HALIFAX, FRIDAY, APRIL 8, 2022

COMMITTEE OF THE WHOLE ON SUPPLY

12:10 P.M.

CHAIR

Rafah DiCostanzo

THE CHAIR: Order, please. The Committee of the Whole on Supply will now come to order.

The honourable Government House Leader.

HON. KIM MASLAND: Madam Chair, would you please resume the Estimates for the Department of Seniors and Long-term Care.

THE CHAIR: We have the Liberals for the next hour.

The honourable member for Bedford Basin.

HON. KELLY REGAN: We’ll continue on with some questions about long-term care, just some short, brief questions. We’re looking for how many Nova Scotians are on the long-term care wait-list and of those, how many are waiting from community and how many are waiting from hospital. Then, if it’s possible, if we could get a breakdown by health zone.

THE CHAIR: If the minister could give me a thumbs up when she is ready.

HON. BARBARA ADAMS: We just wanted to do a sound check, that you are able to hear us.

THE CHAIR: Yes, that’s wonderful, thank you.

BARBARA ADAMS: Right at the moment we have 1,950 Nova Scotians on the wait-list. That includes 1,704 who are waiting for the nursing home level care and 2,406 who are waiting for residential care. That’s 1,631 who are waiting from community and the rest are waiting from hospital.

When you look at the numbers historically in home care and waiting to go into long-term care from acute care, you can look back as far as 2011 to see that there were about 1,900 people back as far as 2011, waiting for long-term care. That was in a time when there were only less than 90,000 Nova Scotians waiting for long-term care.

A few years ago, we had approximately 700 people waiting from acute care to get into long-term care. Of course, this is far too long, for anybody on the wait-list, it is far too long. It is why we are making the investment that we are making in staffing and in our long-term care bed builds.

KELLY REGAN: When I heard those numbers, I heard 1,950 and 1,704 and then 2,000, so they didn’t quite add up. Could the minister clarify those again because the numbers didn’t add up, and if she could give the breakdown by health zone, that would be super.

BARBARA ADAMS: I’ll repeat the answer. There are 1,950 people on the long-term care wait-list; 1,704 are waiting for nursing homes; 246 are waiting for residential care facilities. The breakdown from where they are waiting from is 1,631 of those 1,950 are waiting from the community and the rest are waiting from hospital.

With respect to zones, that is changing on a daily basis and so I don’t have that data with me.

KELLY REGAN: If you could just give us a brief snapshot in time, from today, if you would just send that to us, that would be terrific; in terms of the breakdown by health zones, the picture of what it is today.

I’m just wondering how much it costs to the system per day for a Nova Scotian waiting in hospital for continuing care.

BARBARA ADAMS: Any time that somebody is staying in an acute care bed when they should be in long-term care, it’s an exorbitant cost to the Province, not just in terms of financial cost, but in terms of cost to the staff as well as the family members.

[12:15 p.m.]

In terms of the actual cost for what the Nova Scotia Health Authority is paying for that, I know it’s a new challenge now that we have three ministers looking after the Health portfolio but Minister Thompson is the minister for that department and she would have that breakdown of numbers.

KELLY REGAN: Perhaps the minister could share with us what is the current wait-list turnover?

BARBARA ADAMS: I thank the member for the important question. On average, every year in Nova Scotia, unfortunately the reality is that in order to place people into long-term care it means that someone in that facility has passed away, most often.

So the average for a number of years has been just slightly over 3,000. Pre-COVID-19, in 2019-20, the number of people placed into long-term care was 3,250. Between 2020 and 2021 the number was 2,130 which is over 1,000 fewer people going into long-term care. That just indicates the dramatic impact that COVID-19 had in those first waves, especially when we did not have the protection of the vaccinations.

But things are rebounding. In 2021-22, the number placed was 2,616, so that’s slightly over 500 more people this year compared to the previous year that was impacted so significantly by COVID-19.

KELLY REGAN: We’re hearing from some CCAs on social media that they have not received the increase to their wages which was announced back in February. I was wondering if the minister could explain why that would be happening?

BARBARA ADAMS: Absolutely, it’s a very important question. Any time you are advised that you’re going to get a raise, you would like to see it in the bank account the next day.

While my staff are getting you those numbers, what I can say is that back in 2013, the government of the day cancelled the CCA grant. At the time, they were getting paid 50 per cent of their tuition up until 2013. It stayed that way until 2019. Then the grant was brought back in a very small way: about 150 students at 50 per cent. What that resulted in was an undertraining of CCAs by, on average, about 500 CCAs a year. What happened is the number of CCAs in the sector went down which put tremendous stress on the whole sector both to home care as well as to long-term care.

This primarily female-dominated profession also did not get a significant pay raise, so as a result they were all leaving the sector in droves. When the department was created, we looked at the numbers of staffing for all health professionals and all staff in long-term care because every one of them is valuable, but the most important group that we were short staffed on was the continuing care assistants.

When we met with over 500 of them and heard what their priorities were, in addition to wanting equitable care across the province as well as the right safety equipment, they wanted to be able to take time off. They wanted to be able to have their vacation. When we announced that they would be getting this increase, this became the role of the unions to work with partners, with the CEOs of each of the facilities.

Right at the moment, about one-third of all of the agreements have already been paid out and those CCAs are getting their salary increases. Half of all of the agreements have been told to our staff by their unions that their Letters of Understanding are coming to us as soon as possible. All of the rest are in process to finalize their legal agreements - which of course - as you know - take time - between the employers as well as the unions.

They’re working in partnership to get these through as quickly as possible. It was such big news and such unexpected news that everyone wants to have it yesterday, but the pay is retroactive back to February 10^th.

Everyone will get their pay as quickly as the unions as well as the employers are able to do that. As you know, the employers have been strained by the continued staffing shortages and the Omicron variant, so we are putting in extra staff to try to help them navigate this process.

One of the things that I want to mention is the significant investment that this equates to. This is taking a historically female-dominated profession that has a back-breaking labour caseload, and we’re investing $66 million to top up CCA wages, taking them from an average salary of $36,000 to $39,000 up to $45,000 to $48,500.

We’re extremely proud of that and I know that even Unifor took out a commercial to thank us for this investment. I could not be prouder of the woman who was in that commercial as well as all of the CCAs and the staff who support them.

KELLY REGAN: Can the minister explain, if a CCA is at the top of the pay range right now, are they getting an increase?

BARBARA ADAMS: I thank the member for the question. It’s an extremely important question for everyone. If someone is already at the top of the pay rates in their category, they will go to the top with the new rate.

KELLY REGAN: I’m just checking to see if it’s capped-out at $48,000, so if you’re already making $48,000 you don’t get an increase, or is there an increase for every CCA in there? I think the minister has said the average is $9,000 but if that’s incorrect, can she give us an idea of what the pay raise range is in terms of a dollar amount for CCAs?

BARBARA ADAMS: I am more than happy to state that it equates to approximately a $9,000 a year raise for each CCA. There is no one, to my knowledge, that was making that amount of money because there was simply no investment to that degree by the previous government.

The average was $36,000 to $39,000 for a CCA in the province of Nova Scotia before, raising up to $45,000 to $48,500. I am not aware of anyone who was already at the top of the scale because it simply wasn’t offered. Now, there may be somebody who worked overtime, or there may be someone who worked in more than one place, where their cumulative salary, because they needed to work in two different places, may have been above that. But that is the salary range that we have put forward, and it’s equitable to $66 million this year.

KELLY REGAN: Thank you to the minister for sharing that with the record. In terms of long-term care beds, in 2019, Premier McNeil announced six builds to replace and add beds to the system. I’m just wondering if the minister can please provide me with an update on the status of each project, including how many beds have been replaced or added to the system, and the total capital cost.

We have six builds: New Waterford, North Sydney, Eskasoni, Meteghan, Mahone Bay, and Halifax.

BARBARA ADAMS: I know that the previous government’s focus had been on home care. It was, in fact, an article in the newspaper - it was January 30, 2021, and Premier McNeil at the time said, when they announced some beds, “This is the first phase of a multi-year overhaul of our long-term care facilities.” He announced this a week before he stopped being the Premier. Of course, there was joy that there was finally a change of heart, that the shift had gone from home care into long-term care.

What I can tell the member about all of the facilities is that right now we have 29 facilities currently under development. Twenty-seven sites will be impacted. Two sites are combined. That’s the Queens Manor with Hillsview Acres and Carefield Manor with Dominion Community Guest Home. Five sites are currently under construction phases - which is very exciting, I’ve been to one already - with the remaining homes at various stages of development, such as the project manager procurement, site selection, and conceptual design.

The total new beds anticipated - new capacity beds, with 500 being added to Central Zone through a competitive process - will be an increase of 684. Of the rebuilds, the new capacity will add 136 beds, plus 48 at Eskasoni.

I just want to make a note that all of these projects will meet my ministerial mandate of building at least 2,500 single rooms. In fact, seniors in long-term care will exceed that deliverable, as the total beds that are under way will see approximately 2,852.

Just to give you a breakdown of those first five, Villa Acadienne in Meteghan is in the construction phase. That’s 96 beds, and 10 of those will be new. The estimated occupancy date is January 2023. The Mahone Bay Nursing Home in Mahone Bay is 96 beds, of which 35 are new. The home is now in the construction phase with an expected occupancy date of April 2023.

[12:30 p.m.]

Waterford Heights in New Waterford is 60 beds, 36 of which are new, is in the design phase and the expected occupancy date is 2027. Taigh Solas in North Sydney is 60 beds, of which 38 are new, is also in the design phase. The expected occupancy date is 2025. Kiknu, the long-term care facility in Eskasoni, is 48 new beds. That is, of course, in the construction phase and the expected occupancy date is 2024.

I also want to share some data. For quite a number of years, Northwood had been asking for permission from the previous government to build more single-bed rooms because they felt that was important to patient safety and comfort. What I wanted to say is we had asked the previous government exactly how many single-bed rooms there were in long-term care and how many double. Prior to COVID-19 there were people who were living with three and four to a room.

I just wanted to say that my staff have actually counted and had the numbers calculated so that we would know exactly what we were talking about. The numbers, for the record, are: 4,704 private, single-bed rooms in Nova Scotia. We have 3,222 people living in semi-private - so double rooms - so that’s 1,611 rooms, for a total bed count of 7,926. I just wanted to put that on the record.

Certainly moving forward we intend to keep an accurate record as well, so when we’re doing our inspections of these facilities, we will reconfirm each year the exact total bed count because we want to make sure that we are maximizing all of the beds that we have in Nova Scotia.

KELLY REGAN: Thank you to the minister for that information. There was one left off there. I did indicate Halifax and I didn’t hear the number for that.

BARBARA ADAMS: One of the first things I did when I became minister was to go through the list of beds and locations that had already been approved. Of course, they were all - with the exception of one - located in rural areas, which is fantastic. But, of course, with almost half the population of Nova Scotia living in Metro, it is important that we bring greater ability to house those who are in Metro into long-term care. As we discussed earlier in Question Period, our focus is on building as much housing as possible, both long-term care housing as well as affordable housing in Metro and around the province.

What we can say is that we had put out a request for qualified suppliers and that deadline has already passed. We are currently reviewing all of those applications and we’re doing an analysis of that now. Then the process will move forward quickly over the next few months so that we can move forward with that process.

Of course, I just want to reassure the member and all of those who live in these communities that we work very closely with the Department of Municipal Affairs and Housing. I am very fortunate that my deputy minister also happens to be the Deputy Minister of Municipal Affairs and Housing. When you’re building these facilities, you are building a community. There are things that need to be considered, like transportation, like affordable housing in those areas, which, of course, then impacts the education system, as well as other areas. That’s the process and where we’re at right now.

KELLY REGAN: I didn’t hear a number associated with that particular process. Is there a number of beds that the province put out the applications for?

BARBARA ADAMS: This is 500 beds - which is a significant investment - in Metro. It will significantly help us get people who are sitting in acute-care beds. Right now, we have slightly over 300 people waiting in acute-care beds for those long-term care beds. It’s far too long.

I will note, for those who aren’t aware, that there was a variance put in place back in 2020, before the pandemic hit, when the number of people waiting in acute care for long-term care hit over 600 or 700. The government of the day made the decision to only, or primarily, admit people into long-term care from acute care. That’s a dramatic change in policy that I, frankly, wasn’t aware of until I became the minister, because it wasn’t something that was ever really revealed or talked about.

Of course, that variance impacted the ability to track long-term care wait times. The then-Minister of Health and Wellness from Yarmouth actually instructed his staff to stop collecting the long-term care wait times and reporting them publicly. We have started that process again. We are collecting that data.

The addition of 500 new beds in Metro will certainly impact the Metro wait-list, which is extremely high. Of course, as everyone would know, on the wait-list for long-term care you can see by region where people are on the wait-list. It is an average; it’s a median number. But that 500 for Metro is certainly going to help address that long-term care wait- list.

KELLY REGAN: Is the minister saying that now people are being admitted to long-term care homes from community as well as from acute-care beds?

BARBARA ADAMS: As the member would know, this variance has been in place for two years. There were exceptional circumstances for critical situations where someone was in home and there was an emergency need to be admitted. A small number of people from home were admitted straight into long-term care because their needs coincided with a bed vacancy.

Unfortunately, there are far too many people sitting in acute care beds waiting for long-term care, so that variance, as I say, has been in place for two years, with some notable exceptions that happened to coincide when nursing homes in the appropriate areas with the right levels of care were able to accommodate them.

KELLY REGAN: It’s great to know that the minister decided to take a shot at her predecessor for doing the exact same thing that she’s doing now. Great.

In January 2021, Premier McNeil announced seven builds to replace and add beds to the system. Can you please provide me with an update on the status of each project, including how many beds have been replaced or added to the system and total capital costs?

I have Shoreham Village in Chester; The Birches in Musquodoboit Harbour; Mountain Lea Lodge in Bridgetown; R.C. MacGillivray Foyer Père Fiset in Chéticamp; Grand View Manor in Beswick - probably Berwick; and Northwood, Fall River.

BARBARA ADAMS: I will sort of qualify the taking a shot at somebody for doing something that we were doing - when you inherit circumstances that were put in place long before you were there, and then you add in a pandemic, you have to work with the resources that you have, and that’s exactly what we are doing. We have made historic investments, including $66 million in CCAs’ wages, $17 million for CCA recruitment and grants, $30 million for the Seniors Care Grant. So while there are some things that I can’t undo overnight, we certainly are moving with lightning speed to do just that.

In terms of the question of where all of these projects are, there are those that I have referenced already that are currently under way - that’s Villa Acadienne, Mahone Bay Nursing Home, Eskasoni, North Sydney, and New Waterford. With respect to those that are in the Phase 1 there is Shoreham Village, Mountain Lea Lodge, Grand View Manor, Northwood in Fall River, The Birches, R.C. MacGillivray, Foyer Père Fiset, the new RFP and RFSQ beds.

In Phase 2 we have to replace and renovate - we have 17 existing facilities. Those facilities include Harbour View Haven, Wolfville, Hillsview Acres, Queens Manor, Dykeland Lodge, Gables Lodge, Melville Lodge, Glen Haven Manor, Victoria Haven, R.K. MacDonald, Valley View Villa, Carefield Manor, Dominion Community Guest Home, Highland Manor, St. Anne Community and Nursing Care Centre, Roseway Nursing Home, Maple Hill Manor, and these new RFP and RFSQ beds total 264. We also have invested $11 million into 190 beds.

Just for the information of some members who may not know, these projects are built in partnership with the facilities themselves and I want to put a shout-out to all of the boards of directors of all of these facilities because what they are responsible for is being a critical partner in helping to work through this process. These boards of directors have to help work with finding a project manager and working through the entire planning phase and that is not an easy thing to do, especially over the last couple of years where many boards of directors have lost members, have had difficulty meeting because of COVID-19.

Just for those who may not be aware of the facility development approval process, it is exciting. I certainly know that I was fascinated when my team educated me. So the very first step is the selection of the project manager and that is where the CEOs of the facilities and the boards of directors really play a very significant role that is in the pre-construction documents, the finalization of the contractor selection process - sorry, I skipped a step. Phase 2 is the project team selection which is critical and varies around the province depending on how big the project is.

Step 3 is the functional program, preliminary project and start-up occupancy plan. Step 4 is a conceptual design, preliminary site selection, update project budget. Step 5 is the schematic design, site purchase, and finalization of the budget which is a very significant part of the process. Step 6 is the design and development and updating the project costs, as we are doing all the way along. Step 7 is the pre-construction documents, the finalization of the contractor selection. Step 8 is the furniture, fixtures, and equipment procurement. Step 9 is the household rough in and inspection. Step 10 is the commissioning of the report and Step 11 is the pre-occupancy checklist and licensing of inspections.

KELLY REGAN: I am going to have to include a number of questions all in one I think because the minister is not answering the question. So I am going to put them on the record and then if she wants to talk about all kinds of other things, she can do that as well but I do want to get questions on the record.

I did ask about the status of the seven builds in Shoreham Village, The Birches, Mountain Lea Lodge, R.C. MacGillivray, Foyer Père Fiset, Grand View Manor, Northwood. I will also add into that in January 2021 then-Premier McNeil also announced the Northwood Halifax Campus would be maintained, 100 beds would be renovated to create single rooms, plus the creation of 44 additional beds. I would ask the minister: What is the status of this work?

On January 20, 2021, then-Premier McNeil also announced 236 beds would be added to the Central Zone, of which 44 would be at Northwood. I’m wondering what the status is of those beds.

In January 2021, he also announced a competitive process to replace 48 beds from Ivy Meadows. I would ask what the status is of that work. Then, in July 2021 - just so the minister is clear with everybody here - the then-Premier, the now-leader of the Opposition, announced the replacement of 1,298 beds at 14 nursing homes and three residential care facilities.

[12:45 p.m.]

I’m looking for the status of each project. That’s Harbour View Haven, Wolfville Nursing Home, Hillsview Acres Home for Special Care, Queens Manor, Dykeland Lodge, Gables Lodge, Melville Lodge, Glen Haven Manor, MacLeod Victoria Haven Nursing Home, R. K. MacDonald Nursing Home, Valley View Villa Stellarton, Carefield Manor Residential Care Facility, Dominion Community Guest Home, Highland Manor, St. Anne Community and Nursing Care Centre, Roseway Nursing Home Shelburne, Maple Hill Manor, and I would note that in July 2021, as well, the then-Premier, now-Opposition leader, also announced the addition of 264 new care beds in Central Zone to reduce the wait time to two months.

I just want to make sure that I’m understanding, because she’s alluding to adding beds in Metro, but they appear to have been already announced by the previous government. Full credit to re-announcing things, because we’re glad to see them continue. We wouldn’t want to see them taken away, but I just want to make sure that we understand exactly what’s new in your plan. Please give us the update of each of those places that I asked. We don’t need the steps, I just want to know where they are in the process, how many beds there are going to be, what’s the projected cost, and just let us know where each project is as we go along this process.

Where are they in the process? How many beds? Are they new beds? Are they replacement beds? What is the cost?

BARABARA ADAMS: Just to be clear, in August of 2020, the Progressive Conservative Party of Nova Scotia announced our Dignity for Our Seniors plan. That was long before the previous government announced any beds. I do have the quote that the member referenced from the Premier, January 2021, that he announced in his last week in office, and I will quote: “This is the first phase of a multi-year overhaul of our long-term care facilities” announced McNeil, who had one week left to go as Premier. That is several months after we had already released our plan.

The announcement of 500 beds happened on the eve of the 2021 election that was called in the middle of the Summer, in the middle of two waves of a pandemic.

As I’ve already answered the question, the facilities that are under construction are: Villa Acadienne, Mahone Bay Nursing Home, Waterford Heights, Taigh Solas, and Kiknu in Eskasoni. They’re already under way, shovels in the ground.

All the other facilities are in various stages of the planning process, and as the member doesn’t want me to go through the planning stages again, what I can say is that those that are in Phase One are Shoreham Village, Mountain Lea Lodge, Grand View Manor, Northwood in Fall River, The Birches, R.C. MacGillivray, Foyer Père Fiset.

Those that are in Phase Two are Harbour View Haven, Wolfville Nursing Home, Hillsview Acres Home for Special Care, Queens Manor, Dykeland Lodge, Gables Lodge, Melville Lodge, Glen Haven Manor, Victoria Haven, R.K. MacDonald, Valley View Villa, Carefield Manor Residential Care Facility, Dominion Community Guest Home, Highland Manor, St. Anne Community and Nursing Care Centre, Roseway Nursing Home, Maple Hill Manor.

KELLY REGAN: That is most helpful to have that listed there. I’ve got about four minutes left to go so I might just shift gears for a moment.

Yesterday I asked the minister if she knew how many seniors had died in Omicron. She was not able to share that information. What we do know is that 29 seniors in long-term care died in Omicron. We were able to get that information. And that’s while we have masking and vaccinations, that’s at a time when we know more about COVID-19 than we knew certainly during the first round.

I do appreciate that the minister brought up their Dignity for Our Seniors plan because I have to ask is 29 deaths - most people don’t realize that in this latest wave, we’ve actually had 29 deaths in long-term care homes - I think most people believe that long-term care homes have been relatively immune from COVID-19. In fact that is not the case, we have had outbreaks at a number of homes, and so I wonder would the minister characterize 29 deaths in long-term care homes in this Omicron wave as dignity for seniors?

BARBARA ADAMS: As everyone knows, anyone who passes away because of this disease is a tragedy for those families. I personally know several people who lost loved ones at Northwood during the first wave, long before we had COVID-19 immunizations. Of course, anyone who passes away, we don’t take lightly.

With respect to the member asking me about whether I should be reporting on that number or whether it should be the Minister of Health and Wellness who is responsible for Public Health, what I can say to the member is that we have different ministers for a reason. We expanded the Minister of Health and Wellness’s portfolio for a reason so that there could be greater oversight.

Just for future reference, if the member wants to know how many seniors have solar panels on their roof, I will be referring her to the Minister of Environment and Climate Change. If she wants to know how many people who are seniors are homeless, I will be referring her to the Minister of Municipal Affairs and Housing. If she wants to know how many seniors hit potholes every year, I will be referring her to the minister appropriate for that department.

The Premier has entrusted me with the care of seniors in long-term care and home care. Unfortunately, Madam Chair, the understaffing in long-term care was so pervasive that that contributed to the loss of life in our long-term care facilities, especially during the first wave.

All you have to do is read the report of what happened at Northwood to know that any death is a tragedy and we needed then, and we will now, do everything that is within our power to do that. Which is why we invested $66 million in CCA wages. That was a PC commitment. We are investing $17 million in recruitment and retention. That’s a CCA grant of 100 per cent, for over 2,000 CCAs. That was a PC commitment. We are offering $15 million for long-term care assistants. We are offering 4.1 hours of care for a $25 million investment.

That isn’t from anyone else’s playbook, Madam Chair. That is from the Progressive Conservative Government of Nova Scotia playbook. We are also increasing the safety measures for our staff so there are more staff able to be in the workplace to implement those . . .

THE CHAIR: Order, the time has elapsed for the Liberal caucus. Now we move on to an hour with the NDP.

The honourable member for Dartmouth North.

SUSAN LEBLANC: Thank you to the minister and her staff for being here to answer some questions about the budget. I will say that I wasn’t present, I was in the other room asking questions of another minister last night, so I didn’t hear the minister’s opening remarks, so I apologize if I ask some things that were covered in her opening remarks. Let’s just get to it.

I will say, before I begin, that my constituency of Dartmouth North doesn’t actually have any long-term care facilities, but we do have a lot of seniors. Lots of vulnerable seniors, lots of seniors living in rental apartments, lots of seniors living in public housing, and lots of seniors living in homes that have belonged to their families for years and years, who are struggling to literally keep the roof over their head. I think of them when I’m asking these questions.

We also have a lot of people who work in health care in Dartmouth North. A lot of CCAs live in Dartmouth North, a lot of nurses, and also all of the unions that represent those folks are in Dartmouth North. That’s a little bit of the context in which I ask these questions as a constituency MLA, but also, of course, as the spokesperson for seniors in long-term care.

My first question: Our caucus was very pleased to see the government raise the wages of continuing care assistants. Many people have been pushing for this change for a very long time and it is obviously well deserved. Fairly paid CCAs who are safe at work are essential, to a compassionate future, a caring economy, and also a green future.

I have heard that CCAs have not yet begun to receive their new wage, their wage bump. Again, I apologize if this question has been asked already. I’m wondering if the minister can share the timing of when CCAs will begin to see their wage raised.

BARBARA ADAMS: I am happy to give you that information again. As I say, when the CCAs realized they were getting that significant raise they were all anxiously looking at their bank accounts.

What I can tell you is that the money wasn’t made available immediately. What has to happen is that each employer - we have over 132 - each employer has to work with their unions in order for the agreement, which is a legal agreement, to take place. Of course, because we announced it the way we did, this was outside of the bargaining process. This is also a highly unusual step that most governments don’t take, so they are working through that process.

What I can say to the member is that one-third of the agreements have already been paid out, especially those who are non-unionized. We have been told by the unions that half their letters of agreement and the legal documents that are required to make those payments flow are coming to us very soon. The rest are all in process.

Of course, every employee is pushing every employer and their unions to get those agreements put in place. As soon as each agreement is in place the money will be paid out. It is retroactive back to February 10^th, so every single one of them will be getting that. That’s a $66 million investment.

Certainly, I do know that the NDP has been very vocal about the fact that it is a female-dominated profession, so I am pleased to know that the member is supportive of that decision.

I also would like to make a note that this was important for us to be the Atlantic lead, because it is a competitive environment. One of the other things we are doing in addition to this is we have the ability to help relocate over 200 CCAs from anywhere else in the country or around the world, we have a relocation grant to help bring them here. That’s on top of the salary increases that we’ve put into place.

SUSAN LEBLANC: That’s good to know. Obviously, the sooner the better for those MOUs and those agreements to get finalized.

I understand that it is true that only CCAs who work in publicly-funded organizations will be getting the raise. If that is true, which I understand it is, then I’m wondering if there’s a way for the minister to influence a similar type of raise for all CCAs. I don’t know if that means implementing a wage floor or what that means, but I’m wondering if the minister can comment on that.

[1:00 p.m.]

BARBARA ADAMS: Certainly that was the first thing that many people were concerned about, were those who don’t fall under this contract because we are a government that funds government-funded agencies.

What I can say to the member is that there are hundreds of agencies across the province that are all having to look at that and realize that they have had staffing recruitment issues all along. The majority of even those that we have contracts with, which is 20 in the province, have not been able to hire the staff that they need to supply the contract requirements that we have. This has been a major concern, which is why we increased direct benefits.

I can’t impact the private sector and require them to pay more, but certainly the market itself will drive that and it will dictate that if you can get paid the raise and rate that we are offering, then the private sector, if they want to maintain the staffing that they have, will have to follow suit.

SUSAN LEBLANC: The minister will also know that there are many, many people who work in long-term care who aren’t eligible for the raise. They are essential workers in long-term care; people who do the laundry, and food service workers, who work closely with CCAs and who are experiencing their wages shrink relative to inflation. I’m wondering if the minister can talk about what work is being done to raise the wages of those other essential workers.

BARBARA ADAMS: As one of those allied health professionals, of course we always want to know what everyone else is getting paid comparative to our own salaries.

What I can say is that it is highly unusual to give raises like the one that we gave to CCAs outside of the collective bargaining process. Our government respects the bargaining process and that, of course, is with the Minister of Finance and Treasury Board and the unions, so we are going to respect that bargaining process. It will be individually up to the Department of Finance and Treasury Board.

Certainly I am a strong advocate for everyone in the continuing care sector. Just as an example, we had someone, when I was working as a volunteer at Ocean View Manor, who was in a power wheelchair. It was coming up to Friday afternoon on a long weekend when someone’s electric wheelchair broke down.

If you’ve never been in an electric wheelchair, the crisis that occurs when that happens is enormous. So somebody who works in the maintenance department is as critical to the success of the care that we provide to seniors as the health care staff. All of those agreements are all negotiated through collective bargaining, and we do respect that process.

SUSAN LEBLANC: I just wanted to clarify something in the exchange that the minister was having with my colleague for Bedford Basin. It seemed earlier, just at the very end of their exchange, the minister was suggesting that she is the minister for seniors in long-term care, but not seniors and long-term care.

She said that if there’s a senior who has a problem with housing, she’s going to refer them to the Minister of Municipal Affairs and Housing. If there’s a senior who has a problem with - she gave a number of examples. I’m wondering if the minister can clarify that she is the minister for seniors in long-term care, or Minister of Seniors and Long-term Care.

BARBARA ADAMS: I know it is complicated when you look at having three different ministers responsible for the health portfolio, as well as seniors. Of course, we combined the Department of Seniors along with a section of Health and Wellness known as Continuing Care. The name of the department is a little confusing because it says Seniors and Long-term Care, but that encompasses adult protection. It encompasses long-term care, and it encompasses home care, and all of those things in between.

What we know is that those who fall into those categories - home care, long-term care, adult protection - are under my purview. If somebody wants specific questions about how many of the seniors in the province of Nova Scotia may be in housing crisis, then the expert in that area is the Department of Municipal Affairs and Housing, and that’s the best person to answer those questions.

Certainly, we work in partnership, and I have, as I said, the luxury that the deputy minister for my department is the deputy minister for Municipal Affairs and Housing. I am acutely aware that there are struggles in all areas of a senior’s life. There are financial struggles, there are transportation issues, there are mobility issues, so I am going to respect the fact that we have different ministers responsible for different areas and, while the Opposition members may be needing a little help in understanding who is responsible for what and who is the best person possible to answer those questions, I’m more than happy to help educate those members.

SUSAN LEBLANC: Them’s fightin’ words, Madam Chair. Them’s fightin’ words. I don’t need any help to understand who is responsible for what. I’ve been around five years now. I’ve got a pretty good handle on it.

I’m just thinking of people like my own parents, who are seniors - pretty old seniors. They are, they’re old. They’re 87 and 85, but they live in their own home. They have some health issues but nothing extraordinary and nothing really related to being older. They live on their own, they go to church on their own, they drive on their own, they do everything on their own, they cook and clean. Who’s responsible for them and their issues? Is it that they don’t have any issues, so no one’s responsible for them?

I’m just wondering. The way the minister is describing her role is that she’s in charge of seniors who need health care services, which is really important, but is there anyone in charge of seniors’ recreation, or is it just the minister of those departments, because seniors are people too? I’m not being facetious, I actually want to know. I take back my original comment. I do need some education about this.

BARBARA ADAMS: We’re always happy to help educate. The member referenced that she has five years of being in the House. I have 40 years of working with seniors, so I am intimately aware of all of the issues related to seniors, whether it’s a frailty Level 1 or frailty Level 9. Each minister is responsible for certain aspects of their mandate. If seniors are requiring adult protection, that is my department. If seniors are requiring home care, that is my department. If seniors are requiring long-term care, that is my department. If seniors are looking for programs and grants to help their organizations in the province to help support seniors in their communities, that is my department of Seniors and Long-term Care.

The funding that was in the Department of Seniors, we have enhanced that and put it together. There are all sorts of other things that we are doing. We’re doing the Aging2.0 and the assisting seniors to age well program. We have homemaking services that we fund all across the province. We have the Seniors Care Grant that we brought in. There are other programs, like the Heating Assistance Rebate Program that supports seniors and others of all ages.

It just occurred to me, one of the things that I’m always wanting people to understand is that your age isn’t necessarily indicative of the help you will need as you get older. My mother lived to be 92. She was driving her car right up until she was 90 years old. It was only the fact that she lost the vision in one eye that convinced her she didn’t need to be driving. But there is someone else who has a head injury at the age of 40 who ends up needing to be in long-term care.

So even though I am the Minister of Seniors and Long-term Care slash continuing care slash adult protection, those who need home care services may not be a senior. Those who need long-term care services may not be a senior and my department will be there.

But with respect to housing needs for seniors, especially affordable housing - well, I work with the Department of Community Services, as well as the Department of Municipal Affairs and Housing. If there are people who are having difficulty with transportation, there is a department for that as well. I realize that titles are a challenge for some, but my mandate is very clear. My mandate letter spells out exactly what I am responsible for. The items that I have invested in spell out exactly who we are trying to help.

I’ll just give you an example of the Self-Managed Care Program we have that people often don’t understand. There are a lot of people who need home care that cannot necessarily be provided by the service providers who we have contracted. So they need to go outside of those contracted providers and find someone in their community who can provide that care. We have dramatically increased the funding for that.

That’s not necessarily someone who is a senior, there may be others who are not just seniors. I don’t want anyone to think that my department is only focused on seniors, nor do I want anyone to think, nor should they expect, that every single issue that affects a senior is going to fall under my department because obviously that’s not realistic.

Just to help everyone understand some of the things that are under the Department of Seniors and Long-term Care. We have a dementia strategy, which I am extremely grateful to that previous government for putting in place, and for continuing to support and expand that funding. That dementia strategy is now at $1.1 million. We have one of the highest rates of dementia in the country and that significantly impacts everyone in my department.

We have the Caregiver Benefit program that’s $12.7 million and that provides the important role of caregivers in the province. Not everyone who is a caregiver is a senior but the person they may be looking after is. That program is intended to give caregivers of low-income adults who have a high level of disability or impairment additional funding.

We also have the Supportive Care Program, which is $8.9 million, seeing approximately 1,103 seniors and others in Nova Scotia. This program supports eligible Nova Scotians with cognitive impairment - difficulty thinking, concentrating, remembering things - by providing them with up to $1,000 a month, in addition to their home care, for home support services, personal care, respite, meal preparation, and household chores. Not everyone who gets that Supportive Care Program is a senior.

THE CHAIR: Order. There is a lot of chatter in the room and we can’t hear. Go ahead, minister.

BARBARA ADAMS: There are other programs I really want to highlight that have been in place for a long time and I want to recognize that.

There is a Personal Alert Assistance Program especially for those who are low-income, so that they can get the alert bracelet that goes on the wrist and alerts someone if they fall. It doesn’t necessarily have to be a senior who gets that.

We also have the Age-friendly Communities Grant program and I believe that was over $600,000 in investment around the province. Although those programs will definitely help seniors, it will help their family members who may be younger or older, and it helps seniors’ groups around the province.

[1:15 p.m.]

We also have the Seniors Care Grant, which helps family members who may have been giving their loved one money for medications, who may have been having to pay somebody out of their pocket to mow the lawn. Now, we’re giving money directly to those seniors who are of low income, which would be especially important to the member who is such a strong advocate for those of low income.

SUSAN LEBLANC: I really appreciate the minister doing all that education. I would like to be educated on the following: Why did her party, the PC Party of Nova Scotia, campaign on a platform of building 2,500 new nursing home beds? Then, after they were elected, commit to 500 but say that now they are building 2,800 but they are using the nursing home beds that were already announced by the previous Liberal Government? I just need the minister to square the circle for me of how it is possible to campaign on 2,500 beds, announce 500 and get to 2,800 when you’ve only announced 500 actual new beds that you are responsible for?

BARBARA ADAMS: What I can say to the member is that when we announced, I think on August 5, 2020, when we released our platform Dignity for Our Seniors almost a year before the election was called, we were the first to come out to announce the 2,500 new or renovated beds. That’s what was announced.

Six or seven months later Premier McNeil, a week before he left, made an announcement of some beds as well. He admitted, as I said and I quoted earlier when you weren’t here, so I’ll quote it again, Premier McNeil in the last week before he left said: “This is the first phase of a multi-year overhaul of our long-term care facilities.”

Just to preface that, when the long-term care expert panel came out with their recommendations back in 2019, the minister of the day said that we have been focusing on home care, we are now going to turn our focus to long-term care. That was in January 2020. There were no beds announced.

Then COVID-19 hit, Northwood hit, the Northwood report came out. Then the Premier, in the week before he left, said oh, we had better build some beds, we’ve been here almost eight years, we had better build some beds.

On August 5, 2020, we said 2,500 new or renovated to get single beds for Nova Scotians. Then a week before the election the Liberal Party made a last-hour promise of 500 more beds.

What we do know is that when you promise a province something and you make an announcement and those communities go - this is great, we’re going to get some beds around the province, we’re going to get some beds in Metro, the last thing a new government should or would do is to say oh, well those aren’t our priorities, we’re not going to honour what was done.

Frankly, Madam Chair, that happened to me. When I got elected back in 2017, a week before the election the Liberal Party put out a flyer on the doors of all my constituents that said, we’re committed to a collaborative health centre for our community because we were the only constituency in Nova Scotia without a single family doctor, no mental health services, and no physician.

Right after the election of course the first thing I asked the then Minister of Health was, are you going to honour that commitment? For four straight years the government said, well we might have promised it before the election but we’re not going to do it now.

Possibly because I was the one who won. I don’t know.

What I do know is that the new Minister of Health and Wellness and the new CEO of the NSHA took a look at the statistics in my constituency and said, wait a second, you have no doctors at all, none. You don’t even have bus service to get to Cole Harbour even if we were going two constituencies further to get to them. We don’t have any mental health services.

Well, guess what, we are getting a collaborative health centre, we are getting mental health services, and we are going to get a doctor. That is what a government does when they are taking action. So to round out the square as the member put it, we promised on August 5, 2020, twenty-five hundred new or renovated beds.

When I got into government and saw where those beds were allocated, they are literally a ring around the province with none except for one - I think it’s Bissett Court - is a Metro facility. So clearly that was something we needed to rectify. So, 500 new beds in Metro is an urgent action that we are also taking. That is where those beds come in.

When you look at getting to that 2,500, I can tell you I have a number on my wall that I keep updating every time we add beds. So to get to over 2,800, which is what I referenced before, we have taken on some facility beds that were underutilized and we have converted them - I think it is $11 million that we have used to convert some unused facility beds, VAC beds, into those long-term care beds.

Lastly, rest assured that I agree with the member that committing to long-term care beds is critical because that’s what is required. But what is more important is action. Every single one of those 27 projects is well underway. Could we move them faster? I would move them faster if I could and we are doing everything we can. In addition to those 27 projects, we know we need 500 more beds in Metro.

SUSAN LEBLANC: Our caucus was very glad to see the commitment to 4.1 hours of care honoured in this budget. This is going to make a significant difference to the people who live and work in long-term care and I want to congratulate the workers and advocates who have fought so long for this change.

The Premier’s mandate letter to the Minister of Seniors and Long-term Care explains that in order to meet the staffing needs in long-term care we will require an additional 600 nurses and 1,400 continuing care assistants. With the release of the budget, the government has walked that back to hiring just 550 new people in long-term care.

I am wondering why the number changed and what different information does the minister have now to justify, not justify, but to come to the number of 550 versus the 2,000 workers that was in the mandate letter?

BARBARA ADAMS: It is really important that people understand that we didn’t replace one with the other. We need both.

So just to clarify, we are already short 2,000 staff - CCAs, LPNs, and RNs. That’s the shortage that we are talking about. We need to hire 2,000 in order just to bring us up to the current levels - we’re sitting at somewhere between 3.1 or 3.6 hours of care - although there are a few facilities, I think it’s 10, that already had the capacity and the funding for 4.1 hours of care. What we are talking about with this extra 549 is in addition to the 2,000 that we are short. What that does is it brings every single facility across the province up to the 4.1 hours of care which is the minimum standard of care that we know that we need in our nursing homes.

Just to break down the 4.1 hours of care, we need 23 nurses. I just want to note that over the last few years, from 2012 to 2021, the number of nurses in the province working in home care and long-term care has dropped dramatically. I think it’s 13 per cent in long-term care and 38 per cent in home care. That is a massive drop, especially when you consider that we actually had an increased number of VON visits last year because so many people were discharged home from hospital so quickly.

Then we have the 549 additional to get us up to the 4.1 hours of care, which is 85 LPNs and 441 additional CCAs. We’re talking thousands of CCAs which is why we knew that they were the most critically short-staffed.

Although I will be honest, every other health profession, there are reams of documents that tell us exactly how many health professionals there are. We know to the number how many physiotherapists, nurses, LPNs, and RNs there are. What we don’t know is how many CCAs there are in the province.

For those of us who are in a regulated profession, I have a licensing body that I have to pay for a licence so they know the exact number of staff that we have, where we’re working, which sector we’re in, and who we’re working for. For CCAs, there was a CCA registry and it was voluntary.

With over 6,000 CCAs in the province, I think the number is 6,600 or 6,700, I know the member for Bedford Basin asked me that last night. We have 6,600 CCAs province-wide, 4,026 work in long-term care, 1,914 work in home care, and 660 work in other places.

When you have 6,600 CCAs and you’re short a couple of thousand, you have to take dramatic action. A 23 per cent pay raise, free tuition for 2,000 CCAs, free relocation for 200 more, and the Work and Learn program where students can get paid while they’re working and learning, we have 300 positions for that. We’ve doubled the number of people who can go through the PLAR program, and increasing the staffing ratio to 4.1 means that they won’t be as injured and they will be able to get the breaks that they need.

Just to circle back around again, it is 2,000 that we promised in our election platform. Then we got into government and realized that wasn’t anywhere near enough. We were committed to the 4.1 hours of care as the minimum standard of care. That means an additional 549.

SUSAN LEBLANC: So the budget seems to estimate $25 million for this change. Is that accurate? Is that an annual operational commitment, or is the change phased in over time?

BARBARA ADAMS: What I can say to the member is that there are only, I think, 10 facilities right now that are already up to the 4.1 hours of care. I agree with the member that this is a serious issue and this money is guaranteed.

She asked if it was accurate. Absolutely it is accurate. Is it enough? It certainly will be. Right at the moment, because of the dramatic drop in training in CCAs and the number of people who’ve left the sector because they were so frustrated with the lack of investment, there are almost no facilities capable of reaching the 4.1 hours of right this minute. So that $25 million reflects 70 per cent of all of the facilities being at that 4.1 hours of care per resident per day.

One of the requirements that the facility has to reach is that the facility has to have all of its beds open so that they need and require that level of staffing there. What we know is that to get to 100 per cent of the 4.1 hours of care staffing ratio, it would cost us approximately $35.8 million. I can reassure the member that although we have projected that they will get to about $25 million in use of those extra staffing funds, we are leaving no stone unturned to make sure that we get all of them up to the 4.1 hours of care as quickly as we can.

If we need to invest more than the $25 million in this budget year, we will certainly do so.

[1:30 p.m.]

SUSAN LEBLANC: Now, CUPE has said that in their view, and in the view of its workers, people need at least 4.1 hours of CCA care alone, and that’s not including nursing care. I’m wondering what the minister’s thoughts are on that?

BARBARA ADAMS: Certainly the unions have been strong advocates for the 4.1 hours of care. What I want to share is originally when the former Minister of Health had commissioned the Minister’s Expert Advisory Panel on Long Term Care, he had requested that they give a recommended staffing ratio. I was there the day when researcher Janice Keefe, who I have the utmost respect for, said that we don’t have the staffing data in Nova Scotia to make an accurate determination. And she’s 100 per cent correct.

As a researcher, I know that you don’t want to make a best guess for a minister, but unfortunately, that data collection still did not take place. Right now, one of the other surprises for me becoming a minister is to find out that staffing absences and illnesses in long-term care facilities, how they report that to the Department of Health and my department is through a voluntary report. They’ve all indicated that this is very time consuming and given Omicron and the staffing shortages, not many of them, filled it out. So it’s been really difficult to know exactly how each facility is staffed.

We’re going to solve that with interRAI and other measures that we will be bringing in so that we can collect the data. But what I will tell the member, and I am on record as saying this, whether Janice Keefe was able to say that there should be a specific number for the hours of care, whatever was there, which was around 2.6 to 3.1, was not enough. We weren’t going to wait years to collect the data before we were willing to commit.

The unions did say 4.1 hours of care. Now, it does depend on which union you talk about. Some represent CCAs, and of course, they would want all of those hours to come from CCAs. Others represent the nurses. They, of course, would want to see more hours devoted to nurses because we’ve seen the number of nurses working in home care and long-term care dramatically drop. And lest anyone forget how important it is to have an RN, they work in partnership with LPNs and CCAs.

But the other thing that was missing, which I found very frustrating when I worked up at Ocean View for the six months when the pandemic began, is I was working with allied health staff who worked in two different facilities, and they would work in one facility with 100 residents where they had a physio staffing level of two days a week. Then they’d go to another facility with 100 residents, and they were there full-time. So staffing ratios, it’s really important not to just leave it with CCAs, LPNs and RNs - there’s a whole lot more care that goes in there.

I have met with pastoral care staff, recreation staff, the people who cut their hair, those are people who all need to be factored in. So the staffing ratio of 4.1 is a minimum standard of care.

With respect to what is happening across the country, the only province or territory that I am aware of that is higher than 4.1, I believe, is Yukon and I think they are at 4.3. Other provinces that have a committed staffing ratio are well below ours, so I am extremely happy that we are starting here.

However, one of the other things, as the member mentioned, is the level of acuity going into long-term care is much higher than it used to be. Some of the members always used the story that in the old days some people who lived in long-term care drove their car up to the facility because they were able to do so.

One of the things that we know is that your level of frailty dictates the level of care that you need. Are you a two-person transfer? Do you need a Hoyer Lift? Are you a sliding board transfer or are you being left permanently in a dunk chair? If you are permanently in a dunk chair, you actually require less direct care for mobility than somebody who is up ambulating and needs to have somebody beside them.

One of the things that the interRAI assessment instrument, which the previous government talked about years ago - I wish they had brought it in back then because then we would have the data already - interRAI is going to give us the data. It’s also going to improve the access and flow from acute care into long-term care.

One of the things I do want to mention as well is right now we have almost - well we have 7,926 beds. Unfortunately because of COVID-19 and the pandemic restrictions, there is a large number of people, a significant portion of those who are in the facility that is not of their first choice - it is not closest to home, it is not near where their loved ones are, so the interRAI assessment instrument will also improve our ability to get people moved closer to the people who want to be with them, which is their family and their friends.

SUSAN LEBLANC: The question I asked was about the $25 million, I’m wondering if that was an annual operational commitment. The minister in her answer said that basically if it’s going to cost another $10 million then they’ll find the money for that, Madam Chair.

In the election platform for the Progressive Conservatives, it commits to investing $78 million for nursing staff in long-term care. I’m just wondering if the minister can explain the discrepancy between what’s in the budget, what could possibly be spent, and what was in the platform.

BARBARA ADAMS: The funding that we’re talking about is an annual investment. This is not a one-time thing; this is something that has to be done. If we are fortunate enough, God willing, to get our staffing up to 4.1 hours of care across the province, the money will be there in order to do that.

When we’re talking about other staffing costs, that $25 million is in addition to what is already budgeted for staffing levels. This is an additional amount of money to raise staffing levels. Certainly $25 million isn’t the only cost for staffing, that is how much more we have to invest to make sure that each facility gets up to the 4.1 hours of care as quickly as we can.

SUSAN LEBLANC: That’s a very helpful clarification. The minister has alluded to the fact that this is quite a challenge, 4.1 hours of care per resident per day across the province. She just said, God willing, we’ll get there. We’ll have the money to do it. How long does the minister think it will take to fill the positions to get up to 4.1 hours of care? Is there a goal or timeline in the facilities across the province?

BARBARA ADAMS: What I’d like to say is it’s going to happen as quickly as possible. Certainly, we were so excited to have so many nursing students and CCAs into the program, helping us out for a month. I know that helped our recruitment significantly.

What I can tell the member is that giving CCAs a 23-per-cent pay raise, paying over 2,000 of them free tuition and books to go to school, 300 or more to get the Work and Learn program, 200 that we will pay to relocate here from around the country and around the world, plus the doubling of the PLAR from 300 to 600, we’re short several thousand staff. But with all those commitments and a multi-year investment, we are obviously hoping to get up to those staffing hours as quickly as we can.

Of course, it’s unpredictable, with Omicron, exactly what’s going to happen. When we went through waves one and two, each time we would be on the down crest of the wave we’d sort of breathe a sigh of relief, and then things would start to swell up again. It’s difficult to predict in the future. The one thing I can say, and what I’ve been hearing from around the province, is that the nursing homes that didn’t have any resumes on their desks are now getting requests. There are students who are going, oh, I can get paid to go to school for free, and I’m going to get paid that hourly rate? We are turning the tide.

One of the things I can say is that when you’ve had a decade of under-investment, staff getting injured, highest injury rate of all professions in long-term care, and when you cut funding for a couple of years and then make very minimal investments for the next four years, between 1 per cent and 3 per cent, and then you see a government in the eleventh hour throw a lot of money at it without, really, a strategic plan - actually, that reminds me. When you think about a strategic plan, the last time there was a strategic plan for continuing care, it was introduced in 2006 by the Conservative member of Parliament, the honourable Chris d’Entremont. It was a 10-year continuing care plan.

When the next government came in, in 2015, they made a commitment to a five-year plan. They said, in 2017 we will release a strategic plan. It was on their website, and then it wasn’t. For the next six years, there was no plan. They did have a strategy, which was the Home First strategy, and what happened is they didn’t build a single bed, they didn’t invest in new staff, they didn’t put more staffing ratios in, and the issues just kept building in long-term care to the point where people were leaving long-term care to go work in home care or to go work in a hospital setting, or, frankly, some of them to go back to work at McDonald’s.

One of the things I know is that when you are chronically under-staffed, chronically mandated to work late, you don’t want to work in this sector. My favourite worst story: I was at Ocean View, I think, only two or three weeks, and I had my back to the desk because I was charting on a client. Two CCAs came up and one slammed her fist on the counter and said - I won’t say the word she used - but she said, I have been mandated to work late again. And the other one said, yup, I wish those politicians had to spend one day working in long-term care to know what it’s like.

So I slowly turned around and lowered my mask enough so they would recognize who I was, and they said, oh, Barbara, we weren’t talking about you. We know you understand. We know you know what it’s like, because you’re here, working for free with us because that’s the thing you know you can do most, is to help us in a crisis.

You know why? Because they lost their physiotherapist, and they spent six months trying to recruit a physiotherapist for that facility. At the time, they had 177 beds. They offered two days a week for physio, and I can tell you, those two days a week that I worked for those first two months, I was run off my feet, and I know what I’m doing. I got what we call “crisis care” done. It wasn’t quality care as I know it.

Now Ocean View hired a full-time physiotherapist. People want full-time jobs. Our department provides extra funding to allow facilities that were hiring casual staff to offer them part-time and full-time positions. That is a significant change.

For the member to ask exactly how long it will take - we will keep going until we achieve that goal, and then we will continue to look at ways we can enhance and add on to that. But I am convinced that the free tuition, the significant investments in the salary rate, as well as the 4.1 hours of care - staff are already telling us, we’re going to stay now because we trust you and your government to make things better.

SUSAN LEBLANC: I’m so very pleased for the workers in long-term care who have been advocating for those changes for so long. I’m glad that they can trust their government on that one. That’s great news. I wish there were more people in this province who could trust the government. We could get into a back-and-forth on that one, I think, in terms of promises and needs. Anyway, I’m not going to go there, unfortunately - or fortunately for everyone.

[1:45 p.m.]

I wanted to say, I know that the minister is passionate about the work she does in long-term care and passionate about the work that happens in long-term care. I understand that. I would like to ask her, Madam Chair, through you, to not unnecessarily give the same information over and over again. I know that she knows that I have got questions that I really do feel would benefit the province. I’ve got a lot of questions and not so much time, so I’m wondering if we can, respectfully, try to just answer the question and keep the answers succinct.

I want to ask about Home Care. How is the government expanding the kinds of care available through Home Care in this budget?

BARBARA ADAMS: While my staff are passing me some information, I want to start out by giving you a sort of overview of what Home Care looks like and has looked like in the province of Nova Scotia, because I think it’s really important not to just look at a snapshot but where we came from.

The total number of Home Care visits - and I’m going to reference 2016 and each year for the next five years. In 2016, we had 4.1 million Home Care visits to approximately 29,000 people. Fast forward to 2020-21, and we offered 3.4 million visits to 30,000 Nova Scotians. What that equates to is, back in 2016, you would get about 106 hours of Home Care a year per person. That, just for those who aren’t aware, each Nova Scotian who is eligible for continuing care is eligible for 100 hours of care per month plus 50 hours of VON nursing care. That’s 150 hours a month. So you multiply that by 12 months and that tells you what your maximum amount is. Beyond that, that’s when people tend to need to be in a long-term care facility.

When you combine the hours of Home Care and VON care, back in 2016, the average Nova Scotian was getting 141 visits a year. In the next year in 2017, it was 141 visits, in 2018 it was an average of 132 visits. In 2019 it was down to 126 visits per year. In 2020 when COVID-19 hit, it was down to 116. We had 531,000 fewer Home Care visits in 2020 and 2021 than before. But even before COVID-19 hit, what we saw was the number of people who needed Home Care was going up and the number of visits they were all getting was going down, even though their need levels were going up.

What I can tell you, one of the things that we have done, is the Home Support budget. We have, on average, approximately 11,747 Home Support clients. Home Support is an integral part of the continuum of care that includes both community and residential services necessary to ensure the best quality of life for our residents. It’s a range of personal care and home support services delivered through home support agencies – non-profit and contracted agencies. These personal care services help clients with the tasks that you would be familiar with. So our non-profit agencies receive $138.7 million and our contracted agencies get $9.2 million.

There are a number of other benefits they are eligible for, there is the Instrumental Activities of Daily Living Program, there’s the Home First funding program, there’s the Adult Day Program and quite a number more in terms of supporting Home Care. I can go on if the member would like more details answered.

SUSAN LEBLANC: We’ve heard in some of our offices that VON has cut back on care time so medical and nutritional needs are not being met for some of the patients and clients. Has the minister heard this? I’m wondering if she can comment on that situation.

BARBARA ADAMS: Absolutely, I’ve heard it. Not only did I hear it as minister, but I used to be on the VON board of directors which, frankly, I joined because of the issues that I was hearing from my clients when I was managing a home care agency. When you have staffing struggles, one of the ways that agencies are trying to meet the needs is when you have a lot of people that all need to get out of bed at 8:00 a.m., you’ll often do something like what they would do with my mother which is they’d help get her bath, but they would say, “is there anything else I can do for you, Mrs. Hare?” and she’d say “no, I know you need to get going so you can head out.”

So the actual amount of time that they might spend with the client may have dropped because of chronic staffing shortages. That is not something that we want. Certainly we tremendously value VON, it’s one of our largest service providers, and we are working closely with them on our recruitment efforts. We know that our staffing increases along with the other investments that we’re making are going to directly benefit them.

One of the things that we have significantly increased is what we call the direct care benefits. If you aren’t able to get the kind of care you need because the agencies around you are not able to provide the frequency of care you need, we have increased those direct care benefits from $1 million a year up to $12 million and the change in the wait times has significantly increased.

When we took over as government back in September of 2021, there were over 1,468 people on the wait-list for Home Care. Now the wait-list is down to 1,157 which is directly attributable to the increase in the direct care benefits as well as all of the other investments that we’ve made in recruitment and retention.

SUSAN LEBLANC: Thank you to the minister for that, Madam Chair. I want to know - sorry, I didn’t get the answer that I was looking for, or any answer, in the previous question.

My question was: How is the government expanding the kinds of care available through Home Care and how is that reflected in this budget? Obviously, time is about to run out. The minister was getting some information from the staff there so I am just going to draw out the time and then she can answer next time.

THE CHAIR: Order. I will now look for the Liberals to start.

The honourable member for Bedford Basin.

KELLY REGAN: We will just continue on with a few questions for long-term care. Perhaps the minister could answer: How many Veterans Affairs Canada beds were licensed and funded since she has come into office and where are these beds located?

BARBARA ADAMS: I would like to ask for a 10-minute break to take care of nature.

THE CHAIR: Order. Of course.

I will call for a 10-minute recess.

[1:57 p.m. The committee recessed.]

[2:12 p.m. The committee reconvened.]

THE CHAIR: Order. The honourable member for Bedford Basin.

KELLY REGAN: For the minister, how many Veterans Affairs Canada beds were licensed and funded, and the cost, and where are these beds located?

BARBARA ADAMS: First of all, I want to take an opportunity to thank all our veterans. Certainly, we know, especially with what’s going on in Ukraine, how valuable all of our military personnel are, and I know that veterans who are in our veterans’ facilities are all heroes in our eyes.

Of course, we work very closely with Veterans Affairs Canada. We have temporarily licensed 141 beds. These were vacant beds that were not being used. They are located in Pictou, in the Veterans’ Memorial Building here in Halifax, in Middleton, in Lunenburg, in Harbour View Haven, in Taigh Na Mara, and in the Yarmouth Hospital.

KELLY REGAN: How many residential care facility and assisted living facility beds were converted to nursing home care beds, and again, where are these located?

BARBARA ADAMS: We have 23 from the private sector at Caritas Residence and we have 50 residential care facility beds.

KELLY REGAN: You’ve extended the agreement with Shannex and the Sisters of Charity to keep another 23 temporary nursing home beds open for another year.

[2:15 p.m.]

I’m just wondering, are there any conversations under way to make these permanent?

BARBARA ADAMS: It is certainly an important opportunity to add into our bed inventory as many as we can, so of course these conversations are ongoing. All of our private facilities certainly have the same staffing challenges that all of the publicly funded ones have. We are hoping that the investments that we’ve already discussed today will make a difference, both for them as well as us.

We will certainly work very hard to add as many beds, rooms, into our inventory as we can.

KELLY REGAN: I think at this time we’ll probably just move on to some questions about the workforce.

If the minister could answer how many continuing care assistants are currently trained and working in Nova Scotia? I think you may have dealt with that with my colleague. I was eating lunch, so I didn’t quite catch the numbers.

BARBARA ADAMS: I’m happy to repeat the numbers. There are funded 6,600 CCA positions in the system province-wide: 4,026 would go into long-term care and 1,914 would go into Home Care. There would be another 660, approximately, within the Nova Scotia Health Authority and in other facilities.

KELLY REGAN: Within those that are under your purview, how many permanent continuing care assistant vacancies are there in long-term care and Home Care here in Nova Scotia?

BARBARA ADAMS: A couple of years ago, after the Minister’s Expert Advisory Panel on Long Term Care report came out, around that time there was a survey that was created on staffing levels, vacancies, and illnesses in long-term care. As I mentioned earlier, unfortunately the previous government made that reporting system voluntary and many of the CEOs at the facilities said they did not have the staffing - because some nursing homes did not have human resources staffing to help - let alone to help with that kind of reporting. So we don’t have that kind of data now.

Unfortunately, because the CCA Registry was only implemented in February of this year, we won’t know until June of this year exactly how many CCAs we have. What we do know is that we have approximately 1,500 and I think 60 or so on the CCA Registry right now. They are being added every day, as we speak. It’s one of the pitfalls of being understaffed and not having mandatory reporting on staff vacancies for us to be able to answer that question.

Certainly, once interRAI is in, once the CCA Registry is complete, then we will be able to answer that question more exactly.

KELLY REGAN: Bearing all of that in mind, could the minister let us know how many CCAs have been hired since September 1, 2021?

BARBARA ADAMS: It is a very good question to know how many people are coming in and out of the continuing care sector. Until we have the CCA Registry up and running fully - in physiotherapy for example, you can look and pull up my name to see whether I am listed and where I am working as a primary occupation, that kind of data we will have once the CCA Registry is there.

Having said that, with respect to the recruitment efforts directly for CCAs, we had a trip to Singapore and Dubai and that resulted in approximately 150, as well as Health Association Nova Scotia had over 300 people they were working with to do the matches. Once HANS is finished matching placements with people who are interested, then it moves on to the employers in the facilities to do that hiring.

Of course, while they are hiring someone the staffing levels may have changed since then and because of what was set in place before - the staffing vacancy rates being done by survey as opposed to a mandatory system - we don’t have an exact number for the member today.

KELLY REGAN: There were some numbers the minister threw around there - 150, 300 I think - were those people who have actually been hired or just people they made contact with who might be interested? Could she just clarify what those numbers were that she mentioned?

BARBARA ADAMS: To clarify, it’s 150 from the Singapore/Dubai trip where we have made a match between someone who is interested and an employer in Nova Scotia. It was 350 that the Health Association Nova Scotia have made similar matches. It’s up to the employer, after those matches are made, to determine whether they are going to offer them employment.

Once we have the CCA Registry in place then we’ll know exactly how many net staff we have from one year to the next.

KELLY REGAN: Just to clarify, there have been matches made but none of these people have arrived? Or you don’t know how many people have arrived?

BARBARA ADAMS: The answer, as I was stating, is that once these matches are made then it is up to the employers to work with the applicants in order to determine how, when, and where they go to take their employment and because the CCA Registry is not mandatory, we don’t have those exact numbers.

KELLY REGAN: Does the minister have direct knowledge of any of those matches actually coming into the country and working, since September - any? It could be one. It could be 10. Does she have knowledge of any of these people actually coming? If so, how many?

BARBARA ADAMS: Certainly, I can assure the member that there have been new recruits brought in through all of these recruitment efforts. I don’t have that number with me and once the CCA Registry deadline comes up in June, we will certainly be able to provide the member with that number.

KELLY REGAN: I would just ask that the minister provide us with whatever information she has as of today, at the end of the day or at her earliest convenience next week, the numbers that have actually come in, in whatever manner you have them now. I understand it won’t be complete until you have the CCA Registry up and running later, but we’d like to know just where we are now. We’re 15 per cent of the way through this government’s mandate, and I’d like to know how recruitment efforts are going.

Can the minister confirm we require 1,400 continuing care assistants to deliver the promise of 4.1 hours per resident per day in long-term care, or is this in addition to the current CCA vacancies?

BARBARA ADAMS: Could I ask the member to repeat the question, please?

KELLY REGAN: I just wanted to see if we could get the minister to answer: Can you confirm we require 1,400 continuing care assistants to deliver the promise of 4.1 hours per resident per day in long-term care, and is this in addition to the current CCA vacancies?

BARBARA ADAMS: I’m happy to go over those numbers. We have already identified that there is a shortage of approximately 2,000 staff in the continuing care sector. In order to just meet the standards that were already in place, of somewhere between 2.6, 3.1, or 3.6 hours of care, we need to fill those vacancies of 2,000 CCAs, LPNs, and RNs.

If those are filled, then to get to the 4.1 hours of care for every facility in the province, then we need an additional 549 staff. That’s a breakdown of 23 RNs, 85 LPNs, and 441 CCAs.

KELLY REGAN: When we say we have a shortage of about 2,000 staff, how many permanent continuing care assistant vacancies are there currently in Nova Scotia, and how many temporary ones?

BARBARA ADAMS: I really wish we had that data, but as I mentioned before, the CCA Registry was only put into place in February of 2022. We are giving the CCAs until June to get on the registry. Until they all get on the registry, there is no way to know exactly how many staff we have, where they’re located, whether they’re part-time, or whether they’re full-time. That’s a gap that we wish had been filled a long time ago.

Unfortunately, as I mentioned, the reporting of staff vacancies is something that was a voluntary effort. Given COVID-19 and staffing shortages, historically, across the sector for a number of years, it is an activity that CEOs, frankly, gave up doing, because they had been asking for staffing increases for years. They saw their funding cut, and then at the eleventh hour, significant investment to try to overcome years of 1 to 3 per cent increases in budget.

They indicated that there needed to be a better way for us to be tracking staff. The interRAI assessment instrument certainly is gong to help with that. Once the CCA Registry is back in place and fully implemented in June of 2022, we will have that detail.

KELLY REGAN: Do we know how many nurses, licensed practical nurses, registered nurses, and nurse practitioners are employed by the NSHA to work in long-term care? They have registries, so we’ll go there.

BARBARA ADAMS: One of the major challenges is that people, including myself when I was in the sector, work in multiple places. We have staff that work part-time for VON and they work part-time for the NSHA.

Right now, there is no way we can specify exactly how many staff are working in each of the areas. Certainly, that is an issue that the Minister of Health and Wellness and I have talked about at great length. Oftentimes you will see somebody moving from a home care job into long-term care and now you’ve got a vacancy there, so you’re robbing Peter to pay Paul.

That information, unfortunately, has not been collected, historically. Certainly, we are moving toward a system that will allow us to do that. I understand why, to the member, it would be vitally important. In order to do human resources predictions, you would need to do that.

Just for the member’s knowledge, and for those in the House, we have 132 facilities, but the Nova Scotia Health Authority has only 16. We share many of the same staff. We would need to have the CCA Registry in place, as well as have the ability to identify who’s working where, and that system was not put in place.

KELLY REGAN: I’m genuinely curious here. The minister has identified that we have to have the CCA Registry in place before we know how many people we have. My understanding is - and please correct me if I’m wrong - that we do have a registry for nurses. We should be able to figure out from that registry how many nurses we have working in long-term care. Is there an issue with whether they specify whether they’re part-time or full-time? I’m genuinely curious here.

[2:30 p.m.]

BARBARA ADAMS: In terms of funded positions, we have 992 RNs working in long-term care. We have 189 working in Home Care. For the LPNs, we have approximately 1,746 working in long-term care and we have 87 working in Home Care. For our CCAs, as I’ve already mentioned, we have 6,600.

These are funded positions. Keeping in mind that during the pandemic, we brought in travelling nurses and travelling staff from outside the province. Many of these staff work overtime. Casual staff work part-time. These are funded positions. That’s the number that we’re working with now. Certainly, as far as the CCAs go, we will have a more accurate number in June.

KELLY REGAN: When we do create our CCA Registry, I certainly hope that we have a place for the CCAs to check a) where they’re working, b) whether it’s full-time, et cetera because otherwise we’re going to continue to run into this problem if we aren’t able to tell where people are working. We can have a registry, which is great, but if we don’t know whether they’re working full-time, part-time, or working at multiple facilities, that’s going to be a bit of an issue.

In February, the Standing Committee on Health wrote to the minister asking the Department of Seniors and Long-term Care to provide details of staffing calculations that would achieve the 4.1 care hours per resident per day, and 2,500 new single long-term care beds as per the minister’s mandate letter. The minister wrote back the following month and indicated the required staffing analysis is currently under way at the Department of Seniors and Long-term Care. My question is: Is that analysis complete? If so, could it please be tabled here in the House within the next week and also sent to the Health Committee?

The other question I have is: The minister’s response indicates that investments have been made to hire at least 13 nurse practitioners to provide primary care in long-term care facilities in the surrounding community. Could she just clarify if, yes, investments were made? How many of the 13 have actually been hired?

BARBARA ADAMS: I think there were two questions in there. One was about clinical nurse practitioners and the other was about the 4.1 hours of care.

Yes, the analysis has been done. We’ve referenced it a few times here today, but I’m more than happy to go over it again. Once the 4.1 hours of care staffing levels are fully implemented across the province, it would be an increase of $35.8 million per year to achieve the recommended target of the 4.1 hours of care. For this fiscal year we’re not anticipating that all facilities will be ready to do that, so we budgeted it at 70 per cent or approximately $25.1 million.

In terms of how many new staff will be required - that’s above and beyond those staffing vacancies that we already know about up to 2,000. To get up to the 4.1 hours of care for every facility across the province, for RNs it would be 23, for LPNs it would be 85, for CCAs it would be 441. That’s for a total of 549 actual staff. When you think about the actual impact that will have on the sector, we’re talking about just long-term care for approximately 7,926 residents.

When I first learned, during the pandemic, that there was a hotel that had opened up providing care for some long-term care residents, I was initially concerned because it was in a hotel. I met some of the staff who were working there and I said, “How do you find it here? It’s a little unusual to be in a hotel.” They said, “Oh, we’re staffed at 4.1 hours of care.” I said, “Well, what does that mean?” They said, “It means there’s somebody there when I go to lift that person that needs a two-person transfer, there is someone there that I can ask.”

The physician was on duty. There was enough occupational therapy and physio staffing. There were recreational staff and when they needed to go take a break or go for their lunch, they actually got to do so. They were not mandated to have to work late. The 4.1 hours of care is the minimum standard, but it is going to take approximately 549 staff in order to meet that 4.1 hours of care per resident per day. That’s just for LPNs, CCAs, and RNs. There is also the investment in terms of physiotherapists and occupational therapists to make sure that’s equitable across the board as well.

I believe the member was referencing clinical nurse practitioners. One of the things that we did is we announced 13 clinical nurse practitioners to work in long-term care. The reason for that is, historically, we had a lot of family doctors who covered their own patients in long-term care, but many years ago they moved towards a new system where physicians might cover an entire floor of a nursing home, which made it much more practical, much more consistent. The staff knew when someone was coming in, they knew who to contact about each individual client.

The same staffing shortages for family doctors hit long-term care. There are physicians who, because of the pay, don’t want to work in long-term care. There was a situation that happened - and I forget exactly which year it was, but I remember it was the same day that the then-Premier was announcing the opening of the Dartmouth General Hospital’s new wing. The day before, nursing homes in Truro and Debert had to make an extraordinary decision when they lost their physician coverage. They said, if you were in our long-term care facility and you got admitted to hospital, we were not going to allow you to be transferred back into our facility because we did not have any physician coverage to admit you back in again. So that is a major problem.

What was needed, and we have now started, is a physician strategy for long-term care. We are working with the physicians in partnership with the clinical nurse practitioner care providers. What that will look like is we want to ensure that every facility has sufficient medical coverage. Not just medical coverage, but medical director coverage. What that means is that every facility is supposed to have an identified medical director, but it varies across the sector. There are no real defined requirements for a medical director, no identified hours of care that they need to work, or their duties or their responsibilities, which is kind of surprising, but that is what needs to be in place.

The priority for us, right away, was to make sure that there was primary care coverage in all of these facilities. I know that according to the legislation there is supposed to be an RN overseeing all long-term care facilities, but that has changed and now some facilities have an LPN on duty at all times. Of the 13 clinical nurse practitioners that we’ve identified so far, I am very pleased to say that we have hired six already. Four of them are in process, and three positions are being re-posted. It will be 13 full-time-equivalents for 15 positions.

KELLY REGAN: The minister just said 15 positions. I think it was 13 because six and four and three makes 13, so I will just sort of add that into my question there. Could the minister just indicate where those particular nurse practitioners are stationed?

BARBARA ADAMS: Just to clarify, there are 13 full-time-equivalent positions but there are a couple of those positions where the person is not going to be working full-time. It will actually be 15 positions filling those 13 FTEs. In terms of where we already hired them, Sydney is one, Antigonish, Halifax, New Glasgow, New Glasgow, and Halifax.

KELLY REGAN: And those are the six that you have already hired. Can the minister indicate where the other nurse practitioners will be going?

BARBARA ADAMS: Of course, these are postings that are available to be seen online, so I will just go through the list. There is Queens, Shelburne, Annapolis, Digby area, Kentville, Sydney, Glace Bay, and New Glasgow.

KELLY REGAN: In the minister’s letter to the Health Committee there was a reference to $3.1 million in tuition rebates for current continuing care assistant students. I’m just wondering, what has the uptake been like for those students? Did we see a big increase in the number of students who are taking that course this year? Could she quantify it, what that increase was?

BARBARA ADAMS: I am always happy to talk about free tuition. Of course, the $3.1 million initial investment is for the students who are currently in the program. They haven’t graduated yet but they do know, and of course were ecstatic the day we announced it, that upon graduation if they are willing to sign a Return of Service Agreement for two years to stay in the province of Nova Scotia, they will take that. Of course, they are still in school so they haven’t signed those agreements yet but we are anticipating that a great many of them are certainly going to do that.

[2:45 p.m.]

KELLY REGAN: Could the minister let us know how many students are currently enrolled in school to become a CCA?

BARBARA ADAMS: What we have in the traditional CCA program roll, we have 300 students currently in the program right now. We have 109 in what’s known as the Work and Learn program. We have 90 registered to start the program very soon. Certainly we have more courses being added as we go along.

In terms of just the overall picture what this looks like, there are eight CCA training institutions that are receiving funding to provide the free tuition and the books. The Nova Scotia Community College, Eastern College, CBBC Career College, Island Career Academy, Université Sainte-Anne, Oxford International, PeopleWorx, and Futureworx Career College.

The 106 students have entered the free tuition CCA Program as of March 1, 2022. This does not include the students who were already enrolled before the December 8, 2021 announcement, who are enrolled for future dates, beginning after March 1, 2022. As I said, 90 of those students are registered in the Work and Learn program as of March 1, 2022.

The number of training seats that are available in Nova Scotia: of the 360 NSCC, there were 300 that were filled. Of course, a number of Work and Learn seats that are approved are not yet finalized. What we are planning is $3.1 million of free tuition and book reimbursement for as many students as are willing to sign on with us. We have provision for up to 1,000 this year if we’re able to get enough seats for all of the students and we have enough registrants.

KELLY REGAN: That was a nice, full answer.

In terms of some other staffing, I do recall an announcement the minister made, it was a call for volunteers, to people to come and help in long-term care homes and volunteer. I think, if I’m correct, the minister identified 55 people who are volunteering. Are they still volunteering at the nursing homes?

BARBARA ADAMS: It was extraordinary for people to be calling us up saying we want to come and help work. They may have retired and were looking to come back. Of course, there were licensing requirements so the staff who stepped up did so back then, but whether they maintained an employment status with those facilities - we have over 140 employers so I couldn’t comment on how many are still actively working for the sector.

I certainly do want to thank all of them for coming back to work in the middle of a serious situation, along with all of the students as well as the Red Cross staff and, certainly, the staff who came in from other provinces to help us out. It was an extraordinary thing they did and of course with over 500 students as well who stepped up, we are extremely grateful to all of them.

KELLY REGAN: Actually that leads me to another question which is the Red Cross. I remember seeing - I think it was something from a federal MP - that the Province had reached out to the feds and I think they were providing funding to bring in the Red Cross to assist in long-term care homes.

Could the minister describe what that assistance was? I was never really clear on what it was. Is that still going on? Do we still have workers paid for by the federal government who are from the Red Cross helping out in nursing homes?

If I’ve got the wrong end of the stick there, please do elucidate.

BARBARA ADAMS: Absolutely, the Red Cross came at the request of our department to the federal government, and they did come in, in a big way. Their contract ended at the end of March. I am so happy to report that Roseway Manor was able to reopen their facility. We are extremely grateful to the Red Cross staff who went in there, in their moment of need, to allow the staffing to build back to the point where they could open their doors. I would like to thank all of the Red Cross and the federal government for responding to our request because we made the request and they responded very quickly.

Of course the Red Cross, as the members would know, has been instrumental in making sure that our vaccination rollout phases all across, and to come - the Red Cross has been instrumental in making sure that happened as quickly as it did. Of course, as a physiotherapist I can’t tell you how many times I’ve been out to the Red Cross for the Health Equipment Loan Program. We offer free equipment to seniors across the province in order for them to temporarily, or in some cases palliatively, borrow the equipment they need, so the Red Cross staff were certainly there to help us with that.

Of course, we also have the lift loan program, as well as the Community Bed Loan Program as well. All of the staff in Red Cross have been working overtime to make sure that what Nova Scotians need, they are there to help us provide that. I do want to thank them again, and again to thank the federal government for their willingness to provide those funds to allow us to do that.

KELLY REGAN: I do just want to double back, and this is a question that one of my colleagues had asked me to mention. Because of inflation, some of the projects for nursing home beds have received, it’s our understanding, additional funds. I’m wondering if we could get a list of the projects that have received additional funds to account for the rise in building costs.

BARBARA ADAMS: I just want to clarify. I think I know what the member is asking, but I just want to clarify. Are you asking about a current facility that’s been under construction and cost increases, or are you talking about the CPI announcement increase that we were talking about during my speech yesterday?

KELLY REGAN: No, the construction projects.

BARBARA ADAMS: Of course, we all know that we’re in a housing crisis, and one of the things that has impacted everyone is the exorbitant increases in construction materials. There is the MacLeod Mahone Bay Nursing Home that had come back to our department because the construction costs had increased. There originally was $42 million, and they asked for and were approved for an additional $12 million because of the cost of construction materials going up. That was from $42 million up to $54 million.

I had an opportunity to go down to view the facility, and it was quite something to see where it was located, and where in the community it’s going to be constructed. As unfortunate as cost overruns are, I think they are something that we’re all aware are going to continue, especially over the foreseeable future where we are still in the middle of the pandemic. And there are other factors like the war in Ukraine that are impacting things like gas prices, which directly impact the cost of construction materials.

That is the only facility that is currently under construction that has received additional funds for construction cost overruns.

KELLY REGAN: Has any facility had their construction budget reduced?

BARBARA ADAMS: Of course, the whole construction process is a very lengthy one, and as we go through each step of the process, which I won’t go through again since it was so exciting the last time. What I will say is that at several steps of the process we are reviewing the budgets. In Step 4 there is the updated projected budget and then at several other phases along the process that budget gets refined, so that process is ongoing.

KELLY REGAN: I will take it that some have had their budgets adjusted or the plans adjusted to fit the budget, from the minister’s answer.

Because we are short on time here, I’m going to move on to Home Care, just some quick questions that I’m going to bunch together. I apologize if it’s a lot to take in but I know there are crack people there with the minister who might be able to take the questions down. How many Nova Scotians are currently receiving Home Care services? How many are receiving some service, so partial service? How many are waiting for full service?

BARBARA ADAMS: Just to be clear, there is no construction project that has had its budget reduced. I want to be sure that the member is clear on that.

What I can say in terms of the number of clients who received Home Care, historically - so that we can talk about our numbers as my staff are gathering them, as you say. Historically in 2016, 4.1 million Home Care visits were done. In the next year it was almost 4.2 million. Then it was 4.2 million. Then in 2019-20, part of the pandemic, it dropped down to 3.9 million. The following year, in 2020-21, it was down to 3.48 million visits.

[3:00 p.m.]

What that worked out to was an average of 106.6 Home Care visits per person per year in 2016, then 97 Home Care visits in 2018, then 95 visits in 2019-20, then down to 79.5 Home Care visits in 2020-21. So there were 531,000 fewer Home Care visits in Home Care in 2020-21.

As I say, the biggest challenge people have when Home Care gets cancelled is the families were counting on someone to show up, often so they could go out to get groceries or go to the pharmacy to get medication. Any time someone cancels it is a problem.

Right at the moment the number of clients for 2021-22 is a total of 38,575. That’s a significant increase from previous years. That’s probably reflective of the fact that there are so many people waiting for long-term care - residential care as well as long-term care.

What we have is the nursing care side of Home Care is 21,613 clients and in home support, which is non-RN level care, is 16,962. What that means is that some people are getting a combination, they may be getting RN care for the wound, because they were discharged early from hospital, but now they also need CCA level care for personal care, but then they may need a nurse to come in because of medication or to put on their pressure stockings.

The good news for Home Care, because we have expanded direct benefits which means that your family, the caregivers, the loved ones would be given the money to directly hire people who they know, they trust, who are living locally with them. We’ve directly increased those benefits from $1 million a year up to $12 million a year. The wait-list for Home Care when my government took over in September was 1,468 on the wait-list and now the wait-list is down to 1,157.

I want to thank all of the Home Care staff in the province, who I know have been impacted not just by COVID‑19 but by the escalating gas prices which have had a significant impact on every single person who works in Home Care. I thank them for continuing to show up for work and to do the great job that they do.

KELLY REGAN: Can the minister share the cancellation rate for Home Care is this past year, in 2021-22, versus the year before?

BARBARA ADAMS: One of the things that I will say about the cancellation rate is that I had reviewed it when I was in Opposition, and I had a hard time reconciling with the actual number of cancellations that were reported by the department. This was because there was a significant percentage of the cancellations that were being reported that the families or the client themselves had cancelled.

My experience from working in Home Care for 10 years is that the number of times that the Home Care agency had to call and cancel because they had insufficient staff was significant and was often on evenings, weekends, and holidays. Right now, the cancellation rate year-over-year, I don’t have that degree of detail. What I can say is that especially since January - keeping in mind we haven’t actually talked about this but back in I think it was November, I don’t remember the exact date, we had a mandatory vaccination policy.

That was very important to the protection of everyone who worked in Home Care and in long-term care. There was a concern that we would not have enough staff who were willing to get vaccinated. What I know is that there were fewer than 100 staff - we have over 15,000 staff in our sector - who did not get vaccinated, and they have their own personal reasons for doing that.

Since before January, there were 1,700 missed appointments. Now it’s down to 810. With increased staffing ratios, we are seeing fewer cancelled visits, and that is always a good thing. One of the things that you’ll hear in Home Care over and over again is not just that those visits get cancelled, it’s that a different person shows up often every consecutive day. When my mother was getting the VON years ago when she had cut her leg after a fall - she had VON come in every day for three months to dress the wound - I can’t think of how many days it was the same person who came two days back-to-back.

One of the things that has been an issue in Home Care especially is that a lot of the staff do not have consistent schedules. If a client cancels, they aren’t getting paid. That’s a very difficult industry to recruit to when you are not having consistent staffing levels and consistent staffing visits with your clients because of cancelled visits. Those cancellations are on a downward trend. What we expect once the CCAs make it through their programs and sign those return of service agreements, and we can see some of the others brought in from across the country and around the world, we expect to see those Home Care visit cancellations go down.

KELLY REGAN: I have so many more questions for Home Care and community care, but our time is drawing to a close. I would just note that in the past seniors had its own department, and there was quite a bit of focus on seniors aging in community, aging in a vital way. Let’s face it, there’s only a small proportion of our seniors in long-term care at any given time. Some may be getting Home Care.

We didn’t hear a lot in this budget, and we really haven’t heard a lot from this government, about making sure that seniors live vital lives. I did hear the minister allude to a couple of programs, I think, when she was speaking with my colleague from the NDP. We really haven’t seen or heard much from the government around this particular area.

I did want to flag that for the minister because we know that just in terms of demographics, the vast majority of seniors are not living in long-term care. A lot of them are actually still working right now, particularly because of what we’re seeing with the cost of living and the fact that we’re in a cost of living crisis. Who does this affect most of all? Well, people living on fixed incomes and that is pretty much the definition of most seniors. I did want to raise that particular issue for the minister.

I’ll just leave that with her for her consideration, that there is work underway, begun in 2019, by our government, on long-term care homes, expanding those. I’d be happy to table all of the announcements that were made back in 2019 and after that; I’ve got them around here somewhere on my desk. I’m happy to do that.

What I would say is that we have to also remember that seniors are a vital part of our communities. They’re our volunteers. When I think of my home community of Bedford, how many people are volunteers, how many seniors still work, how many provide really important services in our communities.

I’ve begun to receive communications, whether by phone or letters or whatever, from people I really respect in my constituency who are deeply concerned about the fact that there is no mask mandate right now. They are at the point where they’re deeply concerned about going out. People are being told to go out, have fun, get out there. These are seniors who are fit and deeply involved in our communities, and they’re looking around - remember that masks protect other people, not ourselves.

Suddenly a whole bunch of people are not wearing them anymore because they feel that they’re invincible. They may be, but the seniors on the elevator with them are not. I just want to know what the minister did to actually ensure the masking mandate continued.

THE CHAIR: Order. I’ll now turn it to the NDP caucus.

The honourable member for Dartmouth North.

SUSAN LEBLANC: I just wanted to ask before I begin my second round of questions, number one, I’m wondering if the minister would please table the list of the ongoing bed builds. At least, in the first round with the Liberal caucus, the minister listed the different long-term care bed projects that were going on. I’m wondering if that could be tabled.

I’m also wondering what amount of the department’s budget for this year comes from federal grants and monies.

BARBARA ADAMS: To the member’s first question about whether we could table the list of facilities, absolutely. I know that everyone wants to know exactly where all these facilities are going.

[3:15 p.m.]

The other thing I will remind everyone of and encourage is that my office has extended an invitation to every MLA in Nova Scotia to have a sit-down, one-on-one with me to go over their constituency concerns and needs, and the impact of Home Care and long-term care and Adult Protection Services and the Department of Seniors and Long-term Care on their particular constituency. I am happy to do that.

I’m also looking forward to having an opportunity to talk more about the role of the Department of Seniors and Long-term Care in our facilities I remember hearing in the past once when someone said that the former Department of Seniors did not want to be lumped in with Continuing Care. I certainly know from the staff at the Department of Seniors and Long-term Care that they are actually thrilled to be part of a $1.2-billion department and to be working very closely with all of the sector.

I want to reassure all the members that there are over 200,000 Nova Scotian seniors in the province. Approximately 55,000 of them are frail, approximately 7,926 of them are in long-term care, and we’ve already referenced how many of them are receiving Home Care. The rest of those seniors, who are vital and working in businesses and community groups and volunteering and teaching and in the arts - those are all extremely important seniors as well.

Having said that, when the house is on fire, you put the fire out first. The focus of the previous government - they took their eyes off long-term care and we have put it back on where the priority and the crisis was, especially when COVID-19 hit.

I want to reassure every member of the House that the Department of Seniors and Long-term Care cares about all seniors in Nova Scotia, and there are dozens of other investments that have been made in multiple departments, which I am sure none of the members here want me to repeat, in terms of economic development, infrastructure, housing, transportation. I will save them the list.

All aspects of help for seniors are vitally important to me, and having met and in working with Dr. Ken Rockwood, I am acutely aware of Frailty Level 1 senior needs, as well as Frailty Level 9 senior needs. We will be moving to address all of those as well, but we had our focus on what was most critical, and that was Home Care and long-term care.

In terms of the investments of federal government funding - of course, there is the bilateral agreement and the funding that comes in. The Canada Health Transfer payments that come in, as well as some other federal funding, those go straight to the Department of Finance and Treasury Board. That would be the minister you would want to ask those questions for. But in terms of what that federal funding went to, in terms of the Department of Seniors and Long-term Care, is the Adult Protection database, the Caregiver Benefit, the CCA Registry, the CCA student bursaries, the continuing care Blueprint for Change, the home lift program, home oxygen, and the utilization of increase in nursing visits from VON.

Just for those who aren’t aware, the number of Home Care visits by non-VON dropped by over 530,000 visits last year, but the number of VON visits actually went up from 947,408 to 1,083,826. Despite the staffing shortages in nursing, there were more people getting VON-level care, and that’s primarily because so many people, because of COVID-19, had to be discharged shortly after their surgeries and there was a lot more wound care that had to be done. So the increase from the feds to help with nursing visits and VON was critical.

The others were home support utilization, the joint pilot shared-service model for the Department of Health and Wellness, the Department of Community Services, and HNS, the Self-Managed Care Program, the Supportive Care Program, the U-First! education program with the Alzheimer Society of Nova Scotia, the workplace safety consulting, the wound care clinicians program, just to name a few.

SUSAN LEBLANC: That was eight minutes to answer the question that wasn’t answered, actually. The minister’s answer was to tell me to look at Finance and Treasury Board, but I find it really difficult, as the minister of a department, Madam Chair, that the minister would not know where the funds are coming from in her budget. I really wish she would answer the question: What levels or what lines of her budget are funded by federal programs? I think if I was the minister, that I would want to know that information.

I’m going to go back to another question, which was the one I ended my last hour with. My question was: How is the government expanding the kinds of care available through Home Care? Where is that reflected? The minister did talk about the kinds of work going on through Home Care, but she did not talk about where I can find it in the budget, so I’m asking that direct question. I know that she was asking staff to get that information for her. The question is: Where in the budget does it reflect the kinds of care available to Nova Scotians for Home Care?

BARBARA ADAMS: To the member’s question, she asked me to list where the money from the bilateral agreement was going, in terms of our program. I read a long list of the programs that are being funded by the federal government. I’m sure she doesn’t want me to read them again, but I did answer the question. The list is there, and these things that are included in that budget from the bilateral agreement are in our budget.

With respect to the other question, in terms of where in the budget are our programs listed, I’ll direct the member to page 20.5 in the budget book, called Seniors and Long-term Care. That’s where we list it in the budget and under Home Care there’s $53 million in new money. Under Programs and Services, for nursing services the 2021-2022 estimate was $85.6 million, and the 2022-2023 estimate is $87.331 million. For Home Care and home support services, which includes wages, the estimate in 2021 was $148.715 million and the estimate in 2022-2023 was $157,899,000.

In the Home Care provincial programs, the estimate was $60 million and 50 in 2021-2022 and in 2022-2023 the estimate was $103 million and change. These are things that the expansion of the home support program, the Seniors Care Grant, which is up to $30 million in additional investments and expanding the salaries for the CCAs across the province, as well as putting in funding for the 4.1 hours of care. These are just some of the programs and that’s where they’re located in the budget, in the book which is $53 million of new investments in Home Care.

SUSAN LEBLANC: I’m sorry, I was confused by the long list of things that she read out in a bilateral agreement because right before she read them, she said that I had to ask the Department of Finance and Treasury Board so I stopped listening to be perfectly honest with you, Madam Chair.

I have another question about the budget on Page 20.4 under Seniors’ Initiatives, funding for Age-Friendly Community Program and Senior Safety Programs also includes collaborating with departments across government on the development, implementation and monitoring of policy, engaging stakeholders, and creating partnerships. In the Estimate of 2021-22 the amount was $2,136,000, the forecast was $1,792,000, and then the Estimate this year was $1,633,000.

I was wondering, can the minister explain the cut on that line?

BARBARA ADAMS: I admit to being dismayed that the member stopped listening to me while I was speaking. That’s never happened to me before.

When I referenced that she would need to speak with the Department of Finance and Treasury Board, what I was speaking about specifically was the Canada Health Transfer payments. Those specifically come to the province for the health of each Nova Scotian. So that’s not specific to my department. Then everything else that I referenced, including things like the CCA student bursary, the registry, things like that, I won’t go through the list again but that’s what that was referencing. Some federal money comes straight to us, the rest of it goes to the Department of Finance and Treasury Board.

With respect to the member’s question, it’s a very good question because you never want to see a line in a budget going down. It’s always the first thing that I look for so what I can tell the member is that this was the social innovation NS GovLab that was moved to a different department. Although it looks like the smaller budget line item for me, we didn’t get rid of it, it has been moved to a different department, so it is still there. There have been no cuts in any department lines for my ministry.

SUSAN LEBLANC: I have to say, I’m sorry the minister’s dismayed by the fact that I stopped listening but frankly, Madam Chair, there has been an awful lot of information that has not been asked for. So when that kind of thing happens, people tend to stop listening. I can guarantee the minister that it’s been happening all afternoon.

I hate to say that. I have much respect for the minister’s position and the minister’s office and I know how much she cares about seniors and these terrible issues in this province because I watched her in Opposition for four years rail against the government about it and I had a lot of respect for the way she did that. However, she’s not answering questions today. We can all agree on that.

I want to ask a question about energy poverty which I probably will not get an answer to because probably the minister’s going to punch it over to the Department of Natural Resources and Renewables, but I’m going to ask it anyway.

A common definition of energy poverty is a household who spends over 6 per cent of income on home energy costs - does the minister know how many Nova Scotia seniors are living in energy poverty?

BARBARA ADAMS: So, as the member would know, I am very passionate about my particular portfolio. I eat, sleep, and breathe it every single day. There are some facts in some other departments that I simply do not have the knowledge of, nor would anyone expect that I would have information that would be in the purview of another minister. I could ask the minister or perhaps during Estimates the minister of that department could be approached about that because it’s certainly an important issue. I do know that the facilities that we are going to be building are more energy efficient, and that is something that is within my government department. I would be happy to talk about that if the member would like to know more about our energy efficient long-term care facilities.

SUSAN LEBLANC: No, thank you. That’s okay.

The PC platform explains that in order to meet the staffing needs in long-term care - never mind, I’m going to ask a different question. Glen Haven Manor, Madam Chair, was a publicly owned nursing home that has recently contracted a private management company to manage the operations of the facility. Some are concerned about this move because it means that accountability for running the home is transferred to a private entity. I’m wondering if the minister can please address these concerns. I will say that they have come from family members of residents who live in the home.

BARBARA ADAMS: The governance of every long-term care facility in the province is a concern to all Nova Scotians. What many people aren’t aware of is that it is the boards of directors of these facilities that oversee the actual functioning of these facilities. There are 132 independent organizations.

[3:30 p.m.]

In this particular case, the owner of that facility is the one who determines who operates their facility. Having said that, we have a mixture of privately owned, non-profit, and for-profit businesses that are operating in the province of Nova Scotia and of course around the world, and some are municipally managed as well. What I can say though is that every facility is inspected the same way. Every facility has the exact same set of standards. We have not had the exact same set of staffing ratios, and things like flow-through envelopes that ensure that staffing levels are kept is something that we are going to be bringing in in the Fall.

Right now, what I can say to the member is that every facility must meet the same level of standards. Certainly once interRAI is in place in all of the facilities - that starts, I believe, in May 2022 - we will have a much better idea of the level of frailty and acuity in all of these facilities. There are a lot of residents with dementia, and those with challenging behaviours. We haven’t actually mentioned that we have expanded our challenging behaviours units around the province as well.

To the member’s question, it is very important, and when there’s change made in terms of who is overseeing the facility, you want to be sure that the same level of care is maintained. I’m so glad the member brought it up. The legislation governing this sector has not been changed for decades. I know that previous governments of all colours and stripes have left it undone. This government is doing that. Some of the concerns that the families would have, we will be addressing when we are in legislation.

I want to assure the member and all Nova Scotians that we care deeply about the quality of care that is offered in every long-term care facility in the province. We will certainly be - we work with every facility every week. There’s always sector calls that are going on. We are aware of what’s going on in facilities. Should anyone ever have any concerns, certainly they are welcome to reach out to our department. Our staff are amazing in responding back. We would certainly be happy to do so if there was a family member who had a certain question or concern or recommendation or idea. We would be more than happy to speak with them.

SUSAN LEBLANC: Our caucus has heard from someone whose family member was placed in a home still within HRM but an hour’s drive away from the family in Middle Musquodoboit. When the family agreed to the placement, they were under the understanding that the resident could be moved to their preferred placement, one in their community, once a space became available. Shortly after the placement, the family was told by their continuing care coordinator that the policy of transferring patients to their placement of choice was no longer in place.

They were advised that the province’s priority was to move people from hospital into care. The family understood that they may have to wait due to the unprecedented situation, but they were very distraught at the information that their family member would never be moved.

After our office inquired about the situation, the family was told that the policy has not, in fact, changed. I’m wondering if the minister can please provide clarity. We understand that there may be longer waits due to the ongoing pandemic, but has the policy changed? Why was the family told that the policy had changed?

BARBARA ADAMS: I’ve heard that story hundreds of times, unfortunately. The situation is that in the past, there was a priority list in terms of who got in when. That was changed by the previous government in approximately January of 2020, shortly before the pandemic started. That was, I was told, in part because of the escalating number of people waiting from acute care to get into long-term care.

The variance that was put in place said that the priority and the primary admissions were going to go from those who are in acute care beds to get into long-term care. Unfortunately, I didn’t know that until I became minister. I had no awareness that that variance had been put into place and that people from home were not being told that for the next undetermined number of months, now years, we’re taking primarily only people from acute care beds.

Then in the Spring of 2021, shortly before the election, the then-Minister of Health and Wellness stopped the reporting of long-term care wait times because with the variance - which you calculate based on how long people are admitted from home or admitted from hospital - they weren’t calculating that anymore.

What that person got told originally - that they could not be moved, ever - is not correct. When people contacted our department about that, we clarified that. What I do know is that there are hundreds of people across the province in the wrong bed, as far as their families and they are concerned.

When we asked about whether or not a match could have been made - if there’s somebody here who wants to be there, and someone there who wants to be here - could you not have just switched them? They could have if it wasn’t for the pandemic.

Given the constraints that were in our long-term care facilities, especially in Wave 1 with what happened at Northwood, the last thing Continuing Care told me that they wanted to do was to move someone from one facility and one bubble - we all remember bubbling. We’re not about to move somebody who is already in a bed to another bed. That is heartbreaking because I know that we drove an hour to get to my grandmother in Windsor.

Although it sounds simple - because one of the first things I asked when I became the minister is why can’t we just swap them all to the right beds? It was because of the pandemic and the staffing shortages that we were not able to do that. When you move someone, as simple as it sounds, they have to get re-admitted, re-assessed, have a whole new care plan established, and set up community counsel with the families. It’s a very big deal to move someone, as simple as it sounds.

I will commit to the member that that is something that is top of mind for us. One of the other things that was not in place but will be, is what we call a bed placement system. It’s an electronic system that helps us place people. Right now, it’s pen and paper, and it’s extremely time-consuming and not at all efficient.

For all those who are waiting, and there are hundreds in the exact same situation, I am so sorry that you are not close to the loved ones that you need to be with, especially now that up to five people can go in to visit. I guarantee you, as soon as each of our nursing homes has the ability to transfer, we will do that. With the $66 million going to CCA wages and the $17 million for the recruitment and the retention and the training of CCA students as well, and the salary increases and the raising of the hourly rate, that is all going to go towards achieving what the member is asking about, getting people into the nursing homes, long-term care and residential care beds closest to the family and the community that the loved ones want to be in.

SUSAN LEBLANC: Many long-term care facilities in the province that are older, and there are many, do not have air conditioning systems. Of course, Summers are getting hotter and hotter, and these conditions can be downright dangerous for residents and staff. I’m wondering if there’s any funding in the budget to upgrade HVAC in long-term care and if so, how much?

BARBARA ADAMS: When I started working up at Ocean View, it was warm. I remember being surprised when I saw them starting to put in some air-conditioning systems because when I had first gotten elected, I had calls from the residents there asking, why can’t we have air conditioning? I was told it was because the buildings were too old. It turns out they were able to make that happen. There is what’s called a capital repair fund. Through that, facilities can apply for the funding to do that. This year, we increased the funding in that budget to approximately $10 million.

SUSAN LEBLANC: That’s great information to have. I’m wondering if that fund would also apply to addressing ventilation in long-term care, given the evidence of airborne COVID‑19. I’m wondering if organizations might be able to apply to that fund for improving ventilation systems, in light of COVID‑19.

BARBARA ADAMS: I used to work at the Nova Scotia Environmental Health Centre, and air quality issues were a constant concern, both in health care, especially, and in education. The answer to the question is yes. They can apply for the funds for those reasons as well. One of the things that was necessary was the condition assessments of all the facilities around the province. Those are ongoing in terms of establishing a priority list of needs. Certainly, ventilation and air conditioning, especially in a COVID‑19 environment, are of top priority.

[3:45 p.m.]

SUSAN LEBLANC: I’m going to pass the rest of my time on to my colleague for Cape Breton Centre-Whitney Pier for the rest of the hour.

THE CHAIR: The honourable member for Cape Breton Centre-Whitney Pier.

KENDRA COOMBES: I know the minister talked about the responsibilities of what is and what isn’t in her department. My hope is that she is working with the other ministers very closely with issues that are important to seniors.

With that preamble, I am going to ask this question. We know the cost of living is wreaking havoc in Nova Scotia, the ability to afford essentials. A recent poll from Angus Reid found that people living in Atlantic Canada are the least likely of anywhere in the country to be able to afford an unexpected cost of $1,000; 40 per cent of people could not manage an unexpected expense of any amount. Although poverty for those age 65 and older is generally lower because of the federal income supports, Nova Scotia reports the highest poverty rate in the country for this cohort, which is 7.8 per cent.

What is the plan to address seniors’ poverty? I’m going to ask that to the Minister of Seniors and Long-term Care in hopes that she is working with her counterparts to deal with this issue.

BARBARA ADAMS: I know that her party has raised this issue a number of times. One of the things that I’m aware of as a health professional is when you see a client and you recommend that they need a cane, that costs $20, in order for them to be safe in their home, and they tell you they can’t afford it, that is heartbreaking. That is something I feel very deeply every time I meet with someone who comes through the door because, let’s be honest, those who are well off are not coming through my door asking for help to fund a walker. They are the ones who are most in need, who come through our door.

One of the first things I know - and I mentioned it last night, although I understand it froze a bit - is when seniors start to lose their balance, they lose the ability to carry and walk with items at the same time. When you combine that knowledge with our wonderful program 211, and you ask them, what is the number one call to 211 looking for help, it is help with snow shovelling and mowing the lawn and groceries.

Within the first three months of us getting elected, we implemented the Seniors Care Grant for low-income seniors. That’s $500 straight into the pockets of up to, I think, 70,000-and-change seniors who are eligible for that grant, with an income level of lower than $37,500. That’s an over-$30-million program. That’s a very significant investment to help the lives of those seniors who are of low income. Of course, that’s in combination with the Heating Assistance Rebate Program, which helps Nova Scotians with up to $200 to help with heating costs, which I know have gone much higher here.

There’s the Home Energy Assistance Top-up as well. Then, of course, there’s the Property Tax Rebate for Seniors for low-income seniors as well, which is a very successful program. Then, of course, with the Department of Municipal Affairs and Housing - which, as I say, I am fortunate that my deputy minister is the deputy minister of both - we have the Home Adaptations for Seniors' Independence program. Now, I will be the first to say that home repair is a critical need and a lot of people who need a $12,000 wheelchair ramp can’t afford that, even with a rebate, so there is a lot of work that still needs to be done with that.

The other thing is we have the Senior Safety Grant, and we increase the number through the Department of Seniors section, the Positive Aging Grant Program as well.

A couple of other things are, the equipment that people borrow when they are injured or ill or palliative, frankly, comes from the Red Cross. The member has heard me say - well, it was in the last session of the Legislature - I could not find a pediatric walker for one of my constituents whose seven-year-old daughter suddenly lost the ability to walk. There are a lot of organizations that acquire that equipment and help loan it out. The Red Cross is one of the main ones, so we put an extra $500,000 this year into their equipment fund to help them do that.

There were a lot of other investments, but in terms of those directly addressing seniors with low income, those are some of the key initiatives that we are working on. Of course, I certainly work with the other departments as well, including the Department of Community Services and other departments that impact seniors.

KENDRA COOMBES: I’m very happy that the minister brought up these grants because they were right on my list of questions I want to ask of her.

The PC Government announced the Seniors Care Grant last year and grants are available up to $500. It’s only available to households with a net income of $37,500 or less and it doesn’t cover the cost of groceries and occasional gas. There are several questions I have but one I’m going to ask is: How many applicants to date have been approved for the grant?

BARBARA ADAMS: If you give a grant versus a reimbursement or just straight up give somebody money, sometimes it impacts their income taxes. So there are certain limitations as to what we could allow someone to use the money for. We had to make sure that the $500 that everyone’s applying for was not going to be taxable because that would sometimes bump them out of the heating rebate, or the property tax rebates, or impact other taxable income.

The amount of services that are eligible though do include things - we mentioned the major ones, snow shovelling and lawn mowing, but it also includes things like cooking and meal preparation, driveway maintenance, home repairs, house cleaning, laundry care, medication deliveries, and transportation - things like taking taxis or shuttles. We had to be careful about what we applied the grant to, however we’re always evaluating the program and certainly we want as many people to be eligible for it as possible.

Over the years, as we continue this program, we will look for possible ways to improve it. Right at the moment, slightly over 20,000 people have already gotten the grant and it comes very quickly. It’s the easiest grant to apply for that I’ve ever seen, it comes very quickly. So that’s approximately $10 million that we put in the pockets of seniors within the first four months.

KENDRA COOMBES: I have two questions from that. First of all, why was the decision made not to cover things such as groceries, medication - not medication delivery, but medications - or gas and was it ever discussed about making it a non-taxable income of sorts?

I believe the member wrote that they had to be careful when dealing with the program so that it wouldn’t affect the income of a senior. So I just wanted that clarified.

BARBARA ADAMS: Certainly I, as the members know me well, I think my department has a whole long list of things that I wanted to include - things like walkers and medication and dental coverage and glasses and hearing aids, and why couldn’t we just let them use the $500 on whatever they wanted? Could I have done that I can guarantee the member I would have.

But Canada Revenue Agency has very strict requirements and this is a reimbursement program in order to make sure that it’s not taxable. Certainly there are other opportunities to do other things down the road - and to that member’s point, I wish we could have done that. But CRA regulations did not allow us to do that at this time.

KENDRA COOMBES: I thank the member for clarifying and straightening that up as to the CRA with regards to the income, as well as what can and cannot be covered.

I’d like from the minister, what were the department’s goals of the program? What evaluation framework is used for the program? What are the key indicators that it is having the intended effect that the department had hoped for?

BARBARA ADAMS: It is really important when you bring in a brand-new program, especially one that is costing $30 million, that you are sure that you are achieving what you set out to do. The intention was to help seniors live more comfortably in their homes. There are a lot of programs that support someone who is disabled, or someone who needs a specific medical device, or a wheelchair ramp. But there was nothing really out there except for a very small sector, to help somebody with tasks for those who are in the middle levels of the frailty scale.

In terms of the metrics, the intent was to make it as simple and as easy as possible to apply for, which it is, pretty much beyond your name and your phone number and your address, that’s pretty much it. We wanted easy, simple, accessible, and we wanted as many opportunities as possible for people to use it.

In terms of the metrics, for those who aren’t aware, the receipts that are required, when those are reviewed, that will tell us what the seniors are using those funds for. Not everyone’s receipts are going to be reviewed, but for all of the receipts that are reviewed, we will have a very good indication as to what seniors are using that for.

The early indications are that they are using it for every type of thing imaginable, where somebody is coming into the home to help them do something that they have found difficult to do. We will definitely be monitoring it. Certainly 211 helps us with that because they refer a lot of their phone calls on to the Department of Seniors and Long-term Care and if anyone has never gone to 211 for an orientation you should do so. If you like numbers, you are going to love 211 because they track every phone call that comes in, everywhere they refer the person to, and certainly they’ve been vital in helping us understand what seniors in the province need and want to know.

For those who haven’t seen the Positive Aging Directory, that’s a reason why you’ll see a reference to call 211 if you need information, because 211 helps us to understand what the unmet gaps in the province are.

KENDRA COOMBES: I thank the minister for those answers, especially with such a new program. I want to switch to another form of assistance. I’ll start with this. These programs are run by the Department of Municipal Affairs and Housing but I’m hoping that the minister is working closely with Housing, considering that I believe the deputy minister of Municipal Affairs and Housing is also her deputy minister, if I’m not mistaken? I’m hoping that she’s working very closely with her deputy and with Housing on these programs that impact seniors.

Inflation is causing the cost of everything to increase, including the kinds of repairs that would be covered under the seniors assistance programs. I’m just wondering, when was the last time the grant amounts were increased? Is the minister’s department looking at raising the grant ceilings?

BARBARA ADAMS: I can’t remember if she and I were the ones who’ve had the conversation. But before I became a minister, and even before I became an MLA, I would be referring people to the housing programs, especially for those with disabilities who needed the home renovation grant for ramps. The impression that I had back then was that, if you were of low income enough to be eligible for the grant, you couldn’t afford the other half of your essential co-pay in order to build the ramp. That’s a major barrier.

[4:00 p.m.]

I can tell the member that I don’t set the rates for the Department of Municipal Affairs and Housing. I can assure the member that the Minister of Municipal Affairs and Housing, through my deputy minister who is also his deputy minister, they have all heard very loudly and very clearly, that I have seen more people, sadly, go into long-term care because they couldn’t get the wheelchair or the walker through an older bathroom door. It would have been about $15,000 to renovate the bathroom to make it accessible. Instead of doing that, we had someone move into a long-term care facility at the cost of somewhere between $100,000 and $140,000 a year.

I can guarantee to the member that I will take this back to the Minister of Municipal Affairs and Housing. I appreciate the member raising this because I certainly have in the past, a number of times. We will continue to look at that.

KENDRA COOMBES: That’s great, Madam Chair. I do hope that the minister continues to advocate.

I know one of the frustrations that many people have with the grants program is that they can’t easily tell whether or not they will qualify. I think it would help a lot of people if the website would simply include the chart that shows, based on the household size and location, what amount someone might be eligible for. I’m just wondering: Is this being considered and is the minister advocating for this?

BARBARA ADAMS: We are of equal hearts. One of the frustrations for me, even as a minister, is knowing exactly everything that is possibly available to seniors in the province of Nova Scotia.

These grant application processes, even for grants for community projects, you really have to know that system in order to access everything that you might be eligible for.

One of the first things that I’ve done in terms of meeting with some of the other ministers is ask how we can streamline the application processes. Is there a possibility that when you apply for the Heating Assistance Rebate Program or the Seniors’ Property Tax Rebate that you can apply for all of them at once? I’ve been told that they all operate at different times of the year.

Certainly, I agree 100 per cent with the member. It is hard to navigate these application processes, especially when you have family members who are not here or not involved, or you have someone who’s developing some degree of dementia. It is a real barrier.

We have those conversations on a regular basis as to how to make this an easy process, applying for grants. Not just across my sector, but across all sectors and not just for seniors. There are those in the disability support programs; parents who have very young children who need those programs. Again, a lot of MLA offices are flooded with calls needing to know what the programs are that someone can access.

I remember being told when I was in Opposition about the housing grants that people could apply for. They said that I couldn’t possibly understand them as well as their department, so please refer people to them. For now, that is my recommendation for anyone who thinks somebody might be eligible for something, have them call our department or the appropriate department and we will work on that.

I will certainly take that back to the other departments for the member and continue to advocate to make the whole process as easy as possible.

KENDRA COOMBES: I’m happy to hear that that kind of communication is happening across departments.

I’m going to give the minister another issue that I’ve been hearing about. That is, for many people, the grant does not cover all the needed renovations, as we discussed, that pile up for low-income households. For example, a household in need of a roof repair, a new well, or new windows may have to chose between fixing these issues.

I would like to ask the minister: Has there been any thought within her department about either the department taking this on or advocating for it, making the grants available more frequently?

BARBARA ADAMS: There are so many areas where seniors need help in the province of Nova Scotia and home repair and damages are always a major issue. Certainly, the preparation of our Seniors Care Grant - we understand that if we give seniors $500 for whatever it is that they were using, that they can then turn around and use that money for something else. So while I couldn’t give somebody $500 to buy a walker that they might need, if they don’t have to pay for the snow removal and the lawn maintenance then they might be able to use that money for that walker or for the medication that they need.

To answer the member’s point, we are always looking at what each department is offering in terms of trying to maximize that. Of course, with the federal budget that came out we are also looking at what the federal government is willing to offer us in terms of helping those, especially the low-income, because we know that they are the ones who are suffering the most, especially seniors and especially those who are single income earners in the province. They are the ones most at risk.

KENDRA COOMBES: My question for the minister is have there been thoughts about making these grants available more frequently? We can see a cut off say March 31^st for one and then maybe it starts up again at another time within the year, say in the Fall and has a cut off point, and then again in the Winter with a cut off point.

I am just wondering, has there been any discussion about making these more frequently or more seasonally?

BARBARA ADAMS: It is one of the questions that I asked right off the bat, could we just lump them all together. You apply once and you can go all year long. That would make it easier for people applying. It doesn’t necessarily make it easier for the department.

One of the things that was pointed out to me is that the Heating Assistance Rebate Program and the Property Tax Rebate Program and our grants occur at different times and so they are not coming all at once where you get a lump sum of money now and then nothing for the next 12-month cycle.

Certainly, this was a starting point. This was a let’s start, let’s get it out the door within the first three months of our mandate. We got it out the door. There were the heating rebate and the Property Tax Rebate Program. We had two specific and now we have three, and this is $30 million. Our effort now is to make sure that every single Nova Scotian who is eligible gets that grant money back into their pockets.

These conversations are ongoing because it is a lot more complicated than I realized to put a grant out. I was a little simplistic when I thought well, it can’t be that complicated but I can assure the member it is a whole lot more complicated than I thought.

We are always looking for ways to make it easier and to make things more affordable for Nova Scotians.

KENDRA COOMBES: One of my questions for the minister - and again, this does have to do with seniors’ housing needs. A 2019 report on seniors’ housing needs stated that over 15,000 Nova Scotian seniors’ households are living in core housing need.

I am just wondering if the Department of Seniors and Long-term Care - if they know how many senior-focused units the government has committed to building?

BARBARA ADAMS: Although I am aware of all of the investments that the Department of Municipal Affairs and Housing is doing, the specific number for seniors is a little more difficult to predict. Because what we are seeing happening around the province - not me recently - but certainly we are seeing a lot of seniors moving in with their children and we are seeing children staying at home or moving back in with their parents. When you’re building investments, you never know exactly how many people are going to be living in a particular home and what their age group is going to be.

To the member’s question, and I know it was discussed at length in Question Period, we need housing for all age groups. The other thing that I’m acutely aware of is that we need accessible housing, not just affordable. What I mean is my mother - eventually, unfortunately, it broke my heart - could not get up the stairs to get into my house. That was no longer accessible housing for her. There are things like electric lifts that bring you up a set of stairs, that we don’t currently fund or help with the cost of, but there are seniors who leave their home because they can’t get up the stairs to get to the bathroom or to the bedroom.

Although I know that the Department of Municipal Affairs and Housing is moving at lightning speed, as we say, to build as much housing as we can, certainly they’re keeping that in mind, because we know how many seniors are coming. The number of seniors is going to double in the next 20 years. By the time I’m 80 years old, we’re going to have twice as many of me as there are now. That means that the affordable and accessible housing stock must go up. Since the deputy minister for my department is the deputy minister for the Department of Municipal Affairs and Housing, I can guarantee to the member that those kinds of conversations happen on a daily basis.

KENDRA COOMBES: On that topic, I would just like to keep in mind that maybe times that children are moving in with their parents and parents are moving in with their children out of core housing need. Sometimes it’s not out of what they want to do. It’s out of the need that they need to do it. I hope the minister keeps that in mind.

While we’re talking about accessibility - I’m glad she brought that up - I am aware, because many of them are in my riding, of seniors public housing that is in great need of repair to meet the minimum accessibility needs. For example, doors and hallways are not wide enough for wheelchairs, and multi-storey buildings with no elevators. I’m just wondering what the government’s plan is to address this. Does the Department of Seniors and Long-term Care work with the Department of Municipal Affairs and Housing to ensure access to appropriate public housing for seniors?

BARBARA ADAMS: It is a serious problem. We have similar buildings in my community, and I know that there are two in one of our low-income housing buildings for seniors, there are only two wheelchair accessible apartments, and that is not acceptable. That is not going to meet the needs of Nova Scotians moving forward.

I can guarantee to the member that the PC Party of Nova Scotia, all of the MLAs, and our staff are intimately familiar with the frailty scale, and what happens to your housing needs when you move from frailty levels 2 and 3 into frailty levels 4 and 5, where you start to need canes, walkers, and wheelchairs. I can guarantee to the member that we are always working with the Department of Municipal Affairs and Housing on these issues as well as the Department of Public Works in terms of being able to get from one place to the next. As people age and their frailty changes, my department staff are always advocating . . .

THE CHAIR: Order. Before I turn it over to the Liberals, I will ask you, minister, how much time you require for closing.

BARBARA ADAMS: I’ll need approximately five to ten minutes.

THE CHAIR: Five or ten?

BARBARA ADAMS: I’ll talk fast, so I’ll make it seven.

THE CHAIR: I will turn it over to the Liberals for eight minutes.

The honourable member for Bedford Basin.

KELLY REGAN: I just have one grouping of questions and then I’m going to pass the remainder of time over to the member for Cumberland North to be able to ask a few questions too.

Earlier, the member for Preston had identified some gaps in the program of the Seniors Care Grant. My question to the minister - and then I will lead into another question just to get this all in so she can answer them all together - is the department planning to plug those gaps for the African Nova Scotian community so that this year the members of the African Nova Scotian community who don’t have title to their home or who don’t have a lease, are able to apply for the Seniors Care Grant?

We still have April and May to go and so if they’re working on plugging those gaps, that would be great because I’m sure there are lots of folks who are living in this particular situation who would be more than happy to take advantage of that $500 for seniors to have their snow shovelled, if there is any more, or groceries delivered and things like. That’s my first question.

The other one is sort of a grouping. At the Department of Seniors and Long-term Care now there’s been a lot of beefing up of staffing I noticed when I looked at the galleys. Is there an African Nova Scotian advisor on the senior leadership team at the Department of Seniors and Long-term Care - ditto, Indigenous advisor? Are there persons with disabilities having input into the design of programs, someone from the LGBTQIA+ community? Do we have that diversity eye on the design of those programs?

For the LGBTQ community, what we often see is as people age, they actually go back into the closet because it’s difficult to move into long-term care. Do we have training for long-term care homes for the workers there to be sensitive to those particular issues? It’s a diversity issue, and so I just wanted to leave, as my final question to the minister, around the seniors’ long-term care and the concerns of communities that are often overlooked when we’re designing programs.

[4:15 p.m.]

BARBARA ADAMS: What I can say to the member is that we were so happy that Madam Chair brought the issue to our attention and, to my knowledge, that’s all been taken care of and that is no longer an issue. Certainly, if there’s ever another issue that comes up, we’d be more than happy to take care of that.

What we can tell the member is that there are several designated positions in our department for under-represented communities and we have been meeting with all of the major communities to be sure that we are representing everyone’s voice so that people see themselves. We had some discussions about Villa Acadienne and what that facility looks like and how that’s different for that community versus other communities, and how important it is especially for seniors to hear their language. Especially when you have developed dementia - you might have been bilingual but often as you age and you develop dementia more acutely, you revert to your native language.

We are certainly working with all of the departments in order to try to ensure that under-represented communities are having their needs met. Janice Keefe did a research study years ago that she presented, and I remember the findings - and I hope I remember it exactly the way she said it - there were three main things that determine whether you are happy in long-term care. Number one was the staff themselves and how they treated you - and that’s why we need to treat our staff well. The second thing that mattered was whether the facility looked like what you were used to growing up in. And the third was the food that you got to eat. But I remember - I don’t know whether it was fourth or fifth - was the language that you heard and how you were spoken to.

Certainly what the facility looks like needs to represent all communities in the Province of Nova Scotia. How you are cared for, how you are approached and the rules and regulations that we establish, especially when we re-write the regulations and the legislation, we want to be sure that all of these communities are represented.

One of the things that some of the members would be aware of in terms of new build requirements, we have incorporated diversity into all of our new builds by including a holistic approach requirement in our spaces and design documents in social, physical, mental, and spiritual areas to best meet care outcomes.

For example, in Eskasoni we are building a physical structure that will incorporate First Nations culture into both the building layout, which is awesome, and the care model, which is unique. The building under construction now is in the shape of a turtle. It’s Turtle Island, to reflect the organic nature of First Nations structures as well as their relationship to the land.

One of the other things we’ve done is we added to the procurement process for new beds in Central Zone with a requirement to enhance diversity and equity within a long-term care facility as well as foster connections that strengthen the social capacity of the community, especially those in under-represented communities.

What I can say is that there are a number of other initiatives as well, but this is critically important to our department because we know that as seniors age their identity becomes one of the most precious things that they have.

KELLY REGAN: With just over one minute left, I’m going to throw it over to my honourable colleague for Cumberland North for a final question.

THE CHAIR: The honourable member for Cumberland North.

ELIZABETH SMITH-MCCROSSIN: Maybe I’ll give the minister an opportunity to share what her department is doing with regard to the Adult Protection Act. We’ve had our conversations about that and how ineffective it is for family members, for law officers, and for physicians. Maybe the minister can expand on what work is being done to improve upon the Adult Protection Act.

BARBARA ADAMS: With respect for the lack of time, I will thank the member for the meeting that we had to discuss this very important issue. There are always challenges, especially . . .

THE CHAIR: Order. I’ll now turn it over to you for your closing, minister.

BARBARA ADAMS: I’ll just finish the thought. We did increase the staffing levels in adult protection, and we are always working on changing the requirements and working on new processes to make sure that all of our seniors are safe.

I just have a few brief comments to conclude this important conversation. It is clear from all the concerns we have discussed here that there are significant challenges ahead for the continuing care sector in Nova Scotia and for the Department of Seniors and Long-term Care. Our wait-list for home care and long-term care has been too long for far too long. We need to hire more continuing care assistants, and we will. We need to build and renovate thousands of single rooms in long-term care facilities.

These are long-standing problems created by historic cuts in funding and a lack of planning, oversight, and infrastructure investments. As disappointing as that is, it is also an exciting time for our sector. We are taking action and finding solutions that will ensure that older Nova Scotians have the dignity and high level of care that they need when they need it. In just seven months, we have made significant progress and made key investments that form the foundation and the beginning for better health care now and long into the future.

In this budget, we have invested more than $66 million to provide continuing care assistants with the highest wages in Atlantic Canada. We have provided $25 million to provide 4.1 hours of care in nursing home and long-term care facilities. We have provided $17 million for recruitment and retention, 100-per-cent free tuition, Work and Learn training programs, the Recognition of Prior Learning Program enhancement, and our immigration strategy; $15 million to continue additional staffing in long-term care due to COVID-19 Public Health directives; $11 million to extend or convert new long-term care spaces to help create more bed capacity and support patient flow; $3 million more for workplace safety investments for long-term care; and more than $29 million to provide seniors in need with a $500 Seniors Care Grant.

We have increased our investments by $142.5 million over the previous year’s budget. That’s not promises; that’s real progress. That is also just the beginning. We will leave no stone unturned. We will continue to embrace innovative new approaches and all the tools and talents at our disposal, and there are many. This is how you build a best-in-class system that positions Nova Scotia as a Canadian leader in care. This is how we say thank you to the older Nova Scotians for all that they have done for our province, not just with words but with actions.

It is also part of how we make working in Continuing Care and the Department of Seniors and Long-term Care a more attractive career, so we can recruit students and retrain the workers that we already have.

Our problems are not going to be solved overnight. We need patience and perseverance. By working together across all departments, across Party lines, with all of our stakeholders and others, we will achieve our goals.

It was collaboration and coordination that helped us endure the pandemic and Public Health restrictions for more than two years. This will be the next challenge we will tackle together. I am so grateful for the tremendous effort by a great many people.

Again, I want to thank all of the talented and hard-working and amazing staff who work with me every day at the Department of Seniors and Long-term Care for their tireless efforts. I also want to thank our partners throughout the health care system, all the stakeholders and advocacy groups, union representatives, the staff who care so deeply for our loved ones, the families and volunteers and students who count on us to provide high-quality care.

The Health Association of Nova Scotia, the Continuing Care Association of Nova Scotia, all the educational institutions that train our great staff, and the foundations and fundraising groups that support us financially, thank you all. If we are truly going to reach the status of best-in-class care for Nova Scotians, we need to continue to work together.

Collaboration is a cornerstone of my approach to being minister. I want to hear from anyone who has a good idea to improve the level of care Nova Scotians receive. It doesn’t matter who the idea comes from: a home care worker, an administrator at a home care agency, a long-term care facility, somebody concerned about the safety of a neighbour, an adult advocate for seniors’ rights, or my learned colleagues in Opposition. A good idea is a good idea no matter where it comes from.

I am in favour of anything that will protect our seniors and ensure that Nova Scotians receive the care that they deserve. I have, as you all know, reached out to every MLA in the Legislature, and have scheduled meetings with all those who showed an interest in meeting with me one on one to discuss the unique challenges and needs of their constituencies. I look forward to continuing those conversations when the Legislature wraps up. I am looking forward to the challenges ahead.

As someone who had a career in home care, continuing care, private sector, and the Department of Health and Wellness, being Minister of Seniors and Long-term Care is the ultimate opportunity. It is a chance to fix the problems I used to see on a daily basis. It is a privilege and a responsibility that I do not take lightly, and I look forward to reporting back to you in the near future about our projects.

THE CHAIR: Shall Resolution E37 stand?

Resolution E37 stands.

Order. The time allotted for consideration of supply today has elapsed.

The honourable Government House Leader.

HON. KIM MASLAND: I move that the committee do now rise and report progress and beg leave to sit again on a future date.

THE CHAIR: There is a motion on the floor that this committee now rise and report progress to the House and beg leave to sit again on a future date.

All those in favour? Contrary minded? Thank you.

The motion is carried.

The committee will now rise and report its business to the House.

[The committee adjourned at 4:30 p.m.]