family - your mother is now 63 on the list - and we know how lists can often move.

 

            We all realize that we didn't have an accurate list of those who really needed to go into a nursing home. We've had this proven time and time again. The first part of our change, which was implemented on March 1^st, was that when people were called to go into a home, they would be removed from the list for a period of time and apply to get back on. Since that has come into effect, we've had about 100 people who were called and said they weren't ready to come to the nursing home. The home care they were receiving, part of the Home First program, was working very well for them.

 

            We've had a number of people who have now moved home from the west. This was a huge problem in Cape Breton that I had presented to me on a number of occasions, that they were looking at a nursing home because there wasn't family around them now to look after an elderly parent. For a number of reasons, about 100 people said they weren't ready to go into a home.

           

I really saw the benefit of where we're moving to part two, which is the high-risk, the high-needs person who does need a nursing home very quickly. One of the 100 people who were called, who didn't want to take a bed, had a medical incident a few weeks after they refused. They went to hospital, they got the medical treatment, and based on their frailty and medical issues, they were identified to go to a nursing home from hospital. Within about 10 days, they were in a nursing home. This is how the system should be responding, ideally.

 

            In part two, which will go into effect in the Fall, the assessment will have a proven instrument or tool of measurement to help identify that level of need, the level of risk, and have patients prioritized. Can you imagine how revolutionary that is? Where we're not just going to put a person on a list, and you may be there for a year or two years or longer? You will be prioritized. That's exactly who we should be putting in our nursing homes, so that we don't put the burden of wondering about their care on the person - they don't need that stress - or a family who is also in great wonderment about how their mother or father can be looked after if they have high needs. I think those two elements, those two changes, are going to bring us to a wait-list that is real, that will have the priority people there. I think we're going to substantially reduce the numbers on that wait-list.

 

            I won't accept the idea of transferring people from one list to another. I won't accept people just being put out there and hoping to get home care. We want the right people on both lists, and we want to respond as fully as possible to our seniors who are on either one of those lists. I think the member will see some of that change in his community, and I'd be most willing to hear any comments that reflect what is going on - good, bad, or indifferent. That's the only way we improve the system.

 

            MR. PORTER: Thank you, Madam Chairman, and I thank the minister for that answer. I think most people would be pretty happy to hear that there is a better way, or a way that they're not going to be waiting as long. I guess we'll know what that may look like from the feedback, as you just indicated.

 

I'll ask you a couple of things. I asked you a question in QP one day - I think it was last week - about the number currently residing in long-term care facilities. I think you gave me an answer of around 7,500 in the province today. Correct me if that's wrong, when you get up, if you will. I think that's the number you gave me.

 

Just on the list - we have an overall number of people who have been on the list. We've heard a lot of figures - as high as 2,500 or so at one point, I think I heard, have been on the list waiting for long-term care in some fashion. Based on what you just said, prioritizing, which is certainly the right thing to do - it meets the needs of those waiting, and that's good. So do you see a list? I guess I just want to envision if there is a list of everyone or those who want to at some point get in, and there's a list who need to be there now, and we're going to prioritize that list. Are those priorities being determined by who a physician says, okay, Mrs. Jones, you are on the top, you're in the top percentile, you need to get in before Mr. Porter, as an example, gets in? How do you see that working, or are you that far yet? Can you refine what that looks like at this point?

 

            MR. GLAVINE: To the member opposite, from my experience as both an MLA and a member in my community, I would say that there have been a number of ways of getting on the list. Some of them have families who, for whatever reason - and I'm sure they are very good - perceive now that their parents may need to be in a home. We have physicians who are monitoring the frailty of an elderly person, and they may start pushing.

 

But the list, in many ways, has become that self-fulfilling way of almost creating an even longer list. The list being long - let's try to get you on now, you don't need a nursing home bed today, but down the road, in 12 or 15 months, you're going to need a nursing home bed - we've had many people on the list, as we now know, who weren't ready to go into the home.

 

            In order to get to that priority list based on assessments - many of the people doing the assessment are nurses. They are nurses who have worked with the elderly, already doing assessments, and also some social workers, because it's not always just one area that impinges on a person and their need for a nursing home. We know the rates of dementia and Alzheimer's in our province, which are really big movers of getting people on to a nursing home list.

 

            Some of those coordinators will go through some professional development for this new tool, this new instrument that will be used for an assessment. It will have some more intensive markers that identify - when the assessor goes out to the home and they're not coming into their office, they're looking at the home they have to live in, to navigate. We all know that one of the areas that first come into play is having to go upstairs to the bedroom or the bathroom. So the assessor takes a look at the level of mobility and so forth, and the general health, and very often a doctor's report would be part of that.

 

            We lost one bed, according to my calculation. I've been quoting 7,065, but I'm told by Mr. Elliott that it's actually 7,064, so that's the number of nursing home beds we have in the province. We know that's a strong number for our population, even based on the Canadian average. Even with the highest-age population in the country, it is still a good number of beds. I think for the foreseeable future, with a strong home care program, that will be a good number.

 

            We're also going to see nursing homes built that will be privately done. For a number of people, due to their retirement plans, that's what will fit for them and they will go into that.

 

            One of the big areas that I've been very impressed by, and have had some more detailed information come my way - there are some complexes in the province now where you will have people who sell their home or who may have been in some other housing arrangement, and there are some active-living complexes or homes, there's assisted living, and then a nursing home. We're getting into this campus concept.

 

            One of the big areas that's really making a difference in the impact on our nursing homes - and I think it's the area that we absolutely have to move toward - is more assisted-living complexes where you have assisted living in conjunction with a nursing home and you bring care into the assisted-living complex; people are staying in assisted living much longer, much like in their home, and going into a nursing home at a much later stage than we generally have been doing here in the province.

 

I think it's going to be another one of those paths forward, and it may become one of those areas we may have to look at in terms of some kind of arrangement whereby we have our RNs or an LPN or somebody even assigned to assisted living. That could become a model in the future, as well as those who now go out to homes.

 

            I hope we're going to be creative and responsive to our seniors' needs as we go to a point in time where almost one-third of our population will be over 65 years of age.

 

            MR. PORTER: I just want to touch a little bit more on the long term. So we have this list of people looking to get into long-term care - some who are not ready yet, some who are ready now, some who want to transfer back to their destination of choice. Do we know what that looks like? You'd be looking at three different things in one here, but can you speak to that for a bit? Maybe you don't know those numbers yet - I don't know for sure.

 

The clock runs out on me quickly here, and there are a couple more things I want to cover, but if you could just speak to that for a moment, it would be great.

 

            MR. GLAVINE: Thank you for that question. That's where we hope to arrive - what that real number for long-term care is. It will take us a little while to work through the process.

 

            If you remember back in the Fall session - I remember as we got into late November, early December, there were a fairly significant number on the long-term wait-list. We know that Fall is one of those times of the year when families are assessing whether their loved one can remain in their home through the winter months, and that is probably one of those reasons we saw the numbers go up, or a lot being assessed at one time.

 

            We generally have about 700 at different stages of assessment on the current numbers, but at that time in the Fall, I fielded quite a number of questions in Question Period, and we were at about 2,560. Just since March and the changes over the winter, we're now down to a figure of 2,156. So we've come down about 400 in the past six months.

 

            I never miss an opportunity to speak about rethinking staying in your home as long as possible. I've had the good fortune, both on my side of the family and on my wife's side of the family, for one to be at home for their passing, and one to be in a palliative care unit for one day. So staying at home has been a big part of the directive that we have responded to.

 

            I think more and more Nova Scotians are rediscovering that, if at all possible - we know there are people who need the medical care and need to be there - we can bring palliative care into the home. We're obviously looking at hospice care across the province, but as families, as individuals, and as a province, I would like to see us be a leader in rediscovering how we can safely, and with the right levels of care, stay in our homes as long as possible. I think we will get to a place where that list for a nursing home will be those with very high needs - those who are at risk of danger to themselves.

 

            During the rash of numbers coming into the QEII back about three or four weeks ago, part of those coming there were families that were having the behavioural challenges of a parent with dementia or Alzheimer's. I believe we have to find other ways in the acute care system, in our homes, and keep our loved ones there as long as possible, even with those aging infirmities and diseases, and then have a nursing home place for them as quickly as possible when they do need it. That's a goal that we will work toward, and we hope other governments in the future will be part of building on what we're putting in place as a foundation.

 

            MR. PORTER: It's a good segue into what will be my final piece, I guess, looking at the clock - the home care piece. Just a couple of quick things. I'm interested in that single-entry system. How many people work in it, and what does that map really look like? So there are so many for this part of the province, so many for over here - and you've already touched on the other bit. People do want to stay at home. We deal with these folks on a regular basis as MLAs. They come to our office, and in my opinion, all that I've talked to would love to be able to stay at home. There are circumstances where that's just not possible. We understand that, and so do families.

 

            They are looking at that home care model, and they're wondering how they get on the home care list. That's a little bit different again. Can you tell me how many people are on home care or receiving home care at this point? I'm not sure if you know that number or not, but I'd be interested to know, versus the public. You talked a bit about it earlier - private versus public, what percentage that is.

 

            A lot of people will say, oh, it's quite a long list while we wait for home care, and there is really no definitive time, or they'll tell you, we're kind of curious as to how long the average wait time for home care to start is. Maybe it's based on that priority. Maybe this will all play out in the end when you have everything in place - that priority also represents how urgent home care will be provided for them.

 

            Again, a couple of quick things. I know I'm bouncing around a bit based on our time. One was the single-entry system, and the other is the public versus private home care percentage and wait times.

 

            MR. GLAVINE: I thank the member for that question. The two will obviously work hand in glove if we can keep people in their homes through those supports. When I first started to speak about this, I did have those questions. You can't just tell a person that they have to stay at home - no, obviously not. We have to provide - every measure of care and safety has to be considered when they are at home.

 

We know that many families do make great sacrifices to keep their loved ones at home, and we know those who are on the home care list are people who have come through the provincial entry system. They would be assessed for home care the same way as somebody for a nursing home. There are a significant number of care coordinators across the province, and if you want that number, we can provide that for you. They are people with specialty training to go into the home and assess the conditions. That will either support or possibly not be the best place for them to go home from hospital or to remain there.

 

On that list for home support are also people who are in hospital, but generally that's going to be the nursing care of an RN or LPN. There are many cases where they will go home from hospital only when that care is in place. So I would say we need very responsive nursing care constantly in place. Often that's one of those areas where we could be a bit more vigilant, that as soon as a person enters a hospital, you have a care plan for them. It's a care plan both within the hospital and when they need to go home.

 

            Currently, there are 7,300 clients who receive home support only; 7,200 who receive both home support and nursing; and 11,900 who receive nursing only. Those are considerable numbers, and they are numbers that reflect our aging population. We're closing in on 45,000 Nova Scotians over 80 years of age. If we go to any of our nursing homes, you will see that 80-plus is a pretty common age, and it's also a big segment of those who are staying in their homes. When we put $30 million into home care last year, we knew that it was going to get that strong pickup. It's an area where I believe that with each and every budget for some time, we're going to be needing additional funding. I also know that we do have to do more fine-tuning of the system.

 

With that, I thank the member for his questions. There are about 300 care coordinators in the province, so it's a very, very big job, the demands for home care. But I think there are many who can provide strong testimonials to home care making the difference in the quality of life of the elderly person, and also how home care was instrumental in not having to go to an alternate care in a nursing home. It's a big area.

 

I thank the member for those questions he brought forth.

 

            MR. PORTER: Thank you very much, Madam Chairman, and I thank the minister as well for the opportunity this afternoon. The answers have been very informative on a lot of things. I'll just finish with the comment that you just made: are those 300 care coordinators situated based on population - for example, the HRM obviously has the biggest population - or will there be a change to that on these zones now, as the new district health authority comes into place? I'm running out of time, so I will thank you and your staff today for the time, but if you get a chance to answer.

 

            MR. GLAVINE: Thank you, Madam Chairman, and that's a great question. I know there are a number who would be in our health centres and perhaps in our hospital settings, as well as in our agencies as part of the review of health services. Health services does cut across a very, very significant area of our health care delivery, so this will be one of those areas that our leadership team and the management zones will be taking a look at.

 

Do we have our people in the right place? We know that we have some communities - I'm thinking about Hantsport or an old community that is one of the five communities in the Valley that already have their population at 25 per cent over 65 per cent. There are some hot spots that we will have to look at, and whether or not we have care coordinators in the right place.

 

            MADAM CHAIRMAN: We'll move on to the NDP caucus.

 

The honourable Acting Leader of the New Democratic Party.

 

            HON. MAUREEN MACDONALD: Thank you very much, Madam Chairman. I'm pleased to have an opportunity to come back and talk more about the Health and Wellness Department's budget for the coming year.

 

The first thing I want to say to the minister is, last night when we left off, we were talking about the $200,000 in cuts to addiction services. I believe the minister indicated that that information was going to be provided to me on where those cuts are coming from. I haven't received it, so I would like to have that tabled so we could receive it.

 

            I want to use my time to talk about long-term care. There has been a fair amount of discussion about home care, which is extremely important; I agree that we need to invest in home care. But the reality is that not everybody can stay in their own homes. There are people who, because of the extensive requirements they have, will have to go into a long-term care facility.

 

            I'm looking at the long-term care budget, and I note that we spent - for this year, $554 million is forecast. Almost $555 million. Next year we are looking at increasing that slightly to $567 million. So it's about a $6.9 million increase.

 

            Before I ask some specific questions around the allocation of that increase, I would like if the minister could tell us - there are fees. People who have an income above a certain level do pay for a portion of their health care in long-term care facilities. Can the minister indicate how much money, how much revenue, is raised through fees for long-term care?

 

            MR. GLAVINE: Mr. Chairman, welcome to another session of estimates. I will table that document for the member, and if you want a copy, and further questions, that's fine.

 

            In terms of the revenue generated by those who are in our nursing homes, because we all know there are different amounts paid by those who are residents in our nursing homes, the figure is around $125 million. But we're going to get that exact figure for the member. That's what estimates are all about.

 

            MS. MACDONALD: Indeed, that is what estimates are all about. Minister, I'm curious. There is a $6.9 million increase in the long-term care budget for this year. Now, we all know there are very long waits for long-term care. We know that there were approximately 2,300 people, I think - maybe even more than that. That has been reduced. There has been a shift in policy in the department. So we are now accounting for who is waiting in a different way.

 

            Yet the lists are very long. There are 1,200 or 1,300 people waiting for long-term care. There doesn't appear to be a plan to get that long-term care wait-list down. There's no new allocation for adding more beds into the system, which would be one way to get that list down. We already have around 6,000 long-term care beds in the province, I think? Is it 6,000 or 8,000? (Interruption) It's 7,000. So that number of beds - more than 7,000 beds - exist in our system, in facilities that have to pay staff, have to provide bedding, that need equipment and furnishings, and that need to heat the place and what have you. Those costs don't stop from year to year, in my experience, and I'm having a really hard time imagining that $6.9 million will cover all of the growing costs in the long-term care sector, including wage costs and wage pressures.

 

            I want to ask the minister, where is that $6.9 million being allocated? Is it being allocated to offset wage pressures?

 

            MR. GLAVINE: In many ways the member opposite and former Health and Wellness Minister is aware of the component around wages that drive, whether it's in the department or in our hospitals or in our nursing homes. Wages are the most significant part of that. CPI per contracts are also a part of that increase that we will have to provide in this coming fiscal year.

 

            MS. MACDONALD: So the $6.9 million will be allocated to offset wage settlements. I wonder - I know that there are two different kinds of facilities in terms of funding. There are facilities that have contracts that have CPI built into their annual budget, and there are facilities that don't have CPI. For the facilities that don't have CPI built into their contracts, is it the department's plan to cover any CPI increases in the long-term care sector?

 

            MR. GLAVINE: First of all, I want to convey to the member that the exact figure for accommodation revenue is a bit higher than I had estimated. It's $142 million. I want to go back and say that, in relation to the last question, wages are indeed the biggest driver. Also, one of the areas that I believe is going to substantially help the entire health care system is the way we are approaching the whole procurement area. There are a number of places that have already been identified through the one health authority.

 

            Group purchasing has also helped to mitigate against having a more significant rise in nursing home costs, and 30 days after the budget goes out, these details regarding CPI will be a part of that. Those are still in the work stage.

 

            MS. MACDONALD: I know that long-term care facilities receive small equipment allowances. There's an allowance that's around $365 a bed per year, so a facility with 100 beds would receive about $35,600 for small furniture, fixtures, or equipment replacement on an annual basis. Can the minister indicate whether or not that particular allocation is going to be reduced in any way, and if it is, by how much? What facilities would be impacted by that?

 

            MR. GLAVINE: That figure has been reduced for the 2015-16 fiscal year. We are currently working on the questions that the member has asked, and we're looking at about $942,000 across all of our nursing homes.

 

            MS. MACDONALD: Is the minister saying that this item in the long-term care budget is about $1 million - $942,000 - or that that's the degree to which it will be reduced? I just want some clarity around that $942,000. How much is this particular item in the budget, and how much has it been reduced or is it being reduced by? What are the total savings from cutting that?

 

            MR. GLAVINE: The information I can provide the member is that that amount is being reduced by half, by 50 per cent. In some of the work done by the department this year, the majority of these requests are getting covered through regular capital requests already. Therefore, some of that money was not going to where it was directed, so it really is an adjustment for the way in which we would fund that particular area for our nursing homes.

 

            MS. MACDONALD: I'm wondering if there are going to be any additional cuts or mitigations in the long-term care budget, given that the amount of money that's allocated, or that's increased in this budget, is going to offset wage settlements. As I indicated, there are ongoing costs that increase in these facilities - not just the cost-of-living increases but the need to replace a lot of the materials and supports that people in these facilities require on an ongoing basis so that the facilities can keep their standards of care up to an acceptable level. Can we assume that there will be additional mitigations to long-term care facility budgets?

 

            MR. GLAVINE: I did need to get a little bit of background into how the funding in terms of repair requirements for our nursing homes develop over the course of a fiscal year. The department has reviewed the budget for the coming year, and their assurance is that the amount that is budgeted for this fiscal year will be able to support the needs of nursing homes. I know that just from some of the questions asked during estimates so far, we do have some nursing homes that have more requirements because of their age. We also have to be ever mindful of code and all the safety measures that will need to be taken from time to time. I have visited a couple of those that did have some unexpected work, and that can occur in almost any facility - you get a broken pipe, or something unexpected that occurs.

 

            The information that has been provided to me is that we will have sufficient funds to work through this fiscal year.

 

            MS. MACDONALD: I have to say, I'm very disappointed to know there are going to be cuts in the operating budgets of the facilities in the long-term care sector, particularly around the small equipment allowance, and with more to come.

 

            These are facilities where things like the laundry facility, if they have it inside their long-term care facility, or if they have kitchens, they have high use. These are industrial kitchens with kitchen equipment that needs to be replaced on a regular basis, that needs to be maintained well. You can't have a long-term care facility without some of these central services that are part and parcel.

 

These aren't frills, is what I'm trying to say to the minister. Furnishings, fixtures, and equipment in a long-term care facility are not frills. They're part of your basic operation, and just like in our homes and our households, things break and require repair and replacement. To take that portion of the budget and cut it by 50 per cent and then downplay the impact that will have on the men and women who live and work in those facilities is just not right. I don't know how else to say it. In my mind, that's not right.

 

            This will have an impact. Let's not pretend there is no impact. These allocations would not have existed if they weren't needed. This is going to the heart of these operations, the basic kinds of supplies and equipment that people need to be able to perform the services that they're giving to people.

 

            I am disappointed that the government would go there as a means of balancing the books of the province. I've said this ever since the budget was introduced: putting an additional $33 million in the Health budget is almost laughable. This is a freeze. This represents a freeze to the Health budget of the province. This will result in cuts in long-term care, and we have yet to see the cuts that will occur in acute care.

 

This budget is being rushed through this House in hopes that the government can get out of here before the people of the province really start to find out what is going on and what they are doing to various health care services across the province.

 

            This is the tip of the iceberg that we're seeing in long-term care. Those wait times have grown. There are 1,200 or 1,300 people waiting for a long-term care bed, and they need long-term care. These aren't people who can indefinitely be in hospital or indefinitely be at home. They are people who really need a long-term care bed. There is no plan to try to deal with that in terms of the capacity issue. This business about "well, we have enough beds" - that's just nonsense. The wait-list tells us otherwise, and the growing wait-list tells us otherwise.

 

I'm disappointed. This isn't the last that the minister will hear from me and members of our caucus on this particular issue, on long-term care. This is not going to go away, and we will be watching to see what the other mitigations are as the government unveils the secrecy that has surrounded their real plans and real intentions and the real implications of a budget that has only an additional $33 million for the entire health care system.

 

Thank you, Mr. Chairman. I'm going to yield the remainder of my time to the member for Argyle-Barrington.

 

            MR. CHAIRMAN: The honourable member for Argyle-Barrington.

 

            HON. CHRISTOPHER D'ENTREMONT: It has been a while since we had the opportunity to chat in estimates. It seems like the 12 hours are being eaten up pretty quickly. I know that many of my colleagues have had lots of good questions that are important to the patients and constituents who they speak to on a regular basis, so I just wanted to thank you for your answers to them as well.

 

            I'm going to be a little more specific to the briefing binder, or the Supplementary Detail. I wanted to start with nursing, and then I'll work my way through it.

 

On Page 14.8 it talks about nursing services. Last year the estimate was $67 million, and the new estimate is $70 million, so that shows a slight increase.

 

            I'm just wondering, shouldn't it be a little more significant than that, considering the number of nurses we have to hire in the province?

 

            MR. GLAVINE: Mr. Chairman, I thank the member for Argyle-Barrington, who needs no personal introduction here in the House, but he did receive it.

 

In terms of nursing services, that's long-term care. It's based on utilization for that particular service, and again, it obviously reflects wages that we would require from both the RNs and the LPN complement in our nursing homes.

 

            MR. D'ENTREMONT: If we look at that - so we might as well look at the other three items there, which are home support services and home care provincial programs. Under the home support services, it looks like a slight increase - even if you look at the forecast estimate, it was actually underspent this year. They were asking for a little more this year, so I'm wondering how you are going to square that circle. The home care provincial programs are taking a little bit of a drop.

 

If you look at our estimate, it was $35 million. The forecast ended up being about $35 million, and you're forecasting $34 million. I'm wondering why you are taking that one down a little bit as well.

 

            MR. GLAVINE: Thank you very much, Mr. Chairman. In terms of those line items, the $130 million for Home Support Services has gone up by about $5.5 million or $5.6 million and that is totally, I'm told, in relation to wages. There were some new contracts, if we remember.

 

The other one on Home Care Provincial Programs going down is $1.5 million to DCS for home adaptations.

 

            MR. D'ENTREMONT: Continuing down that list: Facility Based Care. This one I found quite interesting too, because there is a hike in facility-based care somewhere close to $7 million. We've been talking at length in the House about more home care and home-based options, yet facility-based care is going up. I'm just wondering what that one is about.

 

            MR. GLAVINE: Thank you, Madam Chairman, and welcome back to estimates. You've put in some long hours during this session.

 

I thank the member for that. Again, wages were a good part of that increase, but also some new bed openings at Villa Saint-Joseph du Lac and in Cape Breton. Those made up the majority of that increase, which amounted to roughly $7 million.

 

            MR. D'ENTREMONT: Thank you very much. Within these numbers, how is the RFP going to affect some of these numbers? I know that's probably thinking a little further ahead than what the RFP will provide to us, but I'm guessing it would impact some of the numbers on this page.

 

            MR. GLAVINE: Madam Chairman, the member opposite asked a question that will need to see itself play out in the coming months. We will have the program in place. The RFP is currently being developed. We will provide vendors - somewhere between 50 and 60 vendors that provide home care across Nova Scotia, and once that draft by the Kyle consultants is finalized, we will offer that to the vendors to see how they react to going through this process - many who have been involved with home care but without the RFP process in place, but one that has been recommended highly by the Auditor General.

 

We are hoping that there will be at least a few months in fiscal 2015-16 that will see the benefits of the RFP. We know that it will have some levelling effect for the delivery of home care services, from nursing to LPN to CNA to the new provision of home aid worker, but really it's going to be in the next fiscal year, as it works through one full annual cycle, that we will see how this will play out.

 

            However, the real mitigation against any kind of efficiencies and changes of delivery you bring in - we know we have a population that is demanding more, therefore requiring an array of home services. I gave some figures early to a member opposite on that level of utilization, but when we're talking about thousands of home care visits, both for home support and I think about 20,000 nursing home visits last year, that's a considerable impact on our budget.

 

            MR. D'ENTREMONT: Looking to the next page, Page 14.9, we see Addiction Programs and Mental Health Programs. For 2014-15, the addiction program, which I know the minister spoke of a lot when in Opposition - was $4.6 million. The forecast came in a little under, at $3.6 million, so we're estimating $4.4 million. I'm just wondering, was the wait time a little low this time, so the program didn't need as much money? Why are we cutting addiction programs under this heading of Addiction Programs under Page 14.9?

 

            MR. GLAVINE: First of all, I'm pleased to say that this change is within the department. It's not relating to front-line service. There was a vacancy and also a transfer of a position.

 

            MR. D'ENTREMONT: So the next line under, we see a little bit of an increase in Mental Health Programs from $7.8 million to about $9 million. Maybe you can explain the increase on that one.

 

            MR. GLAVINE: There is a significant increase of $1 million to EIBI, and $1 million that will go into responding to the Jana Davidson report. Her report clearly demonstrated that the work on the mental health of our adolescents at the IWK was strong, and it is a provincial facility. However, getting that trauma support care out across the province - she saw this as one of the ways in which we could deal with adolescents in crisis in a much more substantial way than how we had been doing this work in the past.

 

            This was probably the most significant recommendation, one that she was clearly able to demonstrate takes place at B.C. Sick Children's Hospital. It's where - as opposed to just having a psychiatrist dealing with a child - it's really one of those wrap-around services where we have a clinical team that will be providing the care plan for the adolescent in crisis.

 

            This model is proving to be very effective. It's now time to have this move out across the province - I know the member opposite is very well acquainted with EIBI - and to provide more places for our children. Working on having every child prepared with the EIBI program before they go to school is not only a goal and target but one that I believe is necessary to attain. We've made some provision within our Health budget with the department dollars, and we'd be prepared to see if more are needed. Once we get the therapists in place who deliver the program, we will do that quick assessment to make sure that children who will enter school for the 2016-17 year - or I should say, for September 2015, and again in 2016 - that we are meeting that goal of not having a child be delayed from going to school.

 

MR. D'ENTREMONT: Maybe as a sidetrack, since we are talking about EIBI for a moment, being that we've now all had our hands in the program - of development, expansion, and now a secondary expansion too - I'm just wondering, from the service offered across the province, do we have enough specialists in place? Is there going to be a little more hiring on it? It's good to have the money here, but is the staffing going to be available to offer that program province-wide?

 

            MR. GLAVINE: Madam Chairman, I was pleased to have an advisory team come into place during the past year. That provided many of us with an update on the EIBI services - how they are working across the province, where we have the more challenging areas - and just to give some statements about how effectively the program is working.

 

There is also some ongoing evaluation of EIBI. We have now had a program in our Nova Scotia Community College services that is training the therapists. To add 25 to 30 more places will definitely require additional therapists.

 

I've had the really good fortune to get some strong insights into EIBI and to have a parent allow me to sit in on a session where the therapist is interacting with the child. Just to bring this up - the autism support workers, two clinical interventionists, two speech language pathologists, and 1.75 support workers, so really it's a team that will embrace the next 25 children, but it will be additional hirings.

 

            MR. D'ENTREMONT: I thank you for that answer. I probably understand the importance of that program more than some because of what my wife does. She's a resource teacher. She runs the learning centre at École Par-en-Bas, and I can say that she can't get enough training and learning about it. She spends a lot of time just trying to soak up all the data she can to help her students, who are, of course, in the school-age years - the actual high school that didn't have EIBI back in the day. I know these kids are 15, 16, or 17 years old in some cases.

 

There are challenges in helping them and trying to find the best learning paths for them. But I can tell you there's nothing that brightens up my day more than going to visit her and visiting with the kids and having some great discussions about life. So anything we can do there is an absolute must.

 

            I thought I would look at the next page, Page 14:10, at Primary Care Programs. I need a good explanation on this one. The estimate from 2014-15 was $19.340 million. The estimate for this year is $14.530 million. It was also underspent by a few million dollars from the forecast. I'm just wondering, as important as primary care is - looking at doctor shortages, looking at clinics, the availability of those kinds of professionals - why is there a decrease there? Is it a cut, or has it been transferred to another part of the budget?

 

            MR. GLAVINE: The former Minister of Health prefaced his question with part of the answer. That is the transfer of the primary care teams from the department to the Nova Scotia Health Authority, and palliative care are also part of that change. I think that information can be cross-referenced on Page 14.13.

 

            MR. D'ENTREMONT: Since we're still in this neighbourhood, Page 14.11, where we have a lot of the supplementary information - Provincial Programs and Initiatives. So I'll just list a few off, and maybe we can do them as a block.

 

Cancer Care Nova Scotia - we're seeing a cut there of a couple hundred thousand dollars, or at least a hundred and some-odd thousand dollars. We see the Insulin Pump Program, which I find interesting, since we supposedly have expanded that program to people up to 25, but we see a drop in that program by about $1 million. The Nursing Strategy seems to be a bit of a drop. Considering the issues we have around a new nursing strategy, I figured there would be at least the same amount of money in that program.

 

Maybe this is the second question I'll ask after you respond to those ones, but the BTO program was underspent by $100,000. We're still giving the same amount of money. Is there any idea of maybe expanding the criteria on that or trying to bring up the threshold so that more people can access that BTO program?

 

            MR. GLAVINE: I will go through these areas that have been mentioned by the member for Argyle-Barrington. I'm still working on the cancer cut, as to what that may relate to, but in terms of the other areas, the insulin pump program is one where I can look across at the member and know that both of us pushed hard for it for over a number of years, and it was brought in by the last government. We're quite surprised and somewhat confounded in the department that the uptake has not been as strong. Since coming to the department, I've asked about the advertising. We know we have diabetic centres across the province, and so the jury is still out a little bit on that one, but it's basically utilization at this stage.

 

            We have moved it up to 25 years of age, so we're hoping that we will see more pickup. When I meet with the Diabetes Association for our province and those in our department who are with the provincial program, or whether it's with the Canadian Diabetes Association, they are certainly huge advocates of the pump. I've also been able to talk to those who have moved from the needle to the pump, and they talk about just how effectively it works to keep blood sugars constantly in that range that they require. It is a little bit of wonderment in terms of the pump.

 

In terms of the cancer program - and again, the member knows how important these provincial programs are - currently it's relating to vacancy reduction and other efficiencies that the program had identified that could do the same work.

 

            We all know that as we move into a greater amount of electronic communications, we're naturally picking up some savings. I know that as we develop one patient, one record, we will see both a great amount of early investment and savings over the long term.

 

            On the nursing strategy, that is a straight transfer into the Labour and Advanced Education Department. That will go into the training. Also one of the most successful programs that nurses have communicated to the nursing association, to the department - I had a chance just very recently to meet a group of fourth-year nursing students at St. F.X. when I was at Guysborough Memorial Hospital. They said the co-op that they've been engaged in, what a huge difference it is making. So it is basically the nursing strategy, a straight transfer right to the dime, with no reduction.

 

            MR. D'ENTREMONT: We didn't talk about BTO, but maybe we'll talk about BTO another day. It's one of those programs - it's a travel program, the colostomy. If I could remember all those acronyms, I'd be a doctor by now.

 

            Looking at a couple of the other issues, hospital equipment and hospital infrastructure seems to be way down. We just had that issue of sterilization at the Infirmary, so I'm wondering why we're not budgeting a little more for problems that might arise. We know our infrastructure is in terrible shape, so I'm just wondering why we're batting pretty low on this one.

 

            MR. GLAVINE: I wish to convey to the member opposite that that one caught my eye as soon as I was going through some of the line items in the budget. We are fortunate in our province to work at keeping up with equipment that is reaching its end date. During the past year, when I was in Sydney, I was reminded of how expensive a linear accelerator is. They were in year 14, so we had to do an order to have it ready for 16, as it will have the need to come on-stream.

 

            But yes, there's a lot of other equipment, whether it's an echocardiogram machine - fetal monitors and ultrasound. We had two go down within about a month in one hospital, at St. Martha's, and we had to quickly get the resources.

 

            Basically what took place was that there was a - because of some of those issues, like St. Martha's, and then again, getting the MRI in Inverness, we spent money that was available for equipment in the last fiscal year, and so we have put less this year. We always have to see where that may go, but again, we're hoping that with the larger health service planning, we will have that provincial list right in front of us, as opposed to the collections of nine, and each district health authority would prioritize. The department would have to go through a screening process. I think we're going to have much more of a just-in-time replacement information right in front of the department, and hopefully we'll be more responsive.

 

            As the member opposite knows, he has seen and experienced and probably been at - on the occasion of unveiling a new piece of equipment that our foundations - our foundations and auxiliaries in the province are passionate about their work. Since becoming minister, I've been able to see the response of our foundations when there is a call for a new piece of equipment. In fact, as we restructured, I would say that was one of those big questions: what will be the role of the foundations and auxiliaries in relation to their local area?

 

            Of course, I was pleased to say, absolutely no change. You're working for your local hospital; you're the foundation identified; you're the auxiliary - that's who you will continue for in the future. It's local. They see where their work is going as they bring a new piece of equipment that a new service may require, or very often it's replacement equipment.

 

            MR. D'ENTREMONT: If I can ever put a plug in for a linear accelerator for Yarmouth, that would be a good thing - something to talk about at a later date, but far too many people from Yarmouth County travel to Halifax to get their cancer treatments. As much as we work with organizations like the Canadian Cancer Society and the Lodge That Gives, the majority of the people that go to the Lodge That Gives are people travelling up from Yarmouth. Maybe at some point we can have that discussion or debate of having a cancer centre in Yarmouth. We've almost got everything - it would just really be nice to have something like that. Just a plug - nothing more than that today.

 

            Before I let the member for Queens-Shelburne have some time - because I know we're getting short on time before your estimates finish up, and I know there are still a few people who want to have some questions - I wanted to quickly look at master agreement stuff on Page 14.5 - Other Master Agreement Initiatives.

 

So we're in negotiation with Doctors Nova Scotia. We've already heard the issue with OB/GYNs, that some are leaving and that's putting women's health in a bit of jeopardy in rural Nova Scotia. I know there are a number of other debates going on with these negotiations, and I know you can't really talk about it, because there are negotiations going on, but I'm just wondering, why was it a little bit underspent last year, by the Other Master Agreement Initiatives - that's on Page 14.5 - and just maybe how the negotiations are going. What are we trying to get out of it this time?

 

            MR. GLAVINE: We were taking a look at the detail on that particular question. We know that in any given year what that final billing to the department will actually look like is very much a product or a concluding bill for utilization. So that is something that will be in flux from year to year.

 

I believe perhaps some of the collaborative teams, where you have a nurse practitioner, and also there was a Collaborative Practice Incentive Program - these are starting to come into play and into fruition in terms of what it costs us and also a Comprehensive Care Incentive Program.

 

            These are now coming to work for us in terms of utilization in the system. I don't have to go into any details with the member opposite in terms of how the collaborative practices are working - again, both their effectiveness for high-quality patient care and availability in the community where these collaborative practices exist.

 

            MR. D'ENTREMONT: Well, I wish I could stay asking all kinds of questions on this, but I know there are a number of other members and my colleagues that would like to continue to ask some questions.

 

I take this opportunity to thank the minister for his answers. I know he has always been open to answering some of these questions in the anteroom and outside this House as well. I thank him for his collaboration on that. With that, I'm going to share my time, or at least move on to the member for Queens-Shelburne.

           

            MADAM CHAIRMAN: The honourable member for Queens-Shelburne.

 

            HON. STERLING BELLIVEAU: It's certainly a privilege to have the opportunity to speak to the Minister of Health and Wellness on this important topic. I know that every member in here really appreciates the value of our health care system. I appreciate the minister's time today, and having the opportunity to get a few of my questions on record.

 

            I need some clarification. There's an interesting article, and I'll make reference to it - I'll get right into my questions here. On April 3, 2015, the minister did several interviews. Constituents of mine have brought this forward and would ask for some clarification. I'll quote the minister: "We need some form of 'urgy' care. It may not be the highest level as at regional hospitals but we do need to be able to have life-saving means in Shelburne" - which means Roseway - "and we're committed to that."

 

            The constituents of Queens-Shelburne have some need for clarity on this - I don't know if it's a new word or if it's a word in the health care system, and this is the concern they're bringing to me. I'm asking the Minister of Health and Wellness to give some clarification to the members of Queens-Shelburne on this new terminology and what it actually means for Roseway Hospital.

 

            MR. GLAVINE: I thank the member for strongly representing his constituents on this issue. Yes, when I was in Shelburne I did a number of interviews, and here at the House as well.

 

Shelburne is one of those areas that is, by geography, some distance from Liverpool and some distance from the regional hospital in Yarmouth. As we take a look at what areas of the province need a form of CEC - again, this is one of those areas that will need to make sure that they have a service available to them, that yes, it has EHS, we know that service is available, but again, when we're looking at the distance - and when the member gets up for his next question, perhaps he can give me that exact time that it takes to go from Roseway or Shelburne to Yarmouth and to Liverpool.

Having some version of the CEC is what I'm referencing here, because across the province we know that some of the CECs do not provide emergency care in the strict sense. It's really primary care. It's assessing a patient for what kind of care they may need - in other words, some triaging, some of the minor symptoms that the nurse and the primary care paramedic can determine.

 

            However, in Parrsboro we have a situation where we do have an advanced care paramedic - in other words, in my mind, and I think in the department's - is really what we would say is a CEC, where it's a Collaborative Emergency Centre. That distinction was brought out very clearly in Mary Jane Hampton's report.

 

If a family decides to take a member to a CEC in Pugwash or Tatamagouche at one o'clock at night, there is nobody there unless it's a bit accidental - perhaps that a doctor is in seeing a patient - and I know they have palliative care there. They are coming in presenting with all of the symptoms of a heart attack, and there is nobody there to deliver the clot-busting drugs. They will have to move on by the EHS, or possibly they have been very fortunate in that example I'm giving you, of having a doctor that has identified himself as a community doctor and does make himself available in emergencies, but it is one of those versions.

 

            In Shelburne, maybe having the advanced care paramedic right in the hospital along with a nurse overnight, having that same-day/next-day primary care available in a strong fashion - that is worked out with the clinical teams, and I know community meetings have been held. When we look at the first one being Annapolis Royal and we moved on - or during your government, you moved on to Springhill, Pugwash, Tatamagouche, Parrsboro, Sheet Harbour - these had community engagement before they went into effect. When I say "urgy care," it really is a combination of that nursing medical care with some emergency care being able to be provided by an advanced care paramedic, because there is a scope of practice for the primary care and a scope of practice for the advanced care paramedic. Currently, in seven of the eight sites, they would be staffed by a primary care paramedic, who is limited in the medical care that they can provide.

 

            MR. BELLIVEAU: Thank you very much, Madam Chairman, through you to the minister. I'm sure that the residents of Queens-Shelburne will be looking forward to my copy of Hansard, and I thank the minister for that definition.

 

Before I get into my question here - I'm appreciating the clock - the minister asked about the distance between Shelburne and Liverpool. It's roughly half an hour driving on the No. 103; and from Shelburne to Yarmouth on the No. 103 is roughly an hour - and I'm paying attention to the speed limit; we all want to make note of that - but it can be longer if you take the old Trunk No. 3. It's roughly that golden hour.

 

            One of the things that I have asked, I think repeatedly in the last two or three years, certainly has been going longer than - I think the minister can almost predict my second question - is the Roseway Hospital medical centre. This has been on-off, on-off. It never seems to get the shovel in the ground to get this project started in the community. I can assure you that there is a great need for this facility to get going. I know that we've gone through a district health authorities alignment, and I understand that, but this was a priority and Roseway Hospital needs to have some clear understanding of where that facility is. I'm asking the minister to give us a quick update on what the status of the Roseway Hospital medical centre is.

 

            MR. GLAVINE: To the member for Queens-Shelburne, yes, he's talking about a project that is very much needed. I went through the facility there and I had Dr. Keeler explain to me what they would need to have a modern facility, one that now would have students from the residency program or young doctors in their residency year that would work in that facility. When I looked at the flow of that facility, when I looked at the arrangement of examining rooms and so forth, it certainly was beckoning for quite a substantial change.

 

            What I can share with the member at this stage is that it will be very soon that we will have that announcement for the good people of his area who have waited so long for this. I reviewed some of the documents in the department as well, and there were some issues around who was going to do all of the funding. I met with many of the stakeholders on my trip to Shelburne, and there were certainly some issues about funding partners and design of the building. We really got - perhaps over two governments - we did get a bit off track there.

 

            But as you well stated, the need is considerable, and we'll be there shortly to have a final place for the future of that centre.

 

            MR. BELLIVEAU: I have one last question, and I want to thank the minister in advance before I get into my question. Then I'm going to turn it over to my PC colleague for Kings North, because I know this is valuable time, and I want to appreciate all colleagues having an opportunity to ask the minister. I appreciate that scheduling.

 

            Roseway Hospital and a number of hospitals in rural Nova Scotia - and I know there have been a number of questions, particularly in this session and the previous session, about the escalating closure times in places like Fishermen's Memorial Hospital in Lunenburg, Cape Breton Northside General - I've heard my PC colleagues talk about that - the New Waterford hospital. This is an issue of great concern to me.

 

I know the Opposition has raised questions, and I've heard the minister talk about if we could get more nurses and get nurses there - where I'm trying to go with this last question is that I've heard the minister state that there are additional nurses coming out of their medical schools, and we're waiting for that school and for graduation to come each year. I know that was the answer the minister gave last year.

 

I'm trying to get a sense - these communities in rural Nova Scotia, these hospitals are struggling to have additional nurses to address the problem of closures. So my question is simple: is that particular shortage being addressed, and trying to identify the problems in these rural areas and to make sure these facilities are open more? Thank you for your time.

 

            MR. GLAVINE: I really do appreciate the comment made by the member for Queens-Shelburne in terms of having as many members in the House take advantage of an opportunity of local issues in relation to Health and Wellness - our largest budget, our most important area. I must say, I got accustomed to lining up my questions for the Health Minister every year, and I remember very well one very exhaustive year that the member for Halifax Needham went through 20-something hours of estimates on the budget. So members do take their Health and Wellness questioning time very seriously, which is very, very good.

 

            When I became minister, one of the areas that I saw was a hindrance to us giving human health resources - addressing the needs of patients, a whole number of those areas - the full reach and consideration that they needed - I really did experience those kinds of obstacles, some deficiencies in the nine segmented districts that we had. We didn't have the flow that I believe we need. This is where the provincial health authority is now looking at how we can integrate the system in a much stronger way and so have a health services plan for the province.

 

It's never a good announcement for a Health and Wellness Minister when a place that is supposed to deliver some level of care - because there are all kinds of different levels of care in our health centres, in our community hospitals and so forth - but any time it's closed, that's not a thought or a comment or a radio announcement in one ear and out the other. It does weigh on me that we need to do a better job in this area.

 

            We're in the process after getting our regional hospitals, and I think that our regional hospitals function phenomenally well. I took a lot of time on every visit to the regional hospitals to gain a full sense - what is the work that you are doing here? What are the challenges that you have? What would you like to offer this area in the future? I took a lot of time to dwell on that. There are other facilities - whether it's Roseway, whether it's Northside or New Waterford, there has to be some repurposing. We cannot have the highest-trained emergency room doctors in every facility across Nova Scotia. Dr. Ross laid that out for your government very, very clearly, and acted upon it. We will continue his work, and we will use some of his final guidance in the budgeted amount for this year for advancement of the CECs.

 

            I do believe that as we graduate more nurses, especially with the little program in Yarmouth - and I know the number of doctors who will come into the province through our tuition relief program this year - we've had the highest number of CAPP doctors ever, at 16. The College of Physicians and Surgeons is taking a holiday on that program, and part of it is because of the number of graduates now from our Dalhousie school who do want to remain in the province.

 

I believe that we are on our way with the Physician Resource Plan. When a nursing strategy comes out, the member will see very quickly that there are opportunities for quicker results than how we have looked at our nursing education and the provision of nurses around the province.

 

            I can say without any hesitation - and it's not for the member to go a little easier on me in the coming days - that Shelburne and Lockeport and Liverpool are absolutely outstanding and astounding communities across the southern part of our province. Hopefully more young people will gravitate back and there will be work opportunities for them, and as a result, we will have more health providers in those communities.

 

            There are some communities that have not just been challenged in 2015, they've been challenged for a decade to get GPs, to get the right number of nurses. The deputy minister and I were in a little community in Cape Breton last summer, in Neil's Harbour, and again, the Buchanan Memorial Hospital - an outstanding 10-bed facility that does work that they probably shouldn't do, that never closes their ER, with primarily two doctors and one additional doctor who will come in from Inverness for periods of time.

 

            When I sat down with the doctors there - there were three nurses. Before a doctor made a single comment about "I'm 70 years old, and this place is a heartbeat away from shutting down - and I mean my heart," as he said - but he said, there are three nurses here who, if I'm not present in the ER and an emergency comes in, can do almost everything that I can do. That's the kind of high-quality health care professionals we have, who backfill and cover for each other and assure Nova Scotians daily that there is somebody there when the call goes out.

 

            We have to get those better distributed across our province. I believe that's what the one Nova Scotia Health Authority - I believe when I look back 10 years from now, we'll say that's what we will have accomplished for Nova Scotia.

 

            MADAM CHAIRMAN: The honourable member for Kings North.

 

            MR. JOHN LOHR: I'm very pleased to be able to ask the Minister of Health and Wellness today a few questions, mainly about local issues to the Annapolis Valley. As the minister knows, we have Valley Regional Hospital there, which is an exceptional hospital and very well run and enjoys enormous public support.

 

One of the ways that public support has been expressed is in fundraising for the Valley Regional Hospital, in particular the hospice. As the minister knows, there's a dialysis component to that, I understand, too, and I think the $8 million that was to be raised may now be fully raised. It was within $50,000 the last time I saw the number.

 

I wonder if the minister can enlighten me at all to what the plans are with seeing the government portion of that commitment fulfilled on the construction of that hospital and the dialysis?

 

            MR. GLAVINE: I thank my colleague for Kings North for joining the debate on the Health and Wellness estimates. He's asking a question that has been on the minds of people in the Valley for at least a decade now. I'm very familiar with the projects that he references.

 

I can tell him that I have had some recent meetings with the hospice foundation. This project is long overdue. We absolutely need the dialysis in our area. It's going to cover quite a geographic - east and west - that will make the provision of that life-sustaining service so much more favourable to many people. That's very near the end of its design stage now. We will stage-gate the project from design to first phase of development to completion in late 2017 or early 2018. That's the plan for the dialysis unit.

 

            At one time, as the member rightly said, in order to try to create the greatest efficiencies, a building was looked at that would house dialysis on one floor and the hospice on another floor and be connected to Valley Regional itself. Last year we hired a provincial coordinator for palliative care. We have a lot of good things going on in palliative care, but some very huge gaps in the delivery of palliative care. As a result, in recent months I had asked for a report on how we're going to fund palliative care through a hospice. That was one of the reasons that hospice palliative care got attached as a build to Valley Regional. If you attach it to Valley Regional and it's a palliative care unit, then you could maybe take a few beds in the hospital out of circulation and have the operational funding for looking after the beds in hospice palliative care.

 

            The hospice model is very, very much based on a detached building in the community that has a combination of a clinical team and a lot of volunteers. So the bill jumped to twice the cost, because as soon as you have a building that's really an extension of the hospital, all of a sudden your building code changes dramatically, and what may have cost, for easy reference, $100 per square foot, all of sudden becomes $200 per square foot.

 

We're now going back to a stand-alone, I believe, and having met recently with the hospice, they're going to pass a motion to still have it on the grounds of the Valley Regional Hospital, where you would, again, have clinicians available. Maybe the member opposite is aware of how fortunate and of how good our palliative team is, especially our physicians. Their dedication to go anywhere in the county at times of day and so on is really remarkable and heartening to see. They would be there, sometimes close by, to look in on those patients.

 

            Right now they do have the money to build a hospice. A couple of months ago, I said we need to get this project and inform Sydney and Halifax about how we're going to fund. We have a report in front of us now about how we will fund the operations of a hospice, which are dramatically different than funding 10 beds in a hospital. It is a dramatically lower difference, and I believe that we will be able to fund the operation. We're very, very close to getting that project announced, as well as how we will fund other hospice here in the province.

 

Some of those delays have been unfortunate, because the bill became $8 million of fundraising, but as the member knows, it also included revamping and modernizing the emergency room at Valley Regional. The emergency room doctors said look, the layout, the arrangement that we have is not working very well here. That took a big, big chunk of the funds of the capital campaign of around $8 million, but there is certainly money to build the hospice. I look forward to inviting the member opposite for that announcement.

 

            MR. LOHR: I look forward to hearing that announcement, and I appreciate the indication that I would get an invite, Mr. Minister.

 

I just want to clarify a little bit in my own mind what you've said about the hospice. I can appreciate what you're saying about the cost of attaching to a hospital versus a stand-alone building. It was my understanding that the community was raising the money for the capital portion of the hospice and that your department would be funding the staffing. Maybe that's just an erroneous impression, I don't know. Is that correct, that the capital cost will be funded by the fundraising program and the actual operational cost of the hospice will be incurred by the Department of Health and Wellness? Does that change if it's a stand-alone building? I guess that's my question.

 

            MR. GLAVINE: Madam Chairman, it does not change what would have been the former Annapolis Valley District Health Authority. Now it will be the Nova Scotia Health Authority within its current budget envelope. We are working on that formula right now. We've had the department present us with a number of options.

 

The very final cost and so forth to run a hospice - we don't have that experience in the province to draw upon. We don't have any. We may have to go through a year or two to really know what the cost will be. I do know that it is considerably less than what a bed in a hospital would be, but that will be part of making sure that we can operate any hospice that we build within that current health authority envelope for operations. Also, looking at years in the future, the study pointed out the number of hospice beds that we would likely need in the province and on a regional basis. That's very clear to us, but once again, as the member opposite and all of us have a sense of, palliative care in the home is a growing option for many families.

 

            We have patients in our hospitals - I had this presented to me at a number of sites. We have some phenomenal palliative care units in some of our regional hospitals that have worked to make a more home-like setting even within the institution already in existence. The hospice will be one way, but we also have some that will need to be in a hospital.

 

Where I was going with my first comment was that there are people who are palliative who come in - and I know Dr. Vaughan, the deputy minister, is very familiar with those who are in palliative. They will come into a hospital and they will go back home or go to a hospice once we have that. They need some intense medical treatment, and then can get into a place that their family and their loved ones want, best-suited for them during the end-of-life stage.

 

            MR. LOHR: I thank the minister for that answer. From what I understood, as the plan was outlined maybe a year ago, when the hospice was built - because the plan was that it would be attached to the hospital - there would be some bed closures in Valley Regional Hospital, because some of the staff resources would be - there would be a net gain of beds, but some of them would have been allocated to the hospice. Now that the hospice is planned to be a stand-alone unit, will that mean that there will not be any bed closures in Valley Regional Hospital?

 

            MR. GLAVINE: That's a great question that the member for Kings North has asked. What will still likely be needed, which Valley has not addressed, is a dedicated palliative room, where some intense medical treatment is required even during the end stage of life. I had this explained to me as well when I went to the QEII to look at their palliative care unit.

 

            Knowing the kind of work and the amount of work that goes on at Valley Regional - and the escalating needs in our area, which has become a very prime retirement area in our province, and therefore a more senior population - the goal will be within the envelope of the Nova Scotia Health Authority to make a little bit of shifting around within the hospital. A true palliative care room - I've been on site for the opening of one of these - is a larger room that will allow a family to be at the bedside, and other provisions that can make an overnight stay possible. It would mean a little bit of reconstruction, so a few bed designations could change, but the goal here is to operate the hospice within the health authority budget. That's the plan.

 

            The final formula, an option we will select, is there on the table that we're now looking at, and that's why we can say that very shortly the hospice project for the Valley will be able to be announced.

 

            MR. LOHR: Just to clarify, to go back to the beginning, the dialysis component then would not be part of this new formula for a hospital? That would no longer make sense. Maybe you could say where it would be planned that the dialysis portion would be constructed or built or located?

 

            MR. GLAVINE: Yes, it's a move back, in terms of the hospice, from what started out. I remember one of my very first meetings when I became an MLA was with Dr. Jim Perkins, a former president of Acadia, and a team that were committed to bringing a hospice to the Valley. They knew that to really make it a Kings County effort - they were looking at land originally in the Berwick area, and so it was to be a stand-alone hospice.

 

            As we all know, raising the capital dollars - look at Berwick and how they raised $4 million for their sport facility. Right now the hospice and the Valley foundation have the money for a build, and some additional commitment will be made once this is announced, but operations become the challenge, whether it's a sports facility or a stand-alone hospice.

 

            The dialysis unit will obviously be attached to the hospital. This is where we need to have our dialysis unit. I'll have to confer here for a moment, but I'm pretty sure they will need a nephrologist or at least an emergency room doctor available if something unfortunate takes place during dialysis, which is one of those factors. That will be attached. That will blend right in with Valley Regional as it currently exists. The hospice will be a stand-alone building on the hospital grounds.

 

            MR. LOHR: I'd like to thank the minister for those answers regarding the hospice and dialysis. As the minister knows, I've had the same constituents come to me as I think have come to him about the long wait-times for hip surgery in the Valley and the impact that has on their health. They're waiting for hip surgery, and maybe the other hip is okay but not okay, and it's starting to impact other parts of their body. As they wait for their hip surgery, other parts are rapidly deteriorating in other ways, and the problems are becoming worse. I wonder if the minister could tell me what there is in this budget that will directly address the hip surgery wait times in the Valley and knee surgery?

 

            MR. GLAVINE: Thank you, Madam Chairman, and I thank the member for that question. He's well aware, as I am, that the Valley would have one of those very long wait-lists, whether it's a full knee or a partial knee replacement, and hip and foot and ankle requirements. We know that very, very well.

 

At the same time, we are fortunate to have an outstanding team of surgeons at Valley Regional. If we combine last year's budget and this year's budget, that's a commitment - and continuing to go forward - of $6.2 million. That will be starting as of April 1^st. So that will be broken down. If I can give this to the member, it will actually mean $1.2 million additional for foot and ankle surgeries - we currently have a young orthopaedic surgeon who is in a fellowship to do the foot and ankle surgeries; $4 million for additional hip and knee replacement surgeries; and $1 million to begin a multiyear effort to design and implement efficiency and quality process improvements across the orthopaedic patient continuum of care. We know that when somebody is identified by a GP and then gets a specialist appointment, and knowing that it's going to be this amount of time, how can they be looked after as well as possible during that wait between the scan or the MRI that identifies the need for a knee or hip replacement? They now put in place orthopaedic clinics that will help those patients through that period of time.

 

            We also know that having a central wait-list - and the experience of Saskatchewan was remarkable when they went from ever-how-many surgeons, probably somewhere around 30 - they're at 1.2 million population, so they probably had around 30 orthopaedic surgeons. They all had their own wait-list, and they decided to have a central wait-list, to utilize and maximize all of the surgical theatres to the optimum. Each of the surgeons cut down on cancellations as well and made sure they are all filled in a timely way, and they dramatically reduced their wait times - obviously with additional money, as we have done here.

 

I don't expect an overnight resolution to this, but I know that we are on our way to a better day. I believe it was about 117 additional orthopaedic surgeries done at Valley Regional last year. We're hoping for 131 hip replacements; knee, 288 additional; and 12 paediatric spinal surgeries, for a total of 431 additional surgeries as a result of what we've put in the budget this year. We can talk about that health need, but I would say to all of us, as Nova Scotians, if we do the precautionary work to try to stay healthy - there are way too many patients; as people like Dr. Michael Dunbar, who don't even mind stating publicly - I see too many people who are obese, and that impact on the musculoskeletal system has its toll.

 

            We're doing a lot more work, but we know that right now, 24 per cent of our population is between 50 and 65 years of age. In just that 15-year segment, we have a huge cohort that are a prime target for wear and tear on the body. Spending a lifetime on a cement plant floor, or whatever kind of work they've done, they've simply worn out their hips and knees.

 

            We know that we're going to have lots more requirements, so only a long-term plan, only the outstanding work continued by the orthopaedic community - they have been a remarkable example of coming together to address the worst wait times in Canada for hip and knee replacement. We know that. I know that there are three former Ministers of Health here in the Chamber who live with that way too much, and I think this plan - because the strength of it, it was the orthopaedic surgeons that brought it forward as part of a perioperative plan for that province. That's where I think the real strength lies here, and if we take some of the recommendations made recently by the Auditor General, I believe we are on a path for sustained improvement. But we won't get the dramatic improvement simply because of that big cohort of the population that are coming through at the moment.

 

            MR. LOHR: Madam Chairman, how much time do I have?

 

            MADAM CHAIRMAN: We have until about four o'clock.

 

            MR. LOHR: What I understand - and maybe you can correct me if I didn't fully understand you, Mr. Minister, and maybe everyone else in the room knows this except me - but are you saying that we're actually going to follow the Saskatchewan model? So someone in Kentville - in fact, the lady who sent you and me a letter a week ago, two weeks ago - would maybe be on a province-wide wait-list and might end up having the surgery somewhere else in the province? Would that be correct?

 

            MR. GLAVINE: I thank the member for asking that question. It is not only hip and knee and foot and ankle surgeries. This is going to be the great strength to improve patient-centred, high-quality care across the province.

 

When I think about 30 years of coaching and taking young Nova Scotians all across the province for sports events, why wouldn't we, in the name of our health, go up to the Aberdeen, go down to Yarmouth, or go to another facility where we could get a more timely surgery? That really is the opening and the possibility that we will have in front of us here in the province. I think that is truly part of what will make a difference.

 

            Every one of those surgeons - and we can look that up; surgical outcomes are posted on a website, as well as how long their wait-list is - they're all credentialed by the Royal College of Physicians and Surgeons. I would be prepared to go to any part of the province if I needed a hip or a knee that was going to restore my quality of life. This is the thinking that we have to engage in now, and that will be part of truly making a difference in the time to get that hip or knee.

 

            MR. LOHR: I would agree with the minister that we live in a very mobile age. It was only two weekends ago that I was in New Glasgow for two hockey games with my son, and I would not hesitate to go wherever that needed to be. But as the minister knows, not everybody in our society is that mobile, and some of that will present significant difficulties for some people.

 

When can we expect that? Maybe you just said it - maybe I didn't understand you - but is that plan operational right now, that somebody in Kentville might be told, well, you can get the surgery done two weeks from now, but it's in the Aberdeen? Is that in fact operational right now, Mr. Minister?

 

            MR. GLAVINE: Thank you, Madam Chairman, and to the member for Kings North. As we all know, when we relate to the health care system on a personal level, we get some sense of the complexity because of all of the moving parts that need to be in place, and that can bring improvements over time. This work started last year, so in order to get the number of additional surgeries, we had to pay a surgeon, we had to have surgical theatre time available, and we had to have OR nurses and staff as part of that.

 

So the program started last year, but we have a coordinator for orthopaedic work right across the province. This person has that kind of background to know the orthopaedic world, know the doctors, and know the sites and what they can do. That is starting to derive benefits now. If we think about the old system versus the new - one of the areas, for example, we may have had a specialist in Kentville, but maybe there was work that he could do out of the Windsor Hospital, small foot surgery and so forth - they would have had to get credentialed in that health district. Now, under one provincial health authority, we'll actually have greater mobility for our physicians to go to other sites to do surgeries, to do procedures. That's going to be an added advantage for a more highly-integrated system.

 

            One of the areas that the new Nova Scotia Health Authority will have at its fingertips at some point in time, too, will be that picture of the province. Is there more that we can do in one site versus another? Do we need more capacity with the aging population? That's really what got us behind. The wait-list for orthopaedic surgery didn't develop after I became Minister of Health and Wellness. This has been a 10- to 15-year build-up, where every year we got behind, and then the next year a bit further behind, and so forth. As I said earlier, I believe the real strength is that the will, the plan, and the support from government to make more surgeries and procedures happen - it's the combination of all those things that I think will lead to a reduction in the time it requires for hip or knee or foot and ankle work.

 

            MR. LOHR: I would like to thank the minister for those answers. I would like to switch to another topic. This is really a case which a constituent put to me, and that is this lady had her father in the hospital and he was clearly not well enough to come home. He needed to go into long-term care. In this particular case, she was told that to get onto the list for long-term care he had to be home.

 

            My question for the minister is, has there been a change in policy where someone, a senior needing to go into long-term care, cannot get on the list if they are currently in a hospital? That to be on the list for long-term care they have to be at home?

 

            MR. GLAVINE: Just to clarify for the member, the way in which you can enter a nursing home is through home or through the hospital setting. Again, we have those care coordinators who are looking at this on a constant basis. I can tell the member opposite that we used to live this at my kitchen table, because my wife was a utilization and discharge planner. Sometimes she would be scanning the obituary column to see where there might be an opening on a given day, so that somebody from the hospital could go directly to a nursing home. Those are the realities. That's the reality. You have to have an opening in a nursing home, and there are few who leave the nursing home and go back home.

 

            This is receiving very strong attention now. I remember - in fact, this is a really easy figure to remember - I remember doing a tour of the QEII, and there were about 150 long-term placement people just at the QEII. Today we have 141 for the entire province. We've brought down the list from 200 to 141 over about the last number of months. I think it was in November that we were around 200, so in about six months we've come from 200 to 141.

 

            The ideal here is to have that movement from a hospital bed as quickly as possible. Remember, the unfortunate part is that that person has been discharged and then they are given a charge to stay in hospital after so many days. So the quicker we get them out, the better it is on many, many levels.

 

            Somebody who has recuperated, maybe even gone through some restorative care, but getting to a nursing home is certainly the better place for them because all their needs can be met in a nursing home, as opposed to just the clinical in the hospital setting.

 

            MR. LOHR: So I guess just to clarify that point then - and actually, you would know this constituent personally, too. I know she knows you. We know that you've made efforts to sort of consolidate that list for long-term care, and clearly there have been people who have proactively put their name on a list, thinking this will take a number of years and when I need it, it will be there.

            I know you have consolidated that list, but just to clarify for this constituent's sake, if her father was in the hospital and needed to go right from the hospital to long-term care, he could be put on the list while in the hospital? So you are saying absolutely yes? I'll let you say that for the record.

 

            MR. GLAVINE: You know, that's one of the areas that I had explained to me by Dr. Petrie and Dr. Sam Campbell when we were looking at the QEII and the backups and so on there. Some of it is due - when people are in a bed who need to be in a nursing home and have that better flow through the hospital, and sometimes there isn't as strong and robust a care plan as may be needed.

 

I think the member is absolutely right about having a care plan that identifies that this person had such a severe stroke, for example, that we need to be planning for a nursing home placement now, not after they have gone through their recovery and rehabilitation period. I think good care plans for every patient when they enter hospital must become one of those standards. I was told by physicians that that's not always what it can be, but I think those are standards and quality care that we need to build into our health care system over time.

 

            MR. LOHR: Thank you, and I would like to thank the minister for those answers and turn it over to the member for Sackville-Cobequid.

 

            MADAM CHAIRMAN: The honourable member for Sackville-Cobequid.

 

            HON. DAVID WILSON: Thank you, Madam Chairman, and I thank the minister. We're at the tail end here, so I just have a few questions. I know it will be time for the minister to wrap up.

 

When I asked about Dartmouth General the other day, about the closure of 33 beds due to the renovation that I believe the minister's announcing on Monday or Tuesday, the minister indicated that there were going to be some replacement beds at the Camp Hill, and I don't know if he said the IWK, but elsewhere. Could the minister indicate if 33 beds will be available in those other areas? Or if not, what number will be available to make up for the loss of the 33 beds at the Dartmouth General?

 

            MR. GLAVINE: Thank you very much, Madam Chairman, and to the member opposite, the area of the Dartmouth General that will have the most substantial work going on is the transition unit, and a good number of them will be able to go home. There is one floor now available at Camp Hill, but only a small number will be required at first, and then as the construction moves along we will see how many more will be required of that number that could be available.

 

            MR. DAVID WILSON: So there won't be 33 beds available to replace that. Are all those 33 beds transitional beds? If they are, or if they're not, is there any concern about the capacity issue at the Dartmouth General?

 

We know that in recent months, not only at the QEII but definitely at Dartmouth General, there have been what I would call alarms being set off about the capacity issue in the emergency room. That relates right through the hospital, so I'm wondering if the minister could maybe give us some clarity on if that's the case? Will this impact capacity at Dartmouth General? And if so, what are the plans to mitigate that concern?

 

            MR. GLAVINE: Thank you, Madam Chairman, and I thank the member for the question. Over the next few days, the Dartmouth General issue will be addressed. We know that in the health care system, we sometimes have utilization beyond 100 per cent. Sometimes we hear we're operating at 101 per cent, and obviously there are people who are on beds or on stretchers in hallways, and those are very disconcerting times. The capacity will be reduced at the Dartmouth General during the construction period, but in this case they're operating within the central zone, which does make it easier to have patients come over to the QEII. If they are more long-term or transitional care patients, those beds on the floor at Camp Hill are ideally suited.

 

            One of the developments that I had explained to me at Dartmouth General, which is really making a difference in terms of patients coming into the ER, is one of those best practices that I believe we need in other centres across the province. When a patient comes in and they have pneumonia, for example, and it's an elderly patient, they know that they need to be in a bed to be monitored. They are in a state of required care that is more than what they would ever be able to have provided at home.

 

So they have designated about six beds at the Dartmouth General for very intensive care that will, over a 48-hour period - up to about three days - rather than put them in a regular hospital bed and say, this usually takes about a week of hospitalization to be looked at, whether it's a serious infection or something bronchial that needs treatment, they do some intensive treatment. They are sometimes getting patients turned around in two or three days. That's something that is going on that is actually going to help relieve some of the capacity issues while this construction is going on at Dartmouth General.

 

            We do get more concerned when we have those surge periods that the member for Sackville-Cobequid is very knowledgeable about. Those are the worrisome times as we look down the road as to how long this construction will be going forward.

 

            MR. DAVID WILSON: I want to turn quickly to emergency department closures. With the former district health authorities, those districts provided an update on the numbers related to emergency department temporary closures, the hours that they were closed across the province.

 

Could the minister provide us with those temporary closure hours, especially the last six months? We were provided the information six months prior to that through freedom of information, so I'm wondering if the minister could provide us with the time period from October 1, 2014 to March 31, 2015, for the emergency room closures?

 

            MR. GLAVINE: I thank the member for that question. I will provide that for him rather than speak to that now, because I do have about five minutes for closing remarks, so I will proceed.

 

            I would like to say a few words as we close the debate on the Budget Estimates for both the Department of Health and Wellness and the Department of Seniors. I'd like to thank the many honourable members, three former Ministers of Health, who have asked thoughtful questions. I really welcome those, because that's the kind of scrutiny and constructive thought that I believe we all need to engage in here in the Chamber. I believe they sparked some interesting dialogue about the breadth and depth of our health system, about our policies and about the direction we are taking to make the system better for Nova Scotians.

 

            While we spent some time on the challenges and areas where we know we need to improve, I would like to reiterate the phenomenal achievements and the world-class medicine happening right here in Nova Scotia on a daily basis. We have thousands of skilled, committed and compassionate professionals who have been trained to serve others. Because of them, our health system has the potential to be a leader in its class on many fronts. That's exactly what we'd like to discover with a unified, modernized approach to health system planning and delivery.

 

            With the advances we need to make for our seniors in the communities across the province, including in home care and long-term care, this year will be a year of change and progress, of doing things differently so that we can achieve better results, of finding the best ways to stretch every one of our $4.1 billion.

 

I think I have time probably for just one example. This year under a new procurement policy province-wide we will save $1 million in just the ordering of the required number of pacemakers for our health care system.

 

            Some would suggest that we shouldn't change - that we should fight to keep the status quo. Well, we know where the status quo will keep us and it just isn't good enough. Nova Scotia has some of the highest rates of childhood obesity and chronic disease in Canada, an aging population with complex health needs and long wait times for many procedures. This situation is unsustainable and completely unacceptable. Maintaining the status quo would only draw on our financial resources more, limit our choices and get us the same poor health outcomes we've realized to date. As the Minister of Health and Wellness, and as Minister of Seniors, I won't stand by and let that happen.

 

            Future generations are counting on us to make the kinds of decisions today that will lead to a brighter tomorrow. Our Premier, the Minister of Finance and Treasury Board and several ministers have spoken in the House about fiscal discipline and I agree with them - that without this discipline, we won't be able to plan very far into the future. Taking control now hurts a little, but it will set us up for better days when we have more options to address the things that matter most to Nova Scotians - better education, more support for vulnerable children and families, taking care of our seniors and having access to quality health care. These are all topping the list.

 

            We can have the province we all want and deserve. I see that future. I want to be part of building that future for my family, my neighbours and the good people of Kings West and for all Nova Scotians.

 

            I will close now by once again thanking all the members of this committee for your questions and comments about the Department of Seniors and the Department of Health and Wellness. My thanks to Dr. Vaughan and Mr. Elliott and department staff who have worked so hard to support my work and the people of this province.

 

            MADAM CHAIRMAN: Shall Resolution E11 stand?

 

            The resolution stands.

 

            Resolution E36 - Resolved, that a sum not exceeding $1,496,000 be granted to the Lieutenant Governor to defray expenses in respect of the Department of Seniors, pursuant to the Estimate.

 

            MADAM CHAIRMAN: Shall Resolution E36 carry?

 

            The resolution is carried.

 

            That concludes our 40 hours of estimates.

 

The honourable Chairman of the Subcommittee on Supply.

 

            MS. PATRICIA ARAB: I'm pleased to report that the Subcommittee on Supply has met for the time allotted to it and considered the various estimates assigned to it.

 

            MADAM CHAIRMAN: Shall all remaining resolutions carry?

 

            The resolutions are carried.

 

            The honourable Government House Leader.

 

            HON. MICHEL SAMSON: Madam Chairman, I move that the Committee of the Whole on Supply do rise and that you report these estimates.

 

            MADAM CHAIRMAN: The motion is carried.

 

The committee will now rise and report these estimates to the House.

 

            [The committee adjourned at 4:05 p.m.]