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Ontario Hansard - 18-October2017

STRENGTHENING QUALITY AND ACCOUNTABILITY FOR PATIENTS ACT, 2017 / LOI DE 2017 RENFORÇANT LA QUALITÉ ET LA RESPONSABILITÉ POUR LES PATIENTS

Resuming the debate adjourned on October 17, 2017, on the motion for second reading of the following bill:

Bill 160, An Act to amend, repeal and enact various Acts in the interest of strengthening quality and accountability for patients / Projet de loi 160, Loi visant à modifier, à abroger et à édicter diverses lois dans le souci de renforcer la qualité et la responsabilité pour les patients.


The Acting Speaker (Mr. Paul Miller): Further debate?

Ms. Catherine Fife: It’s a pleasure to join the debate on Bill 160, the Strengthening Quality and Accountability for Patients Act, 2017, for second reading.

I have to say that when I was going through this legislation, and after consulting with our health critic, the member from Nickel Belt—who I’m pretty sure is ready to be the Minister of Health, her knowledge of this field is so profound—I have to say that I was genuinely surprised to see some of the schedules in this bill. I will be focusing primarily on three of them.

One of them has to do with schedule 4, which introduces the Health Sector Payment Transparency Act. One of them is schedule 5, the Long-Term Care Homes Act. Schedule 9, which overhauls the licensing framework for independent health facilities, for us is very problematic around the continued privatization of our health care system in the province of Ontario, which was started in earnest by the PC Party under former Premier Mike Harris and has actually been accelerated under this Liberal government, under two Premiers. And then, finally, schedule 10 amends the Retirement Homes Act to permit the confinement of residents in retirement homes despite the lack of proper public oversight of our retirement homes as they currently stand in Ontario.

I do want to say that when our health critic got up, she referenced the importance of getting health care right. She also made reference to the fact that everything in health care is connected. I’ll just give a direct quote from her one-hour lead from yesterday. She said that we should be talking “frankly about what we can do better to reach people who face barriers to achieving their best possible health and well-being. We know that treating illness is important, but to truly focus on getting equitable results and health outcomes for everyone in the province, we have to find ways to reach people struggling to get basic necessities like prescription medication, affordable food and housing, oral health care”—there was a question today on the barriers that exist to dental care—“and mental health and addiction services.”

Schedule 9 under Bill 160, for those of you who don’t know, overhauls the licensing framework for independent health facilities and out-of-hospital private clinics to bring them under one common framework. It prepares the way for further privatization of hospital services. The technical briefing document from the Ministry of Health and Long-Term Care begins with the phrase, “As the number and range of services and procedures being performed outside of public hospitals continues to grow....” The reason that has happened is that the Liberal government has opened the door to the profit agenda in our health care system. We would be much better prepared for an aging demographic, the complex mental health needs that we face and the complex long-term health care needs of the people of this province if the profit agenda in the health care file was not driving the agenda. Imagine how much money there would be for front-line health care workers—nurses, nurse practitioners, our midwives, who continue to fight for pay equity, ironically, to this day.

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Schedule 9 has been designed so that the private, for-profit clinics continue to grow at the expense of the public Ontario hospitals. Now, this is not the solution to the crisis that exists in our hospitals right now; it just is not. Day after day, we bring stories to the Minister of Health and to the Premier of this province, stories from our own ridings, real people experiencing real crisis in health care, and what we get back is just a level of stubbornness to not accept the reality of what’s happening in our hospitals. Until the reality of what hospitals are facing in our emergency rooms across every community in this province, until there’s an acceptance that there is a problem in health care, there will be no solution.

We have now very good sound bites from the Minister of Health: “There is no health without mental health.” That’s true, but there are also 20,000 people on a wait-list waiting for mental health services. Until we move past that point and just acknowledge that there are people in closets, in hallways and in storage closets receiving health care in the province of Ontario—there must be some acknowledgement that this is happening. When hospitals are actually operating at an overcapacity, then the risk to those patients becomes acute. That is not the best way to build up a health care system.

Even in our own Waterloo region—I had the misfortune to end up in the emergency room at St. Mary’s with my husband. There we met a former student of his, because he’s a teacher, and we were in the hallway. We were in the hallway with 14 other people on gurneys. We started to talk to her, and we found out that she is the hallway nurse. It used to be a 12-hour shift in the hallway at St. Mary’s hospital in the emergency room. This hallway nurse position is funded by the region of Waterloo because the ambulance and the paramedics are not allowed to leave a patient until someone can sign off for them. In order to actually keep the paramedics and the ambulances in the community helping other people and addressing emergencies, the region had to fund this position, this hallway nurse. She was actually saying that it was reduced from 12 hours to a 10-hour shift. At 12 hours she was super busy, so you can imagine how busy she was at 10 hours.

My point in this is that these stories are real. This is the truth. This is the reality of the pressure and the stress that our hospitals are under. I can tell you for a fact that further privatization of clinics, and for-profit clinics at that, compromises and undermines the overall goal of the health of the citizens of this province. What you have, though, is a fairly now blatant neo-liberal agenda that says, “We’ve given up. We are going to alleviate ourselves of the responsibility of delivering health care directly with some accountability and with some responsibility, and we are going to formalize this relationship with these for-profit corporate health care clinics.”

It was profound for me to listen to our health critic say that when she first came here, over 10 years ago, there were about 50 to 60 private clinics. According to the latest stats that she has acquired, there are over 900. A business opportunity presented itself to these clinics, and now this government has formally embraced that model.

I want to tell you, it adds insult to injury because part of schedule 9, which brings them all under one common framework, says that these facilities will now be renamed community health facilities. You put a new name on a for-profit clinic; it doesn’t make it about community. In community health facilities, true community health care is so different than the for-profit model, where you are 15 minutes in, one complaint and no holistic view of the health care. You know what I hear, mostly from seniors who genuinely need to have a holistic view of their overall health including their prescription medications that they are on—and what do they have? They have a 15-minute appointment, because it is about moving people in and moving people out. I have some experience with this in my own riding.

So I think it is genuinely misleading to call these for-profit clinics “community health facilities,” because they are not. For me, I was genuinely surprised that this government has doubled down and just embraced it. They’re not even keeping up the façade that they are fully supportive of a public health care system, because in so many examples, they are not.

The other area of serious concern for us is the new provisions which include allowing restraints and confinement in retirement homes, updating these provisions in the Long-Term Care Homes Act. We feel very strongly that no landlord—which is what a retirement home is; people pay to rent space in a retirement home, rent a facility—should confine or restrain a resident. This gives an inordinate amount of power to a potential landlord. It goes on to say that if a person needs that level of care, they should be receiving proper hospital care or long-term care with proper public oversight.

The other issue around restraints and confinement in long-term-care homes: It should not be expanded without the proper staffing and resources for long-term-care homes, which the government refuses to provide. I would say that the state of our long-term-care facilities in my riding of Kitchener–Waterloo has now surpassed the area of concern and crisis that we used to have for child care. Those concerns are still there. I equate very vulnerable young children, who don’t have the ability to advocate for themselves and who are left in the care of others—especially in the for-profit, corporate child care model, which, again, this government has fully embraced—with seniors who are in long-term-care facilities.

Our leader, Andrea Horwath, came to the riding about a week and a half ago, and we met with a constituent whose husband and mother are in two different long-term-care facilities. This woman is spending to the tune of $55,000 a year, and she’s actually topping up to $18,000 so that her mother has some dignity—I mean, that’s really what we’re talking about here.

And so what do you have? You have a government which is now, in this instance, looking in the retirement home situation to broaden the power and control that a retirement home owner would have over one of their residents, which is a huge power imbalance. That’s what we talk about with seniors who are in long-term care, as well as young children who are in child care.

We have so many stories to talk about the state of long-term care in this province. The 30,000 people who are on the wait-list—you can’t deny that those people are waiting, and some have been waiting for a long time.

We have this one story, which I have permission to share, from a woman in my riding. Her name is Lana Jones. It’s genuinely a shocking story. Lana Jones, whose daughter has complex medical needs and requires constant care—this has been ongoing in my office, and we’ve been advocating for her since May 2014. In December 2014, her daughter turned 18 and she lost all of her SSHA funding, and her mother lost respite services. So the system dropped her when she became 18 years old. She was faced with the current pitfall in services that exists when children with autism age out of the system. Her daughter was told by the system, by the ministry, that she was too expensive and not a meaningful contributor to society, by a government worker. We have this well documented.

Our office assisted in getting her Passport funding through the DSO, but it hasn’t been enough. This September, she reached out to our office again about an 88-hour gap in services due to scheduling challenges, where she has to be awake in case of emergency. We were able to get her nursing support during the gap, but respite services are still few and far between for her daughter.

This is another crisis: When we talk about long-term care, sometimes we’re talking about folks who have early-onset dementia. Sometimes they have complex medical needs that are across the entire spectrum. Sometimes they’re the victims of accidents, be it at a hockey game or in a car accident. There is no other option, so long-term-care facilities have become the default place for vulnerable Ontarians to end up. Quite honestly, the directors of some of the long-term-care facilities that I’ve toured say that these people shouldn’t be here; they’re here with seniors. This continues to be a concern for us.

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Back to schedule 9, because I still can’t believe that this government has fully laid it all out, fully gone the whole distance for privatization of health care. When we look at the state of home care, for instance, in this province, and the way that the LHINs subcontract out the personal support worker options in homes—I want to say at the outset that there are good people who work in the LHINs, and now that they’ve absorbed the CCACs—and now we have somewhere along the line some sub-LHINs because we have one of the most complicated health care systems in any First World nation, I’m fairly certain about that. When I met with the LHIN and I’m trying to advocate for people who are accessing home care, these private companies that the LHIN has hired and contracted out truly do not have that level of accountability—direct accountability—to ensure that the quality of those services is met.

Quite honestly, they’ve said that there is such a shortage of personal support workers that they’ve gone into other fields, because being a personal support worker in the province of Ontario—and we met with some of them yesterday—is genuinely a very difficult job, especially when you are paid so little and especially when you’ve entered into a caring field and said, “I want to be helpful to people in home care,” and then you have 20 minutes to spend with that senior or with that individual who requires assistance. When that happens, they become stressed, they become depressed, and then they leave the field. So the key to retaining personal support workers in home care is actually treating personal support workers with respect, paying them with respect, and treating them like the very people who are essentially holding the home care system together.

When you look at how privatization has really watered down the quality of care that we have in Ontario, it is astounding. Think of that 30%—as the Auditor General had identified—of the administration and the bureaucracy and the profit that’s right at the top. Think of what you could do if you remove that profit agenda and you streamlined the system.

Why wouldn’t the local health integrated networks across this province have direct accountability to the kind of home care that they can deliver? They can’t. It is completely and utterly unacceptable that these companies come in, charge and make huge profits, and do not honour their contracts. I would suggest to you, Mr. Speaker, that these companies—and not all of them are like this, but the ones that I am dealing with right now in Waterloo region—have made record profits. That is money, quite honestly, that should be going to the front-line workers because that is where the quality matters.

So schedule 9 doubles down on privatization; it really does. I have to say that it will actually further compromise the quality of health care that you are seeing in this province. I would much rather be in the position, as an MPP, to work towards and find some consensus to build a better system for all Ontarians instead of seeing what’s in Bill 160, where you have essentially renamed these “community health facilities” just to try to rebrand. This is not a public relations exercise; this is one of our core principles as Ontarians, as Canadians, to deliver and honour the commitment to universal health care. It’s what makes us different from the United States on so many levels, and yet here you have a government embracing a very regressive policy. Schedule 9 and schedule 10—they are showstoppers for us, for sure.

Then schedule 5—going back to long-term care—makes it an offence for a licensee to fail to protect residents. Well, right now what you have is basically the business of taking care of seniors. The resident who met with Andrea Horwath and myself described it as “warehousing of seniors.” It was incredibly emotional for her to have the courage to speak up and share her story, but she has a husband she loves and who she cannot guarantee is getting the kind of care he deserves. She has a mother who’s also suffering from dementia, and she does not want to see her mother restrained. She does not want to see her mother’s quality of life further compromised. Who would want that?

When I go door to door in Kitchener–Waterloo with our petition asking for a full review, a full inquiry into long-term care, so that we can fix it—if you’re going the spend the money, if you’re going to spend the time, let’s get it right. Let’s do our due diligence to make sure that this system which has really evolved to not meet the needs of Ontarians—let’s get it right. Let’s fix it. I really do wish that the government would honour that commitment.

For so many reasons, we have so many concerns about Bill 160. Indeed, it is not the solution to a health care crisis that exists in Ontario.


The Acting Speaker (Mr. Paul Miller): Questions and comments?

Mr. John Fraser: It’s a pleasure to respond to the member opposite. I would like to say that there were a couple of things we agreed on, or that I agree with her on or we have some common ground on. She did raise two things: There are great people doing work out there. But I want to say that in long-term care there are some challenges there. I know in my own city of Ottawa some of the challenges we’ve had—and actually facilities that were not-for-profit, as well as for-profit facilities. I’m glad that she also mentioned that, “Well, there are good companies out there that I work with.”

I was at the Ontario Community Support Association this morning, speaking to companies like Carefor, like VON, like Saint Elizabeth—all not-for-profits. So there are really good actors in the field. One of the things when we’re talking about long-term care—and I share the member’s concerns—is that we don’t negate the great work that’s being done there. The vast majority of care—and I know this in my city of Ottawa—is excellent. There are people out there working very hard to provide that care. I think that to characterize the changes in this act as not being useful or not enough—you know, we have to establish the fact clearly in legislation that the failure to protect a resident from neglect and abuse is a serious thing—and failure to comply with an order. That’s why those penalties are in there, to increase the penalties for individuals and for corporations and boards. They’re challenges that if they’re not going to follow the law, there’s going be some penalty. I think this piece of legislation is very important.

With regard to PSWs, I had a chance again to speak this morning—I actually have a private member’s bill that deals with PSWs and DSWs and mandatory coverage for PSWs working in retirement homes and group homes, so that people working in similar situations should have the same coverage. You have it in long-term care but not in retirement homes. I hope the member will support that bill.


The Acting Speaker (Mr. Paul Miller): The member from Wellington–Halton Hills.

Mr. Ted Arnott: I’m pleased to have this opportunity to respond briefly to the member for Kitchener–Waterloo on her presentation this afternoon on Bill 160, the Strengthening Quality and Accountability for Patients Act, 2017.

I know that the member for Kitchener–Waterloo is very passionate about expressing her views as a member, as well as the views of her community. While I think we agree that health care is probably the most important service that the provincial government delivers for the people of Ontario, we’re in different parties and we might draw different conclusions about how we might pursue improvements to the system.

We know that health care is emerging again as a huge political issue in this province. We know that waiting lists in the province are growing longer again for many procedures. Emergency rooms are again experiencing considerable overcrowding. And long-term care is an emerging crisis. I don’t believe the current government has done enough to sufficiently plan for the coming numbers of people who are going be needing long-term care. That’s going be a huge problem in the coming years because of, in my opinion, the last 14 years of inaction.

This Bill 160, of course, is an omnibus bill that opens a whole long, long list of acts and creates 10 new pieces of legislation: the Ambulance Act, the Excellent Care for All Act, the Health Protection and Promotion Act, the Health Sector Payment Transparency Act, the Long-Term Care Homes Act, the Medical Radiation and Imaging Technology Act, the Ontario Drug Benefit Act, the Ontario Mental Health Foundation Act, the Oversight of Health Facilities and Devices Act and the Retirement Homes Act. Certainly, our caucus believes that because so many details of such a substantial piece of legislation have been left to be determined by regulation, this raises the question of how much thought and actual meaningful consultation went into the preparation of this omnibus bill.

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We believe that the government needs to work closely with stakeholders to ensure the development of effective amendments. Of course, if and when this bill goes to committee, we’ll be engaged in that process. We need to listen to the stakeholders and try to improve this bill.


The Acting Speaker (Mr. Paul Miller): Questions and comments?

Miss Monique Taylor: It really is a pleasure to be present today and listen to the member from Kitchener–Waterloo and her depiction of what New Democrats feel about this bill. She raised many concerns.

The first thing, though, that I want to raise is the size of this bill and the 10 different schedules that go into it. As per usual with this Liberal government, it comes under a great title: the Strengthening Quality and Accountability for Patients Act. We have seen many, many times over again great titles that come before us, yet inside we don’t find the best interests of the people of Ontario.

When we’re talking about privatization, when we’re talking about putting more responsibility and allowance for private providers—that is not in the best interests of the public. We know that our health care dollars are very few and far between—it’s probably one of the biggest parts of the provincial budget—and yet we’re allowing those dollars to go into private profits. That is not the purpose of our health care system, nor should it ever be. We’re seeing this throughout different schedules in this bill.

There are serious concerns when it comes to retirement facilities and the ability that they will now have with patients that they didn’t have before. A simple phone call could allow Mom, Dad, Grandma or Grandpa to be locked up. That really shouldn’t be something that is happening in our health care system, by a private provider who is putting quite a huge amount of dollars into their own pocket.


The Acting Speaker (Mr. Paul Miller): The member from Kitchener Centre.

Ms. Daiene Vernile: I’m very pleased to join the conversation this afternoon on the Strengthening Quality and Accountability for Patients Act. I want to use this opportunity to detail some of the important aspects of this bill, and I do that for the people who might be watching us at home this afternoon, if they are wondering what is included in this bill.

I want to start with the oversight piece and talk about who’s taking payments, gifts, from pharmaceutical companies. This legislation, if it’s passed, is going to require the medical industry to annually report payments submitted to health care professionals and organizations. It includes who’s taking meals, travel, research grants and fees for services. The legislation is going to allow for the payment information to be posted publicly on a database so Ontarians can check in to see which doctor is taking this kind of payment. We don’t know the extent to which this is happening within the health care profession, but if it’s passed, this legislation is going to reveal all of that information to us.

The bill is also going to guarantee that all long-term-care home operators are providing safe, quality care for their residents, and they’re going to do this through a stronger inspection program with more robust enforcement tools, including the ability to put out financial penalties.

It’s going to give ambulances the ability to transport patients to the most appropriate care settings—perhaps a patient should not be going to the emergency room; they ought to be going to a mental health care facility, for instance. That’s going to reduce overcrowding in emergency departments, and it’s going to provide the best care for patients when needed, when they do call 911.

Speaker, in my remaining time, I’d like to say that the bill is also going to be looking at retirement homes and improving that.

It’s a very comprehensive bill with many important aspects. It’s going to help improve our health care system. I will be voting for this bill.


The Acting Speaker (Mr. Paul Miller): The member for Kitchener–Waterloo has two minutes.

Ms. Catherine Fife: Thank you to the members who had comments on the 20 minutes that I was able to speak to Bill 160.

I will say, though, on the exposure of payments that pharmaceutical companies are issuing to doctors, that if it’s an issue, then stop it. Other jurisdictions have moved stronger, but this bill does not aim to do that. It does not address that in a significant manner.

And then, under schedule 5 of the Long-Term Care Homes Act: We know that confinement in long-term-care and retirement homes, expanding the authority to restrain and confine residents, should only be permitted if the government provides additional staffing and resources, which it refuses to do. There have been instances where restraints are necessary, but it’s a dangerous practice, and it needs to be monitored. The only way to keep people safe in those instances is to have the staffing and the resources there to ensure that everyone maintains safety.

In our long-term-care facilities right now in Waterloo region, in the Waterloo Wellington LHIN, there are currently 2,625 people on a wait-list to get into a long-term-care facility, and there are only 4,000 beds in 36 homes. There are over 1,000 people in long-term care currently waiting for a transfer to a different facility, and there are 1,622 people who are currently waiting to get into a long-term-care facility.

These numbers are huge. This bill will not address the crisis in our long-term care, it will not address the crisis in our home care, and it certainly will not help the Ontario hospitals who have begged this government for some relief. It is an omnibus bill with some key issues that we could support, but fundamentally, it makes it very difficult for us to move forward and build a universal health care system that is meant for everyone in the province of Ontario.


The Acting Speaker (Mr. Paul Miller): Further debate?

Hon. Bill Mauro: I’ll begin by saying, Speaker, that I’ll be sharing my time with the members for Ajax–Pickering and Trinity–Spadina and the Minister of Research and Innovation.

I’m pleased to have a few minutes this afternoon to make a few comments on the Strengthening Quality and Accountability for Patients Act. As mentioned by other speakers, this particular legislation touches on several different pieces in one bill. One that I think is worth repeating, which has already been mentioned, is a piece in reference to the Ambulance Act. Knowing how this will be impactful in my home community of Thunder Bay, in my riding of Thunder Bay–Atikokan—this is about the work that is done by our paramedics.

Some will know that there are almost 9,000 paramedics working in the province of Ontario and 1,730 ambulances that support this work on a daily basis. About one million patients were transferred last year by our paramedics.

What we do know is that many of the calls that paramedics in their ambulances arrive at are not life-threatening, but as currently constructed, when a paramedic in an ambulance arrives at a scene as a result of a 911 call, it is mandated that they take that individual who is the cause for the situation, the patient in the situation, to the hospital. We know that oftentimes the patient does not need a hospital, but the individual needs a different level of service, the individual needs other care. The change here is going to allow for the paramedics to make that determination at source. So should this legislation pass, we’re going to see our paramedics enabled to make a determination of what care needs the patient requires, divert that patient to the appropriate care setting and keep them out of hospitals if that’s not where they need to be. We all know that ambulances can be in a queue; it can take time to off-load, to get out of the hospital and go back to doing the work that they do. So this is a very fundamental and important change, and I want to commend the Minister of Health for bringing that forward.

Speaker, an old colleague of mine told me a long time ago, “Billy, health care is a political loser.” I remember when he told me that, and he’s right. I don’t think it matters what you do as a government; it will be easy to be criticized, no matter what amount of resources or what decisions you make. If you are an individual living in your home community and you spend a little longer time than you think you should in an emergency room with a loved one, if you have a family member who has to leave your community for care, these situations and many others can be incredibly emotional and incredibly trying. So no matter what you do as a government, no matter how many resources you bring, it is not likely that you will ever find yourself in a position where people will ever be satisfied with our health care system. We can rhyme off numbers of the investments and the changes that we’ve made, so many of them being transformative and substantive; nevertheless, people will find cause to find concern with our health care system.

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We’ve hired around 6,500 more doctors than were working in the province of Ontario when we formed government—over 6,500 more. Some 28,000, in that range or that order of magnitude, more nurses are working in the province of Ontario than was the case when we formed government. The list goes on and on.

I can think of examples in my own community and my own riding of Thunder Bay–Atikokan where we now provide angioplasty services to 700 people a year, where we now provide vascular surgery to about 400 people a year. We didn’t have those services before. We have now committed to providing full cardiac surgery in Thunder Bay by the spring of 2020. This is amazing work. It will represent about 1,700 people who currently live in the riding of Thunder Bay–Atikokan, Thunder Bay–Superior North and the district of Thunder Bay being able to get those incredible services in their home community so their loved ones can be there, so they don’t have to travel, so they’ll get better health care. We will save some lives, we will create jobs and we will have better health outcomes at the end of the day.

This is only one small example of the investments and the changes that we’ve made to health care that directly benefit the riding and the constituents I’ve had the pleasure of representing for quite some time. But no matter what we do, Speaker—I understand that health care is easy for the opposition to pick at. I could go on for 20 minutes easily today, but I’m sharing my time with other members, and my five minutes, unfortunately, have quickly wound down.

There will be more announcements that I will be making in the very near future. My five minutes is up, so I yield the floor to the member from Ajax–Pickering. I thank you for your time, Speaker.


The Acting Speaker (Mr. Shafiq Qaadri): I thank the honourable minister and now call upon the MPP for Ajax.

Mr. Joe Dickson: Thank you, Mr. Speaker, and thank you, Mr. Minister, for your comments.

I’m pleased to speak to Bill 160 today in reference to Open Pharma. The people of Ontario really deserve health care they can rely on and health care they can trust. Transparency allows the public to have access to information in order to be engaged and make informed choices about their health and the health of their families. Ensuring there is transparency with Ontario’s publicly funded health system increases the public trust, as everyone deserves access to information that can support them in being confident that they are receiving the highest-quality care.

That is why our government is committed to strengthening transparency in health care in Ontario. We are introducing new legislation that, if passed, would make information on payments from the medical industry to health care professionals and organizations available to the public. It would require the medical industry to annually report payments submitted to health care professionals and organizations. This would include paid meals, travel, research grants, and fees for a number of things, such as consultation or sponsored speaking engagements.

If passed, the new legislation would allow for the payment of information to be publicly posted on a database, which would give Ontarians insights into the extent of the private sector’s funding of the health care system. We do not yet know the extent of industry transfers of value to health care but, if passed, these changes would allow for us to have a better understanding of these transfers of value.

The minister is quite correct: Five minutes goes very fast.

This would arm patients with the knowledge that they deserve to make informed decisions about their own health care. This province deserves openness and accountability, and we are working to make that the norm. France, the United States, Belgium, Denmark, Portugal and Slovakia have all addressed this issue through legislation. We are aligning ourselves with a growing movement and are leaders nationwide, as we are the very first jurisdiction in Canada. And we are not stopping there. This bill, if passed, will not only increase transparency but will strengthen the health system and accountability and enhance the quality of care for patients.

The previous speaker, the minister, spoke briefly about the Ambulance Act, and I would be remiss if I didn’t mention something that’s happening to me. Previously there was a change where we lost a mental ward with 20 beds to Toronto. Under the Ministry of Health and Long-Term Care and our minister Dr. Eric Hoskins, that is coming back to Ajax-Pickering hospital. The 20 beds of vintage age cannot be used, so new beds with new technology are now on order. When they arrive, they will arrive at Ajax-Pickering, and what a difference that will make for the Ambulance Act, because now we have to sometimes use ambulances to transport our patients back and forth to Toronto. That just doesn’t work when the populations in Durham, particularly Ajax–Pickering, Whitby and Oshawa, are just booming and everything else is running to catch up. This is something very, very special.

I would also mention, when you get to health and long-term care, I go back as far as 40 or 50 years ago when service organizations spent so much time—in Whitby, we had what was called Whitby Psych; it’s now Ontario Shores, and it’s just a fantastic facility. It’s a major improvement than we had in our day overlooking it with a number of cottages, of all things, and it was great—it served the purpose at the time—but better service has grown and better service is there today. We did many things, whether it was a Christmas day where 50 or 60 of us went over and treated 100 patients, a BBQ day where we went over and treated 100 patients, and on and on. We did that several times a year. So there are improvements everywhere.

I’m going to cut mine, so I get it on the mark and I don’t get chastised for running over again. Thank you, Mr. Speaker, and we’ll go on to the next speaker.


The Acting Speaker (Mr. Shafiq Qaadri): I thank the honourable member from Ajax–Pickering and now invite the MPP for Trinity–Spadina.

Mr. Han Dong: It’s my pleasure to share some of my thoughts on this very important bill. I had an opportunity to respond to the member from Nickel Belt yesterday on her debate, so I am pleased to have more time to talk about this bill.

This is a big bill, actually. I see that there are a lot of good things in there, and I really urge all members of this House to spend some time and study this bill. The part I’m going to be talking about today has to do with the Long-Term Care Homes Act. I’m pleased that the safety and the quality of life of Ontario’s 78,000 long-term-care residents remains as one of the top priorities of our government.

I can relate my recent trip to Mon Sheong senior homes in my riding: They do a great job in there looking after seniors, and I think the average age is 90-plus and the turnover rate, they kept under, I think, 7% or 8%, if I am not mistaken. But every year I have the opportunity to visit there, spend quality time with seniors, and I can tell they are well served and they are happy while living there.

While the vast majority of long-term-care homes are in compliance with the provincial rules and regulations, there are still some we want to make sure to bring in line so we offer better protection for all residents. This legislation, if passed, will have new enforcement tools that will ensure long-term-care-home operators with reoccurring care and safety concerns are urgently addressed. This is very, very important.

By introducing maximum fines for all offences, a provision under the Long-Term Care Homes Act will be effectively protecting the residents. For example, for individuals the fine will go up to $100,000 for the first-time offence and $200,000 for subsequent offences. For corporations, it’s $200,000 for the first time and a half a million dollars for a subsequent offence. To me, this is showing our commitment to protect seniors at long-term-care facilities.

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Another part of the bill I found rather interesting speaks to the Health Protection and Promotion Act. It is an initiative intended to protect the health of children and consumers in Ontario. If passed, these changes will protect children’s health by regulating recreational water facilities like splash pads and wading pools. I’m a little surprised that there are very limited regulations around that. Both of my kids enjoy splash pads, like many others in Ontario. In my neighbourhood, Grange Park just got renovated this year, and I urge all members, if you have a chance, to walk down Beverley Street close to Queen’s Park and check out the state of our park, Grange Park. They turned the wading pool into a splash pad. Now a lot of people are enjoying it through the days and nights. They will spend lots of time. So making sure splash pads are safe for our kids to use—for anyone to use, actually—is very, very important.

It has also proposed changes that would improve food safety by revising the definition of “food premise” to include the part of the home that is used to operate a food business. This is actually a big issue in a lot of ethnic communities. For example, in the Chinese community, I often see ads on social media talking about home kitchens. I often think about why there isn’t any regulation to look after them, because this is a potential public health hazard. So I’m very pleased to see some movement on this, and I hope that this will pass. This will go a long way to help many Ontarians when it comes to food safety.

I think my time is up. Thank you very much for this opportunity to debate this bill.


The Acting Speaker (Mr. Shafiq Qaadri): I now invite the Minister of Research, Innovation and Science.

Hon. Reza Moridi: It’s a great pleasure to rise in this House and speak to Bill 160. As we all know, our health care system is really a jewel in the crown of this province. There are many jurisdictions on this planet, globally, that wish that they had a similar system in their own jurisdiction, in their own country. Though our system is an excellent system, indeed it requires continuous improvements, and that’s what this bill is really meant for.

My colleague the member from Trinity–Spadina mentioned the Mon Sheong institution. One of the sites is located in the town of Richmond Hill. I’ve been there several times, actually, and it’s just a perfect example of how our not-for-profit sector provides health care services to our elderly in this province of Ontario.

One part of this bill, if passed, is going to provide a guarantee that all long-term-care home operators are providing safe and quality care for residents through a stronger inspection program with more robust enforcement tools, including financial penalties and new provincial offences. We know that places such as Mon Sheong are perfect places, but still, an inspection provides better enforcement of rules and regulations and, indeed, helps service providers as well as the patients and the residents who reside in these long-term-care facilities.

Also, this would give ambulance services the ability to transport patients to more appropriate care settings. Ambulance services sometimes feel certain restrictions—that they have to take patients to certain hospitals, but this bill will give them more flexibility, particularly when it comes to mental health facilities. Also, it would reduce overcrowding in emergency departments and provide the best care for patients in the most appropriate settings when they call 911.

The bill, if passed, would protect Ontarians in their day-to-day lives by regulating recreational facilities; for example, splash pads and wading pools and personal service settings such as barbershops and nail salons.

These are some of the things that this bill, if passed, is going to provide protection for Ontarians, not only for our elderly, our seniors and people who reside in long-term facilities, but also people who use recreational facilities as well.

The other aspect of this bill is going to provide more transparency. Transparency is very important for patients, in particular, because we all want to know what’s happening, in terms of information, with regard to our health care system. So it’s very important that this bill provides that very tool which the public needs in order to raise their confidence, so that they know what they are getting.

Again, if this bill passes, the legislation is going to require the medical industry to annually report payments submitted to health care professionals and organizations. Of course, this would include paid meals, travel, research grants to certain individuals in the health care sector and certain institutions in the health care sector, and the fees for services such as consultations or sponsored speaking engagements.

Again, if passed, this new legislation will allow for the payment information to be publicly posted on their databases so the public will have continuous access to information. This would, of course, give Ontarians insight into the extent of private sector funding in the health care system.

Countries such as France, the United States, Belgium, Denmark, Portugal and Slovakia have all advanced this issue through their legislation, and we are going to do the same in Ontario. Actually, if this bill passes, Ontario is going be the first jurisdiction in our country—Canada—to pass this legislation, which will bring more accountability to our health care sector.


The Acting Speaker (Mr. Paul Miller): Questions and comments?

Ms. Sylvia Jones: Sometimes during debate, it’s what’s not said that is as interesting as what is communicated. For the last 20 minutes, we’ve had four different Liberal speakers, and not one mentioned schedule 9 and the oversight and the inspection bodies. Probably, frankly, because so much of that information is being left to regulation.

I think that it is valuable, it is important, it is key to transparency to have a little more meat on the bone, so to speak, on what the inspection bodies are going to look like. It’s pretty clear that there is a great deal of control and a great deal of power that they will have. I think that we need to know, as legislators and as the public, what the Liberals have in mind for how those inspection bodies are going to actually operate within the health system across Ontario. I would personally like to see that we spend a little more time talking about—or they sharing their vision for—what those inspection bodies will ultimately end up doing.

The second thing—and a number of speakers did touch on this—was the change in the paramedic responsibilities and duties. In my own community, the Community Paramedic Program has been a pilot project that has been very well received, and I would encourage all Ontario communities to act with that program because it has been such a success. But there are other parts of Bill 160 that are not nearly as clear.


The Acting Speaker (Mr. Paul Miller): Questions and comments?

Ms. Catherine Fife: I just want to do a quick shout-out to Boris and Sheila Natyshak, who are watching their granddaughter, Airika—actually, they’re streaming it. They don’t have the bandwidth or something, so they have to stream this stimulating debate here on health care today.

I will say, though, this is a non-starter when the confinement and restraints in long-term-care facilities will now be expanded without the corresponding increased staffing and resources. This is a dangerous direction to go in long-term care.

It’s worth noting that this House, this Legislature, did vote to expand the scope of the public inquiry to look into long-term care, so that we will look at some of the systemic problems that we have, like the understaffing, like the underfunding. Although the will of the House is such, the government has failed, to date, to communicate this expanded mandate to the judge. I do want to thank, though, the two Liberal members who did support that expansion for that review.

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New Democrats have also talked about bringing a minimum standard of hands-on care. When the Long-Term Care Homes Act was first changed 10 years ago, in 2007—we used to have a minimum standard of care right there in the bill. If it’s right there in the bill, you have to fund it. We do not, today, have that minimum standard of hands-on care for long-term-care homes anymore, and the regulations that were promised at the last review never happened.

We’ve been asking for that minimum standard of care of at least four hours hands-on. If you’re serious that you’re going to increase the use of restraints and increase the use of confinement in our long-term-care homes, which is proposed in Bill 160, you must increase the staff and the resources. Otherwise, it is just too dangerous. This must be changed.

I think our health critic is going to be very busy trying to amend this flawed piece of legislation.


The Acting Speaker (Mr. Paul Miller): Questions and comments?

Mr. John Fraser: I would like to respond to the member opposite’s last comments. I think we read the same bill different ways. In actual fact, right now, confinement is something that’s used as a last resort and as a safety mechanism when it is necessary to prevent harm that person would be doing to themselves or to other people. What’s being proposed here is a framework to protect residents who need that restriction. The legislation, if passed, would establish a consent-based framework for residents who need to be confined in a LTC home for safety reasons.

The consent-based framework for confining a resident would set out criteria for preventing residents from leaving a long-term-care home and would provide protections for an incapable resident whose substitute decision-maker consents to the resident’s being secured.

The protections would also include the opportunity to meet with a rights adviser, who would explain the resident’s rights, including the right to seek a review of the substitute decision-maker’s consent. Licensees of long-term-care homes will be required to contact a rights adviser if a resident asks to meet with a rights adviser or expresses disagreement with confinement. In addition, residents would be given contact information for the rights adviser.

Some residents may need to be confined to ensure their safety or the safety of others. For example, a resident with a severe cognitive impairment who may become lost if they are permitted to leave the home may need to be confined. We do have situations where people can do harm to themselves or other people. What this bill does is it provides some right of appeal, and the ability to understand and know what your rights are in this regard, so that this kind of restriction is used in an appropriate and needed case, and not where it’s not needed. That’s the way I read it.


The Acting Speaker (Mr. Paul Miller): Questions and comments?

Mr. Ross Romano: With respect to this bill, I thought I would just make a few comments. Some of the observations I’ve made out of the comments I’ve heard from across the floor cause me some concern, and one in particular. There are certainly a lot of complaints about the health care system in this province. I struggle when I hear that there are all these strides being made and that it’s still going be an area that we’re always going to hear complaints about, even though we’re doing so well. I look at the community that I represent, the community of Sault Ste. Marie. If you talk to the people in my community, they would certainly oppose those comments. They will tell you things that don’t look like they’re going very well at all in Sault Ste. Marie.

I just had a conversation a number of weeks ago with one constituent within our community. Luckily, this constituent had the financial ability to take measures into his own hands when his wife was very ill. He travelled; he went to the hospital with his wife, and for several weeks she was going through testing. They thought she was suffering from one ailment and started testing specifically with respect to that one ailment. After several weeks of continuing to struggle with health concerns, this constituent said to his wife, “I don’t trust what we’re getting from our hospital,” so they packed up their bags, they travelled to Rochester and went to St. Margaret’s. This is something that people within my community—the ones with the financial ability to do so—are doing on a regular and ongoing basis.

They spent 13 days at Saint Margaret’s, and once an MRI was done, which was done within the first few days of being there, they were able to immediately determine that she was suffering from cancer. They were able to immediately put her on a course of treatment, and hopefully she’ll be okay. But if they had waited the six months or so, she would have not been here.


The Acting Speaker (Mr. Paul Miller): I guess it would be the Minister of Research, Innovation and Science—or someone has two minutes.

The member from Trinity–Spadina.


Mr. Han Dong: I’m pleased to respond to the comments and questions.

First I want to thank the member from Dufferin–Caledon, the member from Kitchener–Waterloo, the member from Ottawa South—who is also the PA to the Minister of Health and Long-Term Care and has a proven record and has done an excellent job in his PA-ship—and also the member from Sault Ste. Marie. I want to thank them for their comments.

I just want to quickly point out that I’m sure the predecessor of the member for Sault Ste. Marie would be very happy with all of these changes that we are bringing forward, as he is a long-time advocate for better health care in this province.

I just want to quickly address the concern brought forward by the member from Dufferin–Caledon with regard to schedule 9. As modern health care evolves and new technologies are being developed, Ontario is strengthening the safety, quality and oversight of and transparency around services delivered in community health facilities.

Our government is proposing legislation that will, if passed, introduce new quality assurance measures and standards, including criteria such as keeping staffing records up to date, regular equipment maintenance to ensure patient safety and the delivery of quality care, strengthened accountability in the system for providing high-quality care, ensuring that patients and their caregivers have access to critical information about the quality of care provided through public reporting, and modernizing and expanding the regulation of medical radiation devices to ensure safe and appropriate use of best health results. This initiative will also allow other health facilities, like private hospitals, to be designated as community health facilities at a later date.

I think these are all good measures going forward.


The Acting Speaker (Mr. Paul Miller): Further debate?

Mr. Victor Fedeli: It’s my pleasure to rise and speak about Bill 160.

I’m going to focus specifically on a couple of issues in my riding and talk about schedule 5, on the Long-Term Care Homes Act of 2007. We talk about how the minister can suspend a licence and issue orders. I want to speak to you about that very fact of what the minister can and, in many cases in Ontario, could and should be doing.

Then I’m going to talk about what happens in the interim, because this summer, in July, Lady Isabelle Nursing Home in Trout Creek, in my riding, was indeed closed, ordered to be shut down. I personally have read the inspection reports, the revocation-of-licence order and the interim manager order, and I must say that over the course of the last five years there has been a history of widespread, ongoing non-compliance, so I have absolutely no issue with the Ministry of Health ordering this facility to be shut down. I have been in the facility, I understand completely why, and I have no hesitation with what the minister has done for the betterment of the residents of that 66-bed facility.

That brings us to the fact that this facility, at that time in July, had already had orders to suspend parts of their licence and whatnot. It was down to about 40 residents, and at that time, the long-term-care facility was ordered to be closed, so the residents are being put into other long-term-care facilities in my riding as beds become available. That’s what is happening. We understand that. We concur.

I have written to the minister. I’m going to just read a little bit of my note, and then a little bit of his reply. Basically, I’m saying to the minister, “Look, this is 80 employees in Trout Creek, a 66-bed facility—shutting it down, I understand why; putting the residents elsewhere, we understand why. But in the best-case scenario, it’s going to take a couple of years to rebuild the new facility.” What we wanted and what the residents of Trout Creek wanted was a guarantee, a 100% commitment, that the 66 beds will be relocated, rebuilt in Trout Creek, and the opportunity for 80 people to get back to work there. The residents want to know their loved ones are going to be looked after, and I know that is being well handled, but we want the beds back in Trout Creek.

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The minister wrote back a very thoughtful letter. He and I have had many discussions about this. One sentence was, “I am committed to working with you on any proposal that involves a plan to keep the beds in Trout Creek.”

So we’re all on the same page about suspending the licence in Trout Creek, moving the residents to other facilities, hopefully rebuilding a 66-bed facility in Trout Creek, and putting people back to work, but that is going to take some time. In the interim, it is causing some problems.

I met with the president and CEO of North Bay Regional Health Centre over the weekend. We talked about the bed pressures at North Bay Regional Health Centre. We all realize that alternate-level-of-care patient numbers are rising. In general, that’s right across Ontario. But he says the recent closure of Lady Isabelle in Trout Creek—the one I was speaking about—has increased their concerns for their patients, physicians and staff, and is even more heightened with their percentage of alternate-level-of-care acute days increasing from 7.5% in June to 25% in late August. So the hospital has been talking with the LHIN about the fact that they need to balance this. What’s happening, of course, is that the alternate-level-of-care patients in the hospital can’t leave and get into an alternate-level-of-care facility because the Trout Creek residents are filling those spaces up as they come. So nobody’s able to leave the hospital, and those hospital beds are being extended as long-term-care beds. They talk about how the frequency with which patients are placed in long-term care from a hospital is decreasing. There’s nowhere to go because those spaces are being filled up.

So that’s the problem. Here’s their solution. As I’ve said in this Legislature many times, when I was mayor of the city of North Bay we participated in funding the hospital. At the time, we funded about 10% of it out of the municipality—and 60 beds have since been closed. I’ve been in this Legislature just over six years, and as I was leaving the mayor’s chair, the hospital was open, but now 60 beds are closed. So the hospital is saying, “Hey, we’ve got these beds that are closed in the hospital. We’ve got long-term-care patients who can’t go anywhere because the long-term-care facility is being filled up with the Lady Isabelle long-term-care residents who are being moved out because that facility is correctly being shut down. Why don’t we take 15 beds, in a turnkey proposal to leverage those vacant beds, and make a community partnership to ensure that these patients are in a transitional care location versus acute care?” So take them out of the hospital bed—they can’t go into a long-term-care facility because there’s no room today, because of this problem caused by the shutdown—and move them to these 15 of the 60 empty beds.

I’ve got to say, this doesn’t sound too bad. The province is saving money, in a sense, by having 66 beds that are no longer being occupied. It will be that way for a couple of years, while a new proposal and a new developer or whatever come forward to build a brand new multi-million-dollar facility for 66 beds. So why not use some of those funds that aren’t being spent and fund these 15 beds? They already exist; they are down the hall in the hospital. It’s not a bad idea.

Speaker, I did want to use part of my time to address the fact that, indeed, in schedule 5 of the Long-Term Care Homes Act they talk about how the minister can suspend licences and revoke licences. It says here the directors can revoke the licences. You know, it’s one thing to shut these facilities down. I understand that in Trout Creek it’s the second time in history—I could be wrong, but this is what I’ve been led to believe—that a facility has shut down.

Again, I have absolutely no hesitation in concurring with the minister’s decision and the ministry’s decision. I’ve been in the facility and understand why it’s shut down. But if you are going to do this, you should also acknowledge that for every action there’s an equal and opposite reaction, so there’s a problem that is created. These guys have come up with a pretty creative solution to use some of the ministry’s money that’s not being spent on these beds.

I wanted to bring that situation forward. I wanted to be on the record describing the Lady Isabelle situation, which created a situation at the hospital, which has developed an interesting solution. I wanted to use about half of my time on that.

The other half, really, talks about something else, again, with the Long-Term Care Homes Act, 2007. This is something else that is not in there, and that’s the second half of what I wanted to spend some time talking about.

This time the facility that I’m going to speak about is in North Bay, Ontario, and it’s called Cassellholme. Cassellholme is a long-standing district home in North Bay. When I was young and growing up, it was, as long as I can remember—not having been involved in that industry as a young boy—the only place we had in town. It was our district home. My grandmother ended up in Cassellholme, at the long-term-care facility, when our family could no longer take care of her. She was requiring medical assistance at that time. She lived with us for as long as I can remember growing up. I think I’ve talked many times in this Legislature about the great stories I had with my grandmother—both my grandmothers lived with us as long as I could ever remember, from the day I was born until I was well into my twenties; actually, it might even be after that, that my grandmothers Fava and Fedeli lived with us. One of them did move into Cassellholme for the great medical care that they offered there. That’s a little bit of history of what I’m talking about.

Cassellholme has been working towards a redevelopment for years; it might be a decade. Again, back in the day, when I was mayor of the city of North Bay, I recall at the time Cassellholme talking to us. It’s partly funded by the municipality. It’s the way the north works, and perhaps rural Ontario. It’s provincially owned, partially municipally funded, with a board. The board has provincial appointees and municipal appointees. Although I didn’t sit on the Cassellholme board, I reviewed their budget annually and was able to contribute my thoughts to their budget process. It was one of the ones that is not an A class and needs to be redeveloped by 2025, as so many of the older facilities in Ontario need to be.

I remember back at the time—this would be probably about 2009 or 2010—it was about a $24-million redevelopment. That’s what it would have cost back then. I remember our former MPP coming to North Bay, on the weekend, as I do now, and making an announcement that the province will be funding—actually, it was $40 million and the province would be funding $24 million of it. That was an announcement back in about 2009, I guess.

Here we are in 2017 and it still hasn’t happened. Today, to build it now, it’s a $60-million bill. That’s what it will cost—not what it would cost; what it will cost—Cassellholme in the city of North Bay to build.

Again, they bring an interesting conundrum, and I’m hoping that this is a situation that we can look at. On behalf of the residents of North Bay and my constituents, I intend to bring their amendment.

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I know that when this comes to committee, they’re going to come to committee and speak to this, but I’d like to have the opportunity now to put on the record basically what it is they want to talk about and the request that they want to make.

They tell me they have a very specific request that has been made to the province, but it has not made it into Bill 160. What they’re basically saying is that Cassellholme and other district homes have the ability to borrow on their own for this reconstruction. Right now, they have to have the city of North Bay as a borrowing partner. The city has to be the one to borrow the money. Cassellholme is asking for an amendment that they and other district homes have the ability to borrow on their own without their municipality—or, in this case, municipalities; I have 11 mayors that I answer to in the riding—having to borrow for them.

I’ll speak predominantly about North Bay because it is the largest of the 11. It has 54,000 citizens; our smallest, Mattawan, has 120 people. They have a mayor, a town council, a municipal building, and they have 120 people. We go from as small as 120 to as large as 54,000.

They’re asking also—and this is a bit technical now—“that the province provide the present value of the provincial share of the redevelopment up front.” If you remember back when I mentioned it in 2009, the MPP made the announcement: “We’re giving $24 million to Cassellholme for this $40-million build.” Well, now what they’re asking is $30 million, which is the number that is, I understand, already agreed by all the parties: “That the province provide the present value”—$30 million—“of the provincial share ... up front.” That means that they don’t have to borrow it, and those borrowing costs would not be borne by the individual provincially owned/ municipally owned facility.

They’ve said: “We had been asking that the required legislative changes be made” in this Long-Term Care Homes Act, which was going to be tabled as an omnibus bill, but those changes, unfortunately, did not make it into the bill.

They are definitely asking me to bring this forward, and they will be, as I say, coming to the hearings, making a proposal, having everybody in the room—all of the MPPs and the staff who are there—come to an understanding that here’s the reality: You have all of these district homes all across Ontario that are required to be redeveloped by 2025, but there’s no real money there. There’s money coming from the province on a year-by-year basis, but they need this money to be up front to reduce the overall cost.

Again, they are a licensed long-term-care-home facility. As I said, I have 11 mayors. In this particular case, there are nine of these municipalities that are in the region that are funding Cassellholme. I can get technical, Speaker, in the few minutes I have: “District homes are governed by part VIII (specifically sections 122-128) of the Long-Term Care Homes Act. Cassellholme, supported by all the other district homes, has been working for over a year with the Premier’s office, the minister’s office and the Ministry of Health and Long-Term Care and the minister’s office and Ministry of Municipal Affairs to remove the provisions in the Long-Term Care Homes Act that prohibit district homes from borrowing on their own faith and credit, except to bridge operating revenues to the maximum of 25% of total annual revenues”—and they go on, so on and so forth, with the subsections.

Basically, what they’re saying is: “We need (a) your money, province, up front; and (b), we want to be able to borrow our share without having the municipality have to borrow it for us.” This is what they’re saying; this is what they’re going to bring.

They are also saying that all of this, of course, “has been prompted by the ministry’s requirement that district homes redevelop by 2025 on one hand”—I’ve said that. But on the other hand, municipalities really genuinely aren’t interested in having to pick up the bill for this. They will pick up the tab of the interest, because they all pay a share of the operating costs over time. Each municipality can be several million dollars a year. These municipalities of district homes are mandated to have one in each city, I think it is, that type of thing. That is how it is throughout the north. They are mandated to do this. They are mandated to have a board. They get to put some seats on the board, and the province does.

But this is big now. Now we’re talking $20 or $30 million that’s the other share. And quite frankly, especially in the north, the municipalities just don’t have the capacity to go out and borrow that kind of money. Some are going to refuse to and some just don’t have the ability. They are unable to carry a mortgage for the redevelopment.

If the province pays their half or their share up front and the facility is allowed to borrow their share themselves, certainly any mortgage lender would be able to provide an adequate and fair mortgage for that facility using the facility as collateral. So we want those restrictions to be removed. It’s going to be very difficult, Speaker, to proceed with any redevelopment, although they are necessary, mandated and must happen by 2025, if they don’t respond to these local requests. They are, as I say, coming to the committee and asking us to put forward the necessary amendments to the bill at the standing committee, and therefore in this Legislature.

Speaker, that is really how I wanted to address it. There are many, many issues in Bill 160, the Strengthening Quality and Accountability for Patients Act, but my choice was to talk to you, in the 20 minutes that I had, about Lady Isabelle in Trout Creek and the issues that have been created with their closure, and about Cassellholme and the issues that have been created by their requirement to redevelop by 2025.

I say thank you very much, again, to you, Speaker, and to this Legislature for the opportunity to share the stories from my riding of Nipissing.


The Acting Speaker (Mr. Ted Arnott): I want to thank the member for Nipissing for his presentation.

Questions and comments?


Ms. Cindy Forster: I thank the member from Nipissing for his comments, particularly around the long-term-care sector. I as well experienced a loss of long-term-care beds in my riding, and it took 10 years from the date of the announcement to actually rebuild those beds. They weren’t new beds; they were just beds that had been removed from a larger nursing home that ended up being demolished and replaced by a retirement facility. It took 10 long years, and we have a wait-list in my area of about 1,400 seniors waiting for those beds.

The member from Kitchener–Waterloo talked about our concerns around schedule 10, which amends the Retirement Homes Act to permit the confinement of residents in retirement homes. These residents in retirement homes—this is like a landlord. These people pay in some instances $4,000 or $5,000 to live in a retirement home, and it seems that we are going to be giving the landlord the right to actually confine residents. There is a concern that we may be implementing the use of physical restraints. I can tell you that there aren’t enough staff in the retirement homes to actually monitor any residents, let alone three or four residents who could potentially be confined in those retirement homes.

Hospitals moved away from using physical restraints, as did long-term-care facilities. Now they use bed rails down, mattresses on the floor for those patients who may find themselves in and out of bed on a regular basis when they are in some state of confusion. So schedule 10 is very concerning for us.

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The Acting Speaker (Mr. Ted Arnott): Questions and comments?

Hon. David Zimmer: I just want to speak to the long-term-care aspect of this bill. There are 78,000 long-term-care residents here in Ontario. A top priority is seeing that they have the quality of care and the protections they rightly expect and should have.

How are we going to go about doing that? We want to make sure that Ontario families and seniors have confidence in their care, confidence in their environment and that they receive the highest quality of care. To do that, the bill contemplates some new enforcement tools. These enforcement tools will include financial penalties for homes with repeated non-compliance. What we want to do is ensure that all home licensees are immediately addressing concerns for the benefit of their residents.

These enforcement tools will include a set of maximum fines for various offences under the long-term-care legislation. That means some of those fines for an individual could go as high as $100,000 for a first offence and $200,000 for a second offence, and for a corporation, $200,000 for a first offence and up to $500,000 for subsequent offences. There is going to be a whole regime to guard against failure to protect residents from abuse and neglect, and also failing to comply with orders made under the act.

As a part of the enforcement tool, there’s a new inspection strategy that’s going to be enhanced. It’s called the resident quality inspection strategy. In the exercise of those inspections, they’ll monitor the safety and the well-being of the homes. If they’re not in compliance, then those fines will kick in. This will provide a safer environment for residents.


The Acting Speaker (Mr. Paul Miller): Questions and comments?

Mr. Norm Miller: I’m pleased to have the opportunity to comment on the speech by the member from Nipissing on Bill 160. He focused on schedule 5, the long-term-care part of the bill, and he gave some excellent examples of issues within his riding, starting off with the situation of Lady Isabelle Nursing Home, which is in the process or has closed. That affects the northern part of Parry Sound–Muskoka, as well. I think he made a very good case for a temporary situation that would help, with North Bay providing 15 beds.

I do have a need for more beds within the riding of Parry Sound–Muskoka as well. I know in Huntsville, we have Fairvern Nursing Home, which is, I believe, a C-class. It needs redevelopment. The district has put together a plan to redevelop it. They have the land. The municipality of Muskoka has put $10 million towards the project. But to make a long-term-care facility work, the way they’re funded on a per person basis, it needs to be at least 96 beds, or it just doesn’t work financially. So I would say to the member from Nipissing on his proposal for Trout Creek that they need to bump the number up a little bit to make it work. Also for Fairvern, they need 96 beds, or it just doesn’t pay for itself on an ongoing basis.

I would also simply say that the minister has talked about 5,000 new beds. They certainly aren’t in Parry Sound–Muskoka. I have yet to see any new beds anywhere in the province, although the minister mentions that number a lot.

There is a great need for more long-term-care beds. Wait-lists are increasing, and there’s this situation where we have these facilities that desperately need redevelopment. That is the case in Huntsville, where Fairvern is located. The district is behind it and looking to make something happen.


The Acting Speaker (Mr. Paul Miller): Questions and comments?

Miss Monique Taylor: It’s definitely been an interesting afternoon to sit in the House to listen to Bill 160, the Strengthening Quality and Accountability for Patients Act. For those tuning in at home, they would say, “Wow. Strengthening quality and accountability for patients: That sounds like it’s a good thing for the people of Ontario.” But what they don’t realize is that it’s a very large bill with many different schedules that reach broadly throughout our health care system.

What the bill doesn’t do is really ensure that we are strengthening the quality. It does nothing to increase the number of beds in the long-term-care sector, to ensure that the thousands of seniors that we are going to be seeing in the generation to come will be able to have one of those beds. We have thousands currently waiting throughout our cities, throughout our municipalities and our regions, waiting for beds.

There’s nothing in this bill to say that there are going to be more beds to alleviate the pressure that we’re going to be seeing coming in the future. It does nothing to stop the hallway medicine that is currently happening, where people are in the hallways and they’re at their sickest points—if they’re in the hospital, they’re very sick—and they have noise and lights, and no dignity and no bathrooms that are available to them. Nurses are treating them at their most vulnerable time in front of everyone to see. There is nothing in this bill that does anything to take care of that.

And it doesn’t talk about pharmacare, and the need for an actual, real, universal pharmacare that covers all patients in Ontario, and not just a very small few.


The Acting Speaker (Mr. Paul Miller): The member from Nipissing has two minutes.

Mr. Victor Fedeli: I want to thank the members commenting—the member from Welland, the Minister of Indigenous Relations and Reconciliation, the member from Parry Sound–Muskoka and the member from Hamilton Mountain—for their comments on Bill 160.

Speaker, I would like to take this moment, then, to continue to speak about Lady Isabelle and Cassellholme. At this time, I want to be able to say thank you to the wonderful staff. We’ve toured Lady Isabelle about every second year since I’ve been an MPP, including this past summer, and the staff are simply the best you’re going to find. They are absolutely wonderful, hard-working men and women, and the residents there absolutely adore each and every one of the caregivers and the administration who are in that building.

Over at Cassellholme, the same applies. As I said earlier, my grandmother lived there for a while. Patty and I would visit Cassellholme on numerous occasions for events and birthdays: 100th birthdays and 75th wedding anniversaries, if you could imagine 75 years together. We do a lot of events at Cassellholme, and the staff there are absolutely and spectacularly remarkable people, remarkable caregivers. You can tell the compassion that they have for the residents, the love and care that they show for them. The administration are excellent and a superb group of managers. The final group would be the volunteers. There are so many volunteers who help the people at Cassellholme.


The Acting Speaker (Mr. Paul Miller): Pursuant to standing order 47(c), I am now required to interrupt the proceedings and announce that there has been more than six and one half hours of debate on the motion for second reading of this bill. This debate will therefore be deemed adjourned unless the government House leader specifies otherwise.

Minister?


Hon. Kathryn McGarry: We’d like it to continue.

The Acting Speaker (Mr. Paul Miller): Okay, debate will continue. Further debate?

Ms. Peggy Sattler: I am pleased to rise today to participate in this debate on Bill 160, the Strengthening Quality and Accountability for Patients Act. In particular, I wanted to focus my comments on a couple of the key schedules of the bill, specifically schedule 1, the amendments to the Ambulance Act.

Speaker, some of my colleagues in this Legislature may recall that on numerous occasions throughout the spring, I raised a concern about lack of government approval for a pilot project which my community of London had been working on for a number of months—well over a year, in fact. That pilot project was a partnership between the emergency services and it was a partnership with the London Health Sciences Centre and also with CMHA. CMHA in my community operates a 24/7 crisis centre. When people go to that 24/7 crisis centre, they can usually access counselling within about 20 minutes.

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By contrast, when people experiencing mental health crises call 911 and get picked up by an ambulance, they are taken to the hospital emergency room. That is, as has been pointed out, because of the legislative requirements of the Ambulance Act. Unfortunately, when they are taken to the hospital emergency room, they often have to wait hours and hours and hours before they are even triaged and an assessment is made about their condition. All the while, the ambulance and the paramedics have to wait at the hospital until they know what is going to be happening to this patient.

This is quite costly. In my community, it was determined that if the ambulances could go straight to the crisis centre instead of to the hospital for patients who are experiencing non-acute mental health issues, then there could be savings of about $2.5 million a year, which is significant. This is a significant savings that could then be reinvested into our health care services in the community.

Last March 20, I shared the story of a constituent of mine, Angela Jolly, who had been waiting almost a week on a stretcher at London Health Sciences Centre for access to a mental health bed. At that time, on March 20, 2017, the emergency room was operating at 130% capacity. As we have been hearing over this last little while, that’s actually pretty good. We are hearing of the emergency room operating at 140% or 150% capacity. On that particular week, it was at 130% capacity with 22 patients waiting for beds. Some of those patients had been there for more than a week, in fact, when I first learned the story of my constituent’s experience.

I raised this issue in the Legislature and I called on the Minister of Health to take action to address the mental health crisis in London, which was not a new issue that suddenly materialized in March 2017. This was an issue that we had been facing in London for years.

On March 23, three days later, the hospital ER was, on that day, operating at 152% capacity. There were 26 mental health patients waiting for beds. At that point, I called on the Minister of Health to approve London’s pilot project, to approve this single partnership between the London Health Sciences Centre, CMHA Middlesex and Middlesex-London EMS and allow that to proceed in my community of London. At the time, the Minister of Health was unequivocal: No, it could not happen.

On March 27, I once again called on the government to sign off on this pilot project and allow it to proceed in my community.

Then, on March 30, more crises were erupting all over the place in London. I called on the government once again to stop dragging its feet and do something to look at how to facilitate this pilot project going ahead in London and make sure that this kind of helpful intervention could be put in place.

On April 3, I again asked the government to work with my community, work with those community partners and find a way to allow the pilot project to proceed.

On April 24, which was almost a month since the first time I had raised the issue, I once again asked the minister in question period about the pilot project. At that time, the capacity of the ER was 146% and there were 18 patients waiting for beds. Still the government refused to offer any kind of solution to my community in order to move the project ahead.

The following month, on May 31, I raised the issue for the seventh time in this Legislature and shared the story of another constituent, David Warren, whose wife had been waiting more than three days in the hospital ER. She had been taken to the hospital ER under a Form 1. She was involuntarily taken to the ER and she had to wait—actually, she had to be transferred to St. Thomas because, after more than three days of waiting at London Health Sciences Centre, they told her that there was still no bed and she would have to go out of our community to get the treatment she needed.

So, Speaker, after these seven attempts to get the government to work with my community and get this pilot project in place, I was cautiously optimistic, on June 5, when I read the news release from the government indicating that there would be amendments to the Ambulance Act to allow paramedics to transport patients to non-hospital facilities. Certainly there were concerns about what exactly this would mean, but it appeared that this might provide the vehicle for the pilot project to move ahead.

At the time, however, along with my cautious optimism, there was also great concern because the government’s press release announcing these amendments also indicated that the full rollout of any changes to the Ambulance Act would take approximately 24 months to complete. So two years after the passage of this legislation there would be the possibility that London’s pilot project could finally be in place. That would represent a period of about four years since my community first came together to work out a business case and put plans in place for this pilot to move forward.

You can imagine, Speaker, my concern when I finally saw Bill 160, the Strengthening Quality and Accountability for Patients Act, which includes, as one of 10 schedules, amendments to the Ambulance Act to enable the diversion of patients by paramedics to non-hospital sites. I am concerned because instead of moving forward with enabling legislation to allow the pilot project to go ahead—although I have to say that I really do question whether the government couldn’t have found a way to just allow the pilot project in London to move forward. However, instead of moving cleanly with some simple legislation, the government packaged these amendments to the Ambulance Act within omnibus legislation that includes many, many other very contentious changes to health care legislation.

Not only that, but the amendments that they have proposed to the Ambulance Act are much broader than what my community was looking for. They are, in fact, so broad that there are numerous and quite justified concerns about what this legislation will mean for the province. There is nothing in the legislation that talks about what these non-hospital sites will be. In my community, we were looking strictly at the CMHA crisis centre. It’s a community service. It’s operated through a non-profit board. However, in this schedule 1, the amendments to the Ambulance Act that are outlined in this legislation are wide open in terms of where paramedics could divert patients instead of taking them straight to the hospital. As I said, this has aroused all kinds of very legitimate questions. For example, will patients be able to decide where they are going to be taken? Will paramedics be protected from additional liability that may arise from this new ability to divert patients away from emergency rooms? Will paramedics be pressured to treat and refer patients inappropriately because of lack of provincial funding for ambulance services? How will the acuity of the patients be determined? How will safeguards be put in place to ensure that patients who are diverted are the patients who should be diverted?

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Speaker, if the government had moved ahead with a pilot project in London—which is what my community has been working on for years, as it happens—we could have done the research from that pilot project. We could have determined what kinds of mechanisms needed to be put in place to ensure patient safety when they are being transferred. However, the government has decided to move ahead with this full provincial rollout of amendments that are so broad that there are a lot of legitimate questions, and that may create all kinds of barriers to the pilot project proceeding in my community.

That’s just one schedule of the act that I wanted to focus on today.

I also want to spend some time talking about schedule 5 and the amendments to the Long-Term Care Homes Act.

I can’t help but be struck by the fact that this debate is taking place on the very day that the public inquiry into the safety and security of residents in the long-term-care system is holding its very first public meeting on the Wettlaufer murders and the circumstances that led to the Wettlaufer murders in Woodstock and London. The inquiry is meeting today in Woodstock and tomorrow in London. As you can appreciate, Speaker, there are many, many people in my community who want to be part of that public inquiry, who want to talk about their personal experiences with loved ones in the long-term-care system, and who are very concerned that the focus on the circumstances of the Wettlaufer murders will restrict the kind of input that they can bring to that public inquiry.

Schedule 5 makes amendments to the Long-Term Care Homes Act. There are some positive changes—making it an offence for a licensee to fail to protect residents from abuse or neglect—but very, very problematically, it also makes amendments to allow for the use of restraints and the confinement of residents. Unless we provide long-term-care homes with the resources that are required to safely use restraints and confinement in dealing with residents, unless we ensure that those staffing ratios and that funding are in place, we could be jeopardizing the lives of some of the most vulnerable people in our province. The proposed amendments are not accompanied by any indication that there will be enhanced funding.

As my colleagues and I in the NDP have reinforced in this Legislature and outside of this Legislature, we need to look at all of the systemic issues within our long-term-care system. In particular, we need to look at staffing ratios; we need to look at quality of care. We have been advocating for a minimum standard of four hours of care per resident per day, adjusted for acuity and case mix. We need to look at those things.

We need to look at regulation, enforcement and inspections. We need to look at capacity—the availability of long-term-care beds. We need to look at the impact of for-profit privatization on the long-term-care system. We also need to look at the accountability of this government for responding to numerous recommendations that have been brought forward by the Auditor General and the coroner about what needs to happen in our long-term-care system.

It is irresponsible of us to move forward and approve an amendment like this, allowing for the use of restraints and confinement of long-term-care residents, without ensuring that all of those other protections are in place: the staffing, the funding, the processes, the procedures, the checks and balances, everything that needs to be addressed from a systemic perspective. Those things have to be dealt with before we should be looking at that.

I hear regularly from constituents in London West about their personal experiences and their concerns about what has happened to their loved ones in the long-term-care system. I don’t know how many constituents I have spoken to, women my age, who have either reduced their employment from full-time to part-time or who have left the labour market altogether because they have a loved one in a long-term-care home. They have gone in there too many times and seen that there is no staff to feed their loved one. There is no staff to move their loved one from the bed to the wheelchair so that they can be taken to watch TV in the common room. They have felt obligated to be there to provide the services for their loved one that staff at our long-term-care facilities are simply not able to provide because there are too few of them. There are not enough people, not enough health care professionals, PSWs or RPNs to provide the kind of care that vulnerable seniors need.

I can’t believe that my time is up and I’ve only been able to address two of these 10 schedules, but it does give you a sense of how problematic it is when you bundle all of these kinds of changes—very significant changes—to our health care system that really need to be dealt with individually so that they can have the kind of comprehensive review and analysis that is necessary to make sure that we actually are strengthening the quality of our health care system and we actually are ensuring accountability for patients in Ontario.

Speaker, I can tell you, as my colleague the very eloquent member for Nickel Belt, the health critic for the NDP, stated in her lead on this legislation, that this is not a bill that the NDP can support. There are simply too many red flags. There are simply too many concerns for us to be able to support this bill.


The Acting Speaker (Mr. Paul Miller): Questions and comments?

Mr. Granville Anderson: Thank you for the opportunity to speak to the Strengthening Quality and Accountability for Patients Act this afternoon. I thank the member from London West for her comments.

This bill, if passed, will guarantee that long-term-care home operators are providing safe and quality care for residents. I often hear from residents in my riding that the quality of care sometimes is not up to par, and the accountability and the inspection should be more vigorous. What this bill does is to provide some of that safeguard and some of that strengthening of our ability to make sure that our homes are safe and that our most vulnerable sector gets the protection they deserve.

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This bill would also give ambulances the ability to transport patients to more appropriate care settings, such as mental health facilities, that best address individual needs. If a patient doesn’t need to be in a hospital in a waiting area, they are providing a setting that hopefully is safe, secure and comfortable until a permanent setting is available for these residents to be in, Mr. Speaker.

This bill also would reduce overcrowding in emergency departments in providing best care for patients, as I alluded to, in the most appropriate setting when they call 911 for assistance, Speaker. It would also protect Ontarians in their daily life by regulating recreational water facilities, like splash pads and wading pools, and personal service settings, like barbershops and nail salons. The proposed changes under the Strengthening Quality and Accountability for Patients Act would roll out important initiatives that would help Ontarians’ health care system to continue serving all Ontarians today and well into the future. That’s what we all want for our seniors.


The Acting Speaker (Mr. Paul Miller): Questions and comments?

Mr. Rick Nicholls: It’s a pleasure to speak to Bill 160, the Strengthening Quality and Accountability for Patients Act. They can probably short-term it, because it’s an omnibus bill, and call it the “soup-to-nuts bill,” because there’s an additional 10 schedules in here. In my two minutes, I just don’t have enough time to address those 10 schedules.

But I will say, though, that in the Chatham–Kent–Essex riding that I am so honoured to serve, I have over 20 combined long-term-care and retirement homes. I know that so well because I visit them—all of them—at least twice a year. I have a little fun with them, and probably humour them with my “sing along with Rick” series. But I also have an opportunity to interact with staff and to talk to them about some of the issues and challenges that they are faced with. They are doing the best they can with what they have, and sometimes what they have is hardly enough. It’s hardly enough.

I have some real concerns, because this government is noted for establishing red tape. We all know what red tape is. The more red tape to ensure quality and safety in these long-term-care and retirement homes—it puts a greater emphasis on that, a greater burden on them as well.

In the Chatham–Kent–Essex area—I’m sure it’s happening throughout Ontario—we are finding more and more that people in these long-term-care homes are cutting back. And what does that mean? That means they are cutting back on quality, they are cutting back on the service that they can provide, and job losses are occurring throughout Ontario in that sector.


The Acting Speaker (Mr. Paul Miller): Questions and comments?

Mme France Gélinas: It is always interesting to listen to my good colleague from London West and her comments on Bill 160, the Strengthening Quality and Accountability for Patients Act.

A big part of this is schedule 4, the introduction of the Health Sector Payment Transparency Act. Let me tell you about another part of our health care system that needs quality and accountability for patients: Ontario needs to ban the practice of commercial arrangements between manufacturers and wholesalers in pharmacies to avoid exclusive deals.

What does that mean? Well, for somebody in Sudbury, it means that—say you have cancer. You deal with the pharmacy at the cancer treatment centre. You need a specific drug to take to deal with your cancer, and then your drug plan tells you can have that drug but you have to deal with their pharmacy of choice. Of course, I live in northern Ontario. The pharmacy of choice is not in northern Ontario; it is someplace in southern Ontario or God knows where.

Then this package arrives on your front door, and sometimes it is a cold-chain medication that you need, so we are talking about a package this big right on your front door to have your little package of oncology pills. Then you take them back to the cancer treatment centre so that somebody can explain to you what you do with that. Why, Speaker? How can we ever link this to good-quality care? It is impossible to do. This bill gives us an opportunity to change this. Quebec just passed Bill 92, and Bill 92 was passed to do just that. It bans those deals with the preferred providers of pharmacy services, to give everybody a chance to deal with their local pharmacy, if they so wish. This will be something we will bring forward.


The Acting Speaker (Mr. Paul Miller): Questions and comments?

Mr. Han Dong: I want to thank the member from London West for her thoughtful debate. She mentioned quite a few things. I want to talk about the Ambulance Act, which she referred to. She made some good suggestions, especially around the pilot option. I think legislative and regulatory changes need to be in place to provide that framework for these projects to go on. I’m sure there will be lots of opportunities in the implementation of these initiatives, if this bill passes, to figure out the details of those operations. If this bill passes, I look forward to amendments and clause-by-clause during the third reading process.

I also want to clarify what the proposal is. The proposed changes would allow our EMS workers to treat and release low-acuity patients who do not need additional medical care or to treat and refer patients to a health setting more appropriate than an emergency room. These changes will help to reduce off-load delays at our hospitals, meaning ambulances can spend more time attending to more emergency calls. Right now, when someone makes a 911 call, these individuals will be brought to emergency rooms. We know that many 911 calls are not of a life-threatening nature. In the process, we are reviewing our emergency services to ensure that we continue to respond quickly to emergencies and provide the right level of service to non-urgent care.

I look forward to further debate on these changes with regard to the Ambulance Act.


The Acting Speaker (Mr. Paul Miller): The member from London West has two minutes.

Ms. Peggy Sattler: I want to thank the members for Durham, Chatham–Kent–Essex, Nickel Belt and Trinity–Spadina for their comments on my speech.

In answer to the member for Trinity–Spadina, I want to state very clearly that my community was ready last year to move forward with this pilot project. We were ready to put it in place and to include a robust evaluation mechanism so that we could learn from the pilot and feed those learnings back to the government before any of this would be rolled out provincially. Unfortunately, instead of allowing my community to proceed, the government has chosen to bury amendments to the Ambulance Act within a very complex and also quite contentious piece of omnibus legislation that is not helpful to the urgent need for something to be done to address the mental health care crisis in London.

Speaker, I want to be clear. We recognize there is a need to strengthen the quality of our health care system because, goodness knows, the quality has been deteriorating rapidly in this province. In my community of London, we have longer wait-lists for joint replacement surgery than anywhere else in the province. The only way that people can get a hip or knee replaced within two years is to come to Toronto. They can’t get access to that surgery in London, and that is shameful. It is a disservice to the people in my community, who have a right to access the health care they need in a timely way in their community.

Second reading debate deemed adjourned.


The Acting Speaker (Mr. Paul Miller): It being 6 o’clock, this House stands adjourned until tomorrow morning at 9 a.m.

The House adjourned at 1800.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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