Good morning. Let us pray.

Prayers.

Mr. Calandra moved second reading of the following bill:

Bill 7, An Act to amend the Fixing Long-Term Care Act, 2021 with respect to patients requiring an alternate level of care and other matters and to make a consequential amendment to the Health Care Consent Act, 1996 / Projet de loi 7, Loi modifiant la Loi de 2021 sur le redressement des soins de longue durée en ce qui concerne les patients ayant besoin d’un niveau de soins différent et d’autres questions et apportant une modification corrélative à la Loi de 1996 sur le consentement aux soins de santé.

As the parliamentary assistant to the Minister of Long-Term Care, I thank him for this opportunity to speak to the proposed amendments to the Fixing Long-Term Care Act, 2021.

It’s an understatement to say that the last couple of years have been challenging for the long-term-care sector and the broader health care system. COVID-19 challenged all of us, and it continues to challenge us today. There were also many learnings and realizations that should not be lost. The shortfalls in our health care and long-term-care system were exposed.

I am proud to be part of a government that has set such a high priority to improving our systems, providing a higher quality of care and being prepared for the future with new health care facilities, resources and staffing. To this end, our government released the Plan to Stay Open: Health System Stability and Recovery. We are acting to secure the stability of our health system. It is paramount that we maintain stability and we continue our recovery and be prepared for new challenges moving forward.

In keeping with the staffing challenges evidenced across the health system, the strain on home care workers, nurses and administration has also increased. Patients are waiting for long periods of time in hospital emergency departments. They’re also waiting for long periods in hospitals to be transferred to a bed in a long-term-care home. Furthermore, health care workers across the health system have not had the time they need to rest, recharge and recover from the increased pressure brought upon the system from back-to-back Delta and Omicron waves. The picture is made even more serious when we look at the challenges we could face in the fall and winter, our flu season.

If no further action is taken to strengthen the health system, Ontario could experience a 2,400 hospital bed shortage by the peak of a potential flu and, perhaps, another COVID-19 wave later this year. As Minister Calandra mentioned, much of the focus over the last few months has been on hospital emergency departments, and rightfully so. However, emergency departments are part of a much larger system. Long-term care is a critical part of this system. These amendments are actions we can take now to address these challenges, actions that will help us to avoid overstraining the health system and establish better models of care.

One of the main ways to help with hospital capacity challenges is to ensure that patients are getting care in an appropriate setting. There are many patients in hospitals across the province whose care needs could be met elsewhere. Long-term care is one of those places. These are referred to, as you know, as alternative-level-of-care patients: ALC. Many of these patients have care needs that can be met in long-term-care homes. Moving these patients out of the hospitals and into long-term care frees up much-needed space in hospitals for patients who require hospital treatment. This also benefits the ALC patient since they are being moved to a more appropriate setting where they can receive care again. These are patients who want to move from patients to being residents in a home, a long-term-care home.

That’s why, as part of our plan to stabilize the health system, we are seeking to amend the Fixing Long-Term Care Act, 2021, in order to improve how we transition ALC patients into long-term-care homes, because our priority is for people to live and receive care where they can have the best possible quality of life close to their family and friends. In hospitals right now, there are currently about 1,900 ALC patients waiting for long-term-care homes. Some of these patients have been waiting for more than half a year, even though they no longer require hospital care. We are all aware of the challenges our hospitals are experiencing. Having ALC patients in hospitals contributes to backlogs in acute care services in hospitals because they occupy beds and use staff resources that other patients urgently need. When they cannot be discharged, these patients continue to receive care, but in the wrong setting. The hospital is not the appropriate place for them to be. They no longer need acute care, but are in an acute care setting.

The proposed amendments we are putting forward would, if passed, support the movement of some ALC patients to temporary care arrangements in long-term-care homes, in an appropriate setting, while they wait for their preferred home. It is important to note that this would only apply to ALC patients who are eligible to receive, and would benefit from, care in a long-term-care home. And this would only happen after conversations with a placement coordinator and after efforts have been made to obtain consent. By allowing a placement coordinator to assess and authorize an ALC patient’s admission to a long-term-care home, but with their best care in mind, this amendment will, if passed, enable attending hospital clinicians to discharge patients from the hospital to a more appropriate care setting that better meets their needs. These changes, if passed, may be met with some concern at first and there may be initial barriers to implementation. But parameters within the changes will help ease concerns.

One of these parameters is that the home must be within a specific distance from the patient’s preferred location, including that it is near a partner or spouse, loved ones and/or friends. Another parameter is the requirement that the long-term-care home must be able to meet the ALC patient’s care needs, whatever these needs may be. In addition, field guidance will be developed to support implementation and promote ongoing conversations with ALC patients, which will encourage and help with their comfort level. Long-term-care placement coordinators will be encouraged to make ongoing efforts to re-engage with patients at frequent points throughout the placement process. At any stage in the process, patients can change their minds or choose an alternative care option.

The next part—this is very important to me, in particular, and to the whole program: Furthermore, hospital patients who have applied to live in a long-term-care home but have been moved into another suitable home temporarily will remain on the wait-list and be prioritized to permanently move once a bed becomes available at one of their preferred homes. In other words, they won’t lose their place in the queue. Change is hard, so they can also choose to remain permanently in the initial home that they are moved to.

The changes will also recognize the importance of partner and spousal reunification in long-term care.

These proposed legislative amendments will, if passed, reduce ALC patient volumes and support their movement out of hospitals now and in the future. This change is crucial because it would help ensure that patients who need hospital treatment can get the emergency treatment, surgeries and other hospital services they need when they need them. At the same time, it would make sure the ALC patients receive care in a more suitable setting that will offer a better quality of life while they wait for their preferred long-term-care home. We’ve all probably been in long-term-care homes. You see the social interaction, the laughter in the dining halls, and the extra care they get—allied health services and other services that are available in a long-term-care home that aren’t available while they’re waiting in a hospital in an ALC environment.

The Ministry of Long-Term Care is also taking several other actions that will ease the strain on the health system. These include the following:

—opening up long-term-care beds that no longer need to be held for pandemic-related isolation purposes, through a minister’s directive coming into effect on August 23, 2022;

—reactivating long-term-care respite care programs for high-needs seniors to prevent possible hospitalizations;

—expanding specialized supports and services to support movement out of hospitals and to avoid entry into hospitals;

—enabling community partnerships to provide more supplies, equipment and diagnostic testing in long-term-care homes, to prevent potential hospitalization.

These interconnected actions, along with the proposed changes to the legislation I detailed earlier, will help reduce the number of ALC patients in hospitals and ease the strain on hospitals now and in the future. This will, in turn, reduce the risk of a hospital bed shortage at the peak of a potentially challenging flu and COVID-19 wave in the fall and winter.

This proposed amendment is part of a broader strategy from our government to ensure recovery and stability in the Ontario health system. Informing all of this work are the lessons that we learned from the COVID-19 pandemic. This includes the changes to the legislation we are proposing today.

It is no secret that COVID-19 exposed long-standing issues in the long-term-care sector—issues that were the result of decades of inaction and underfunding. The pandemic shone a spotlight on a system strained by critical staffing shortages, increasing capacity pressures, complex and diverse resident needs, gaps between staffing levels and resident needs, and other challenges that the long-term-care sector was experiencing well before the COVID-19 pandemic.

Health care workers on the front line have worked day after day, long hours, to protect our friends, families and loved ones, to provide them with the care they needed. Our government has taken many steps to support our front-line health workers in long-term care and help the sector through the pandemic. To this end, we’ve invested billions of dollars in COVID-19 emergency funding, which has helped the sector to respond and cope with the multitude of challenges that have accompanied the pandemic.

From the earliest stages of COVID-19, the government took decisive action to support all long-term-care homes, staff and residents. As always, our government is working hard both to help Ontarians stay healthy and to ensure that the appropriate level of care is available when it is truly needed. That’s what these amendments are about. Ensuring that the long-term-care sector is stable and that their residents experience the best possible quality of life, supported by safe, high-quality care, is a priority for our government.

That’s why, at the end of last year, we introduced the aforementioned Fixing Long-Term Care Act, 2021. This landmark piece of legislation was proclaimed into force on April 11 and speaks to our government’s ambitious plan to fix long-term care in Ontario. This plan centres around three key areas: building modern, safe, comfortable homes for Ontario seniors; improving staffing and care; and driving quality through better accountability, enforcement and transparency. We’re taking action and making progress under all three of these areas.

When it comes to building long-term care homes, for instance, we’ve made historic investments. We have invested $6.4 billion to build over 30,000 new and 28,000 upgraded long-term care beds. We’re making incredible progress on these projects and already have more 30,000 new and 28,000 upgraded long-term-care beds in development.

Of the 365 projects that are in the pipeline, 115 projects have proposed to be part of a campus of care model. The model focuses on integrating the long-term-care home into the broader health care system. Additionally, with the redevelopment of older homes, the prior system of three- to four-bed ward rooms is being eliminated, and all homes will now be up to modern design standards. No more ward beds.

We also recognize the diversity of our aging populations. That’s why 39 of the announced projects have proposed to serve Ontario’s francophone population, and 30 have proposed to serve indigenous communities. The progress we are making and the bed allocations we are announcing on a monthly basis is what this province needs. In the first three months of this year alone, our government announced bed allocations in every corner of the province. We are building beds for our loved ones in the communities that they call home.

We also marked the sales of unused government properties to build new long-term-care homes in Etobicoke, Hamilton and Mississauga. These sales are part of the surplus provincial lands program. The program uses the sale of unused government properties to secure much-needed land for building long-term-care homes in large urban areas of the province where available land is costly and difficult to secure. The program also opens the door for additional uses for unused land, such as affordable housing and recreational facilities.

Another innovative program we have created to build is the accelerated build pilot program. In February of this year, we celebrated the completion of the first brand-new long-term-care home built under this program. The new home, named Lakeridge Gardens, is built in Ajax and is located on the same grounds as the Ajax Pickering Hospital. The home will be part of a campus of care at Lakeridge Health to ensure residents have access to the specialized care they need and access to the broader health care system in Durham Region. The proximity of long-term care to other services like this will contribute to greater collaboration, communication and efficiencies in our system.

Of course, when building new and upgraded homes, it is vital to ensure that there are enough staff to provide care within these homes. That’s why strengthening staff is a key part of our government’s plan to fix long-term care. When it comes to staffing, our central commitment is to increase the hours of direct care provided by registered nurses, registered practical nurses and personal support workers. And as the minister has previously stated, we aim to increase it from the 2018 provincial average of two hours and 45 minutes per resident per day to a system average of four hours per resident per day over four years. To achieve this ambitious target, we are investing up to $4.9 billion by 2024 to help create over 27,000 new full-time positions for registered nurses, registered practical nurses and personal support workers in long-term care. This includes a commitment to invest $1.2 billion and $1.8 billion for staffing increases in the 2023 and 2024 fiscal years respectively. In addition, this funding will support a 20% increase in direct care time by allied health professionals, including physiotherapists and social workers, by March 31, 2023.

Increasing staffing levels is important, but it is just as important that the right culture of care is present in the staff. The focus must always be on the residents and providing them with the care that they want and they need. To build this culture, the ministry will continue to engage with residents, essential caregivers and families to understand what quality of life and quality of care means to them.

We have already taken many steps this year to achieve our ambitious staffing goals. This year, we are providing $673 million to long-term-care homes to hire and retain up to 10,000 long-term-care staff. This major investment will lead to more direct care for residents.

A month earlier, we announced a $73-million investment over three years to train and provide clinical placements for over 16,000 personal support workers and nursing students. This enabled the creation of a new program known as the preceptor resource and education program for long-term care. This program provides more opportunities for career development within long-term care and ensures that PSW and nursing students receive critical hands-on experience to better serve the needs of residents. Clinical placements are a key part of nursing and PSW education and provide students with critical hands-on experience under the supervision of experts or existing long-term-care staff.

Positive clinical placement experience supports recruitment, because many students take jobs in the homes where they completed their placements. At the same time, it provides existing long-term-care staff with an opportunity to oversee those students. We will continue to do what is needed to ensure that there are enough staff in long-term care to meet our target of providing a system average of four hours of daily direct care per resident.

In addition to all the progress we’re making on long-term care staffing and capital development, we’re also making progress to drive quality in long-term care. We’re achieving this through instituting better accountability, enforcement and transparency in the sector.

Another important aspect of driving quality is ensuring that residents have the food and nutritional support that they need. That’s why we invested over $40 million in additional nutritional support funding for long-term-care homes this year.

A key factor in driving quality is the inspection system. The inspection system exists to keep residents safe, and the ministry continually assesses information and reprioritizes inspections daily based on harm or risk of harm to residents. As part of the work to fix long-term care and ensure long-term-care resident safety, our government is investing an additional $72 million over three years to increase enforcement capacity. This will allow us to hire 193 new inspection staff, which will double the number of inspectors across the province in the 2022 fiscal year. This will make Ontario’s inspectors to long-term-care homes ratio one of the highest in Canada.

The new proactive inspection program adds to the current risk-based program of responding to complaints and critical incidents. The program also takes a resident-centred approach by allowing for direct discussion with residents so that the focus is on their care needs as well as the home’s programs and services. The results from proactive inspections will help the government determine where the sector can benefit from additional resources, including guidance material and best practices.

Another important way to drive quality is by amplifying the voices of residents and their families and caregivers and listening to their insights and experiences. The Fixing Long-Term Care Act requires every long-term-care home to take a survey of residents, families and caregivers to measure their experience with the home. Homes must make every reasonable effort to act on the results of the survey to improve the home.

The Fixing Long-Term Care Act also requires every home to implement a continuous quality improvement initiative that must include an interdisciplinary quality improvement committee for the home. The committee is intended to support an ongoing culture shift in long-term care that encourages continuous quality improvement through collaboration between the long-term-care homes, staff and leadership as well as representatives from the residents’ council and family council. Among its responsibilities, the committee makes recommendations regarding priority areas for quality improvement in the home.

To improve transparency under the third pillar of our fixing long-term care plan, our government launched the Long-Term Care Homefinder website earlier this year. This website and search tool provides prospective residents and their families with a one-stop shop to find and compare long-term-care homes across the province, and it also provides them with other resources to help them to make an informed choice when considering long-term care. In addition, we have continued to expand the behaviour-specialized units, also known as BSUs, across the province. BSUs provide specialized care to individuals with responsive behaviours that cannot be effectively supported in their current environment and for whom all other applicable services, like regular long-term-care beds and community supports, have been fully explored. Specialized care in a BSU is required due to the frequency, severity or level of risk that the individual poses towards themselves, co-residents, visitors or staff members. This includes $5.9 million to establish four new BSUs in Ajax, Scarborough and Toronto. We’re also investing $3.6 million to continue the operation of three BSUs established in 2019 in St. Catharines, Mississauga and Whitby.

Ontarians who need long-term-care services frequently report that they prefer to remain in their own homes for as long as possible. Our government listened by launching the Community Paramedicine for Long-Term Care Program to help seniors remain stable in their own homes while also providing peace of mind for their caregivers. This is a great program. This program was announced in October 2020 for five communities, with a total commitment of $33 million over four years. The program was then expanded to additional communities, with a further commitment of $137 million over four years. And last fall, we announced that we were investing another $82 million over two and a half years to expand the existing Community Paramedicine for Long-Term Care Program to an additional 22 communities. This final expansion made the program available to all eligible seniors across Ontario.

The program provides individuals eligible for long-term care and soon to be eligible for long-term care with 24/7 access to non-emergency support through home visits and remote monitoring. The program also leverages the training and expertise of paramedics in a non-emergency environment to help seniors and their caregivers feel safe and supported in their own communities. This has the added benefit of potentially delaying the need for care in a long-term-care home or a hospital visit.

As of this summer, there are more than 23,000 individuals receiving care through the Community Paramedicine for Long-Term Care Program. This is yet another action we are taking to help maintain the stability of our health care system while ensuring that Ontarians receive the care they need and deserve.

It is extremely important for our government to hear from the people within long-term-care homes when moving forward with our plan to fix long-term care. That’s why we’re always connecting with residents; essential caregivers; families; and long-term-care staff, including registered nurses, registered practical nurses and personal support workers. The feedback and insights that we receive from people on the ground in long-term care are invaluable and help shape the solutions and direction our government pursues. This will continue to be true moving forward as we continue to innovate and evolve in long-term care and in the broader health system.

For the reasons I mentioned at the beginning of this speech, this is a critical time for action in Ontario. That’s why we are doing everything we can to fix long-term care and to ensure that our broader health care system is stable. That’s why I’m here today, joined by Minister Calandra, to put forward proposed amendments to the Fixing Long-Term Care Act, 2021. Through these proposed amendments and the other actions we are taking, our government is taking a holistic approach to solving the challenges facing the health system. Using this approach will ease the current strain on the health system and help ensure that every Ontarian has access to care when they need it and where they need it.

My office, like I’m sure many offices across the province, has received calls from families saying, “My parent is being pushed out of hospital. I don’t have the ability to care for them”—

Interjection.

Interjection.

Anyway, what’s happening is—and we all hear this—patients are being pushed out of hospitals. Family members are concerned. They’re threatened that if they don’t take their family member home because there is no care for them, they’re going to be charged with a bill. This is a great concern.

As we’re changing the system, I’m asking the minister specifically: What will the consequences be for families who choose not to be pushed out of the ALC into a long-term-care home that they choose not to be in?

It is my pleasure to start my hour lead on Bill 7, the More Beds, Better Care Act.

Because I have a little bit of time, I want to place this in context. Our hospital system has been overcrowded for a long time. You have heard me and many others talk about hallway medicine for a long time. What does hallway medicine mean? It means that if a hospital has 300 beds, they have 350 patients admitted. The other 50 who don’t have a bed will end up in a hallway, in a TV room, in a bathroom, at the end of a unit, wherever they can place them. This has been an ongoing problem.

This government is making the link that, in general, most large community hospitals have about 20% of their beds which are occupied by what is called alternate-level-of-care—they’re referred to as ALC. Most people who get that designation are frail, elderly people. They want, like 90% of all elderly people, to live at home. They want to be supported at home. But the home care system fails them. The home care system does not allow them to stay home safely. They end up in trouble. They fall. They don’t take their medications when they are supposed to. They end up in the hospital. Once they’re in the hospital, the attending physician says, “I cannot send you back home because I know that the home care system will fail you again and you will end up in more trouble,” so they put them towards a long-term-care home. They become ALC simply because they cannot do the transfer to a long-term-care home as fast as their care needs are no longer requiring hospitalization.

I want to go a little bit into what could be done to prevent 20% of most community hospital beds being presently occupied by patients labelled as alternate-level-of-care: Fix our home care system. Give people the care they need where they need it, which is at home.

I have many examples of people from my own riding whom the home care system has failed.

I want to share the story of Lucie Laplante. Lucie Laplante’s husband is Gabriel. Gabriel is in—oh, no, not this story yet. I will start with another, shorter story, because I see that I only have a few minutes on the clock.

I will start with Mrs. D. Mrs. D lives in Hanmer, in my riding. Her husband broke his neck several years ago. He has been on the mend, but he suffered another fall a year later and has deteriorated. She sold their home and moved to something that would be more accessible for him, but she cannot bring him home from the hospital, because there is no home care. He needs a lift to get out of bed and into a wheelchair to get around. He is unable to stand on his own. He went for rehab for three months at the Clarion, which is a hotel that is presently being rented by our hospital to care for people in overflow—because our hospital is overflowing. He has been in the hospital since December 2021. While at the hospital, he got out of bed, fell and banged his head. She is making an inquiry on her own to find private home care, and she is buying all of the equipment that he needs to stay home, like a hospital bed to have at home. But everybody is telling her that he needs to stay at the hospital because home care is not available. The hospital is telling her that they could provide home care for one hour a day, five days a week, as long as she got a lift and a wheelchair. She wants her husband to be cared for at home, not at the hospital, but she’s having difficulties working out a discharge plan, although she is willing to pay for all of the equipment needed. She wants her husband at home. This story repeats itself over and over. This person is now being placed for a long-term-care bed when all they want is to go back home.

I see you’re looking at your watch, Speaker, so I will sit down.

Families in my riding of Windsor–Tecumseh have reached out to me with respect to uncertainty for the transfer of their loved ones from the hospital to a long-term-care home that might not meet the needs of the residents and the families.

Could the member explain what measures will be taken into consideration when proposing appropriate long-term-care homes for ALC patients?

I think the member herself has just highlighted the fact why the legislation is needed and why the member should actually be in support of the legislation. That question frankly puts it all out on the table.

Right now, it does not give the families and the patient other alternatives. The conversation stops. This legislation allows the conversation to continue. It allows us to highlight some of the other homes that might be available for this patient in and around the patient’s preferred choices. That is something that this legislation does.

It also provides resources so that we can ensure that any patient who is discharged, with their consent, into a long-term-care home has the resources they need in order to manage that. Just given what the member has said, I think it highlights the need to actually vote in favour of this bill for patients who are wanting to become residents of long-term care.

As I mentioned in my speech, it is part of this transition to Ontario health teams. It’s part of long-term care being the solution to the acute-care challenges that we have faced for decades in this province, Mr. Speaker. We are in a position to participate, and we are. It is part of building an integrated health care system.

As I mentioned yesterday, when we are building systems and making it better, the NDP—the opposition—typically go to their old standby: tearing down what is being built up. This bill allows us to continue that transition, to continue to be part of building an integrated system. It’s better for patients who want to be residents, and I would hope that the member and the members opposite would support this.

She talks about surprise inspectors. Doubling the amount of inspectors allows us to do that work, and if you vote in favour of this bill, it puts it right in there. So I would suggest to the member, vote in favour of the bill for once and you can help us build a better Ontario health care system, as opposed to tearing down what we are building.

The Minister of Francophone Affairs and the parliamentary assistant have helped me identify just how important it is that we bring services to people in their languages, and culturally appropriate services. But it wasn’t just those two ministers; it was part of the most diverse caucus in the history of the province of Ontario that helped me understand, helped this government understand how important it is, whether it’s the Coptic community, the Persian community or the Muslim community, so that people can have services in their own language.

If we are building a diverse province that we are so proud of, services should be available to them in their language, and in the culture that they know best and that they are comfortable in. And that’s what we have done with the largest buildout of long-term care in the history of this country.

Now, the irony is that the member voted against each and every one of those initiatives. So I would suggest to the member to work with us, to help us as we expand services to our friends in the north, because it is so important. Whether it’s the francophone community in northern Ontario or whether it’s our First Nations partners in the north, they were ignored for so long.

That’s why so many Progressive Conservatives from the north are here for the first time: to fix a problem that the other two parties never addressed. We will get it done, Mr. Speaker, and I hope he votes for this bill, because it gets it done for the north as well.

Ontarians and people across my riding of Scarborough Southwest are anxious. Our health care system is in a crisis. Staffing levels are at an all-time low. We are seeing a mass exodus of health care workers who have been on the front lines since 2020, protecting our province in the face of COVID-19. We’re hearing about ERs closing their doors, patients waiting up to 24 hours. And now, this government is forcing for-profit, private solutions to public problems that people have entrusted us to solve. This is unacceptable.

Every single one of us in this chamber, regardless of party lines, have been entrusted with a responsibility to represent hard-working, tax-paying Ontarians, many of whom have come from across the world with skills and experience and want to contribute to the health care sector. Free access to health care—universal health care—is at the core of who we are as a province and as a nation. It is universal health care that made sure that when my family faced an unimaginable tragedy, we did not fall through the cracks. I know my story is not unique; many share this, many rely on our universal health care.

It is a big part of why I am here today. We all carry an immense responsibility in this chamber to protect the people of Ontario and protect the values that make our province great. And today, I plead. I am calling on the government to protect our universal health care system that makes sure people get the care they need when they need it, and not only when they can afford it.

Yes, Mr. Speaker. I announced that on Thursday, and of course the opposition have said they are not supportive of that.

It is so important that we bring back respite care to the province of Ontario. We’re in a position to do that, Mr. Speaker. Many of us have heard how important this is during the campaign. We’re in a position to do that because over 85% of long-term-care residents have their fourth dose of vaccine, so we can do that.

I implore the member: If you believe in what you have just asked, then surely you will be supporting this bill.

Interjections.

I hope the honourable gentleman will do the honourable thing: Withdraw what he just said, stop getting people worried about what is happening. This is a way of building health care in the province of Ontario, including in Ottawa, and he should be a part of helping us do that.

Interjections.

If he went further, Mr. Speaker, he would know that the act guarantees that and it actually provides up to $60 million on a go-forward basis to ensure that we have behavioural supports for patients, that we can provide kidney dialysis for patients, because for the first time, long-term care will be part of the solution as we build an integrated health care system in the province of Ontario. And despite what he is saying, we will continue to do that on this side of the House, despite the failings of 15 years of Liberal government.

A constituent of mine—who wishes to remain anonymous, so we will call her Sarah—reached out to my office to share her “health care horror story.” Sarah explained that after waiting for three hours at Juravinski Hospital for a scheduled surgery to remove suspected ovarian cancer, the surgery was cancelled at the last second because there was not a single bed available for her post-procedure. Sarah’s surgeon had mentioned that numerous other patients experienced the same last-minute cancellations just a week prior, all due to a lack of beds.

Premier, our emergency departments are at their breaking point, with ongoing surgical delays. What is this government going to do to alleviate the increased ER visits that we are seeing from Ontarians with undiagnosed issues resulting from pandemic delays, surgeries being pushed back and preventable illnesses progressing?

Premier, is this inaction around bed availability this government’s cruel and shameful strategic move to convince Ontarians that private clinics are the end-all and be-all solution to our health care woes?

Yesterday, the part-time long-term-care minister said 100% of residents have access to AC, but of course that doesn’t mean their bedrooms when they’re in quarantine or asleep. In fact, he was proud that one in 10 long-term-care residents don’t have AC in their bedrooms through the summer heat where they have to stay for 24 hours a day when there’s a COVID outbreak. He also said consent is required to move patients from hospitals to long-term-care homes that they don’t want to.

He asked me to read the bill, so I thought I would: “This new provision authorizes certain actions to be carried out without the consent of these patients. The actions include having a placement co-ordinator determine the patient’s eligibility for a long-term care home, select a home and authorize their admission to the home.”

It also says—because I’ve read language before. Subsection 60.1(4) of his own bill says actions can be “performed without consent if reasonable efforts have been made....”

So given he made two inaccurate statements twice in one morning, will the minister explain why he thinks misleading residents is a better strategy—

Interjections.

Further petitions?

Resuming the debate adjourned on August 23, 2022, on the motion for second reading of the following bill:

Bill 7, An Act to amend the Fixing Long-Term Care Act, 2021 with respect to patients requiring an alternate level of care and other matters and to make a consequential amendment to the Health Care Consent Act, 1996 / Projet de loi 7, Loi modifiant la Loi de 2021 sur le redressement des soins de longue durée en ce qui concerne les patients ayant besoin d’un niveau de soins différent et d’autres questions et apportant une modification corrélative à la Loi de 1996 sur le consentement aux soins de santé.

I would like to start by correcting my record. This morning, I gave the story of one of my constituents. I simply called him Mr. D. I said that he was waiting for a long-term-care placement. Mr. D has passed. He is no longer. I was giving the story about him not getting the home care he needed, but he is not on the long-term-care list; he has passed—just to correct my record.

The bill that we have in front of us has a very telling title. It tells us that we want more beds—that is, to free up hospital beds; and better care—that is, people who need long-term care should be in a good long-term-care home to receive the level of care that they need.

I started my remarks by saying the first part of the title of the bill, “More Beds,” is really because our hospitals are in crisis. You have heard me talk about hallway health care for a long time. Our hospitals are full—at more than 100% capacity most of the time. Even in the summer, which is usually the slow season for hospitals, you can look at 152 hospital corporations in Ontario, and the vast majority of them are full-to-overcapacity already, and this is before fall has even come. So the aim of the bill is to free up some of those beds.

The crisis in our health care system, in our hospital system, is not new. You will remember, many times, bringing examples of—I remember my good friend Leo Seguin, who spent 10 days in a bathroom at Health Sciences North because there were no beds left for him to be cared for. And this happens in every hospital when all their beds are full but the people that they see are too sick to be sent back home. They need hospital-level care. They get admitted into a TV room, a hallway, a bathroom, a shower room, whatever they can to keep the patient there so that they can be looked after.

If you look at a large community hospital, most of them have about 20% of their beds that are occupied by what we call alternate-level-of-care patients. Alternate-level-of-care patients are patients who were admitted into the hospital, they received the care they needed to get better, and now they cannot be sent back home.

The example that I was giving this morning, and I have a pile of examples—90% of frail, elderly seniors want to be home. Their loved ones, their families, their neighbours do everything they can to try to support them at home, but they need the home care system to be there, and the home care system fails them day after day, week after week, to the point where they end up in trouble. They end up in the hospital, and their physician looks at this and says, “It is not safe for me to send you back home. The home care system will not support you. The home care system will fail you again. We will send you to a long-term-care home.”

Once they don’t need the level of care in a hospital anymore, they are labelled “alternate level of care,” ALC, and it simply means we are not able to send you home. The home care system will not be there for you. You will be going to long-term care. Once this happens, they get assessed, and they get to pick a long-term-care home of their choice. They can put up to five homes, but they don’t have to. They can put only one long-term-care home.

The aim of the bill is really to take some of the frail, elderly people who are patients in our hospitals, who have been labelled alternate-level-of-care, and get them into a long-term-care home. In theory, they will be getting better care in a long-term-care home. This is addressed not only to their physical and medical needs but to the need to socialize and the need to eat with other people and the need to take part in activities that they’re able to enjoy. That’s the theory behind what we have.

But we all have to realize that, when you move to a long-term-care home, there’s a good chance that you are moving to your final residence. The great, great majority of people get discharged from a long-term-care home after their passing. So families take that decision seriously—“Where do we want our loved one to go? Which long-term-care home will best meet the family’s needs so they continue to have frequent visitors and continue to be part of the family and we’re able to take them home for a special birthday, and is not too far?” If they speak French, they may want to go to a home that’s able to provide services in French.

In Sudbury, we have Finlandiakoti, which offers services in Finnish. They are supported by the Finnish community in our area etc.

There are many that either are able to offer different languages or are anchored in different cultures so that the food that is served to you is food you’re used to eating and the activities are activities that are in line with your culture and things you like to do.

All of this happens at a very, very slow pace because most of our long-term-care homes are full. I can give you the statistics. They are available online, if anybody wants to know. You can go right now—information on long-term care. I looked at the one in my riding called Sudbury-Manitoulin. You can see that we have 1,555 long-term-care beds—we are higher than many other areas of the province because we have very few other services to support people in the community to keep them there, as opposed to other parts of the province that are able to keep frail, elderly people in the community longer—and right now, on the wait-list there are 1,107. I will let that sink in: 1,555 beds for the Sudbury-Manitoulin area, which is a huge area, and we have 1,107 people on the wait-list.

I want to talk a little bit about the different homes.

We have two private, for-profit—we have more than this, but we have two Extendicare long-term-care homes in Sudbury: Extendicare Falconbridge and Extendicare York. Both of them are big homes—Extendicare Falconbridge has 232 beds, and Extendicare York has 272 beds—but they have very small wait-lists compared to others. Extendicare Falconbridge has 53 people on their wait-list. Extendicare York has 37 people on their wait-list. I was mentioning Finlandiakoti. Finlandia has only 108 beds, but they have 445 people waiting for those beds. I’m strong in math. If you look at the difference between the two—if you put your name at Finlandia, you will wait 32 times longer than if you put your name to go to Extendicare York. Extendicare York is an older home that still has four beds to a room. It hasn’t been renovated for as long as I can remember; I would say at least 50 years. It is not the long-term-care home of choice.

That brings me to the content of the bill. Bill 7 is quite modest, really. It’s a page and a half. That’s it. That’s all. That’s the entire bill. So what the bill does is that it changes—section 1 of the bill amends the Fixing Long-Term Care Home Act by changing the definition of “personal health information” under the Personal Health Information Protection Act. This is significant, because what the bill will do is it will give a bigger amount of people the right to assess you, to see if you could be transferred into a long-term-care home, whether you give your consent or not. In a hospital, nobody can do anything to you without your consent. If you don’t consent to a test, it will not be done. It is the bedrock of our health care system. Everybody has to give consent before anything is done to them. You don’t want a vaccine? If you don’t consent to a vaccine, you’re not going to get a vaccine. In our health care system, you have to consent.

But this bill takes away consent. First, it used to be that once you are finished your active treatment in a hospital, a physician had to assess you to see if you meet the criteria to be transferred into a long-term-care home. The bill changes this—that, now, it’s not only physicians who can do this, but other health care professionals can do this. And then it takes away your right to consent. That professional—be it a nurse, be it a care coordinator, be it a social worker, be it a physician—is allowed to go and assess you to see if you meet the criteria to go into a long-term-care home. Not only are they allowed to assess you without your consent, they’re allowed to access your personal health information and they’re allowed to share that personal health information with the long-term-care home of their choosing.

This is not how health care is supposed to work. In health care, the dignity of the person, the quality of care is always linked to you. You only get done to you what you consent to. But this bill changes this and gives physicians, nurses, social workers, care coordinators, the right to assess you to see if you meet the criteria, whether you give your consent or not. The bill gives physicians, nurses, social workers, care coordinators the right to share personal information about you to a long-term-care home that you don’t want to go to. They have the right to do that. They are giving themselves in this bill the right to do that.

The second part, section 2 of the act, also amends the Fixing Long-Term Care Home Act by adding section 6.1, which provides for a modified long-term-care-home admission process for alternate-level-of-care patients. I have described what the admissions process looked like before. Section 2 of the bill will change this.

Usually, you need to have consent from the patient or from their substitute decision-maker to be allowed to go and assess. This is being taken away. It goes on to say, if an attending physician reasonably believes that an ALC patient was eligible for admission to a long-term-care home, paragraph 1 would authorize the clinicians to “request that a placement co-ordinator carry out” an action described under paragraph 2.

Placement coordinators are people who exist right now in our hospitals. They are usually linked to the home and community care sector, HCCS. They are the ones who manages all of the long-term-care-home wait-lists. For every home, there will be a wait-list for a private bed, for a semi-private bed, for a basic bed—for all of the homes, they will keep the wait-lists. Those wait-lists are available online if you want. You won’t see names on it, but you will see numbers. Every patient is assigned a number so that you can see where you are on the different lists that you have chosen.

The bill will change all of this. It brings forward a new admissions process for alternate-level-of-care patients. So the attending physician requests a placement coordinator to carry out the assessment. The placement coordinator would have the authority to:

“i. Determine the ALC patient’s eligibility for admission to a long-term-care home.” Usually, this is only done with consent. With this bill, they can do this whether you consent to it or not.

“ii. Select a long-term-care home ... for the ALC patient in accordance with the geographic restrictions that are prescribed by the regulations.” I have to tell you that the geographic restrictions prescribed by regulations—we don’t get to see the regulations. I know that they are being worked on right now. I know that the Minister of Long-Term Care has the full intention of making those regulations available within a week of the bill passing. But there’s this element of trust. We have to trust that the regulation as to how big of a geographical area will be in the regulations will make sense—that it will make sense to us in northern Ontario.

I have to admit to you, Speaker, the level of trust in this government regarding the safety of our long-term-care homes is very, very low in parts of the province where we have seen people dying by the hundreds in our long-term-care homes through COVID, with a government that was not prepared, that didn’t do anything to protect them. To trust that whatever those geographical limits will be will make sense is a big pill to swallow. I can talk to you about when our hospital was designated crisis 1A.

People will say, “Oh, but they were placed within the city of Greater Sudbury.” The city of Greater Sudbury is huge. You can fit Toronto, Mississauga, Hamilton—you can fit many, many cities in southern Ontario into the geographical area of the city of Greater Sudbury.

Some of the people I represent, my constituents—if some of you come from northern Ontario, you will know where Onaping and Levack are. The long-term-care home that is closest to Onaping and Levack is in Chelmsford, which is about half an hour’s drive away from their community. So if you come from Onaping or Levack or Dowling or Chelmsford or Azilda, you want to go to the long-term-care home in Chelmsford. Unfortunately, the long-term-care home in Chelmsford, called St. Gabriel Villa, has 128 beds and 367 people waiting to go to that home. Usually, the average beds available per month is three. I will let you do the math. There are 367 people waiting for a long-term-care bed and they take, on average, three new residents. That means most people will wait over 120 weeks before they are admitted into that long-term-care home. But if you want to go to Extendicare York, you can get there within a week.

For the people I represent, if your loved one is 90 years old, going into a long-term-care home, there’s a good chance that the spouse is also close to 90 years old. He may very well be able to still have a driver’s licence, because I have many elderly people in my riding who are still very good, but they are very careful about where they drive. They would drive from Onaping-Levack down Highway 144 to Chelmsford, because this is where the Canadian Tire is. This is where the grocery store is. This is where the bank is. That’s okay. But to make it all the way to Extendicare Falconbridge, that’s, at a minimum, an hour’s drive to get there.

Think about it. You want to go see your wife every day. You are worried about her because she is in a long-term-care home. We’re telling you that we will place her in a long-term-care home that is within the city of Greater Sudbury, but that is an hour’s drive away. That means an hour there, an hour back. Two hours of your day on the road when you’re 90 years old to go see your wife means that your wife is not going to be supported.

That means that your wife will be wondering, “Why am I being abandoned? Why have I been moved to this part of the city that I have nothing to do with? I come from Onaping-Levack. This is where I want to be. This is where my children are. This is where my grandchildren are. This is where my friends, my family, my husband, my home are.” We will place you within the city of Greater Sudbury, but an hour’s drive away from where you live, where your husband of 60 years won’t be able to go see you, because it is just too dangerous for him to drive all the way down there. He could go see you if you were in Chelmsford, because there’s one highway; you go in and that’s it, that’s all. But to make your way and zigzag through the city to make it to Extendicare, where there are beds available, means that he won’t be able to go see you.

So when we see in the bill, “Select a long-term-care home ... for the ALC patient in accordance with the geographic restrictions that are prescribed by the regulations,” can you see how people are nervous when they see this? First of all, we don’t know what the geographical area is going to be, but if the geographical area is the city of Greater Sudbury, then that means that if you live in Alban, Estaire, Onaping, Dowling or Whitefish—everybody that I represent—you could very well find yourself in a long-term-care home that is an hour away from your loved ones, from your circle of care.

I can tell you exactly what happens to those good people who get transferred to a home where they have no support. You feel, first of all, “Why am I here? Why am I so far away? Why is it that I don’t see my family anymore? Nobody loves me. Nobody cares about me.” It’s easy to get depressed. It’s easy to give up. And when you’re 90 years old and you meet the criteria to go into a long-term-care home, it’s a good chance that you have a number of health issues that qualified you to go into a long-term-care home, and those health issues will take over.

There are statistics that exist for people who get transferred into a long-term-care home not of their choosing, into a long-term-care home that is away from your circle of care, from your family, from the people who support you. You will see the huge difference in life expectancy. The average life expectancy in a long-term-care home is around three years; if you don’t go into the long-term-care home of your choosing, if you don’t have a circle of care about you, if you miss your friends, if you miss your spouse, it will be in months, not in years. Is this really how we want to treat frail, elderly people? I am worried. I am very worried.

That was paragraph 2, subsection 3: A placement coordinator would have the authority to:

“i. Determine the ALC patient’s eligibility for admission”—that is, without their consent;

“ii. Select a ... home ... for the ALC patient in accordance with the geographic restrictions that are prescribed by the regulations”—regulations that nobody has seen;

“iii. Provide to the” long-term-care home “licensee ... the assessments and information set out in the regulations,” including “personal health information.”

Remember, your personal health information is something that is just that: It is personal. You get to decide who sees that information and who doesn’t, and you do that through consent. This bill takes that consent away from you. The coordinator will do the assessment, will access your personal health information and will share that personal health information with the long-term-care home of their choosing, not of your choosing.

This is a dangerous door to open, Speaker. I fully understand that our hospitals are full, that we are expecting a surge in demand for our hospital beds coming this fall, that 20% of our hospital beds are being occupied by people who could be cared for someplace else. But I can’t help but think there is a cost to those decisions, and the cost to those decisions is that frail, elderly people lose their right to consent. I’m not willing to do that, Speaker. I’m not.

So your personal health information will be shared with a long-term-care home. There could be many reasons why a patient, a hospital patient, would not want their personal health information shared with a specific long-term-care home. They could have an ex-wife or ex-husband who works in that long-term-care home, and the relationship is not good. So you would have never chosen that long-term-care home because you-know-who works there, but you have no choice, you have no say. The bill takes away your right to consent to sharing of your personal health information, and the health information is shared with the long-term-care home that the care coordinator has chosen, not you.

And “iv. Authorize the ALC patient’s admission to” the long-term-care home. So the admission has been authorized by the placement coordinator. The placement coordinator will also have the authority to “transfer responsibility of the placement of the ALC patient to another placement coordinator....” This always brings confusion. I can tell you that a transfer of a loved one into a long-term-care home after a hospital admission is always something stressful. Most of the care coordinators are nurses or social workers. They do a fantastic job trying to calm the residents, calm the family, explain the process. But now we are giving them a job to do, that is to move that patient out of that bed, out of that hospital bed, and into the long-term-care home that has beds available.

Paragraph 3: “A physician, registered nurse or person described in paragraph 3 of subsection 50(5)” would be authorized to “conduct an assessment of the ALC patient for the purpose of determining the ALC patient’s eligibility for admission to a long-term-care home.” Some long-term-care homes have specific services that are not available. Some will have lockdown units for people who have dementia, who are hard to control. So with a lockdown, if your level of care is such that you need a lockdown unit, then you could only be transferred to a home that has that level of care, so that is in the bill.

Then it becomes even more interesting. “A long-term-care-home licensee” would be required to—so the long-term-care home now has a requirement added to them to:

“i. Review the assessments and information provided by the placement co-ordinator....” So whether the patient has consented to it or not, the long-term-care home has no choice; it has to review the assessment.

“ii. Approve the ALC patient for admission” unless one of the conditions specified in the Fixing Long-Term Care Act for not approving the admission was met. And usually, as I said, it’s a patient that has a level of care—some are on dialysis, some need a lockdown unit, some need special care that may not be available in that home. But I would tell you that the placement coordinators know the long-term-care homes inside and out. They will know where to refer the different patients.

And then, “iii. Admit the ... ALC patient” as a resident “when they present themselves” at the long-term-care home. This is where we have this gap. So once the patients present themselves at the long-term-care home, the long-term-care home has to admit the ALC patient as a resident once they present themselves to a long-term-care home. So the Minister of Health goes to great length to say, “You will not be forced out of the hospital into a home that is not of your choosing,” but we will have taken away your opportunity to consent. We will have assessed you. We will have shared your personal information with the long-term-care home, and the long-term-care home will have to admit you if you present yourself.

Then paragraph 5, subsection (3): “A person with authority to carry out an action listed in paragraph 1, 2, 3 or 4,” that I just went through, “a hospital ... or any other person prescribed by the regulations” would have the authority to “collect, use or disclose personal health information if it is necessary to carry out an action listed in paragraph”—the actions are to do the assessment.

So that would be a person listed: a physician, a nurse or a social worker—I still have a lot of problems with giving them the authority to do an assessment without consent, to access your health information without consent and to share your health information without consent. But this bill now says that there could be “any other person prescribed by the regulations.” I’m a little bit afraid to read that part of the regulations.

The bill already talked about physicians. They already talked about nurses. They already talked about care coordinators. “Any other person prescribed by the regulations”—I don’t think you and I, Speaker, should be the one deciding if somebody is ready to go into long-term care and which long-term care they should go to—

Joe the plumber. Yes, maybe. No, no—Joe the Plumber is not a good one either.

It’s that we have to have faith that the government will do the right thing for frail, elderly people needing long-term care; this is not an easy one to agree to when we have not seen the regulations. I don’t want Joe the plumber to be the one doing that work.

Then, again, subsection (4) of the new section would provide that the actions described under subsection (3) may only be performed without consent of the ALC patient or the substitute decision-maker after “reasonable efforts have been made to obtain the consent.”

It’s making it clearer and clearer all the time that—you try to get someone to agree that they need to go to long-term care. You try to get someone to agree to list that long-term-care home that doesn’t have a big wait-list—because it is an old home that hasn’t been renovated in 50 years. It has one bathroom per floor. It has a room with four people to a room. It has no air conditioning. It has very little facilities. Those are the long-term-care homes that do not have a long wait-list, and you can understand why. Would you want to put your mother at Orchard Villa when they were still in an outbreak of COVID a couple of weeks ago? I don’t think so. Those are the homes that are available.

What this said is after “reasonable efforts have been made to obtain” consent. “Reasonable” is not defined in the bill. Again, we have to trust that the government is going to do the right thing and put the bar for reasonable at the right height. But who knows? If reasonable is: “Mrs. Gélinas, would you like to go to Extendicare York?” “No, absolutely not. I don’t want to go.” Okay. “I tried. She said no. I’m moving on. I’m now going without consent.” What is reasonable, when it’s not defined and all of the other provisions in the bill lead me to believe that there is very little respect left for frail, elderly people in our hospitals, waiting? There will be very little respect left for frail, elderly people labelled ALC, waiting for long-term-care placement in our hospitals once this bill will have been passed—not good.

But it does say in section 6 that ALC patients or their substitute decision-maker could provide their consent at any stage of the admission process. So this bill is describing a new admissions process that does not need your consent, but at any time in the process you could give your consent. It just reinforces the fact that we are taking your right to consent away from you.

It does go on to say that you are not authorized—“any person to restrain an ALC patient or to physically transfer an ALC patient to a long-term-care home without consent.” So they did keep consent for one thing. We’re not going to be able to tie you down while you’re screaming and shouting that you do not want to go to this long-term-care home. So, for anybody out there, if this happens to you, remember, if you scream and shout loud enough that you don’t want to go, they won’t be allowed to restrain you. I’m joking. We should never get to this, and I know I’m not funny. At least the bill says that you won’t be allowed to restrain patients to physically transfer them.

This bill is about transferring patients. The transfer of a patient in a hospital to become a resident in a long-term-care home requires consent. This is what our health care system is based on, and this bill takes all of that away.

Section 3 of the act would amend subsection 61(2) of the long-term-care-home act to confer authority on the Lieutenant Governor in Council to make regulations governing the actions that may be performed under the new section with respect to ALC patients, including prescribing and governing any procedures that must be followed as part of the modified admissions process for ALC patients.

So it is clear that this bill is about the admissions process for ALC patients. The bill says this many, many times. The bill says that we will take away their right to consent, and it goes on to say that there’s a general definition of personal health information that is being changed just for the Fixing Long-Term Care Act and its regulations.

There’s also section 9 of the bill. Section 9 of the bill does not apply to an authorization by a placement coordinator of an ALC patient’s admission to a long-term-care home in accordance with section 60. The amendments would further clarify that an admission of an ALC patient to a long-term-care home under section 60 would be distinct from, and would not preclude, an admission to a long-term-care home under the HCCA crisis admission provisions.

Let me talk to you a little bit about the crisis admission provisions. The minute that the Minister of Health declares a hospital in crisis, then there are new provisions that apply. There are provisions that apply in our Health Care Consent Act, 1996. If you were at question period this morning, you would see that the Minister of Long-Term Care made reference to it. Basically, what the Health Care Consent Act, 1996, talks about is—and I will read it:

“Despite any law to the contrary, if a person is found by an evaluator to be incapable with respect to his or her admission to a care facility”—that’s long-term care—“the person’s admission may be authorized, and the person may be admitted, without consent, if in the opinion of the person responsible for authorizing admissions to the care facility,

“(a) the incapable person requires immediate admission to a care facility as a result of a crisis; and

“(b) it is not reasonably possible to obtain an immediate consent or refusal on the incapable person’s behalf....

“Consent or refusal to be obtained

“(2) When an admission to a care facility is authorized under subsection (1), the person responsible for authorizing admissions to the care facility shall obtain consent, or refusal of consent, from the incapable person’s substitute decision-maker....”

Basically, what this means is that if the Minister of Health declares a hospital in crisis, you can take anybody who is labelled ALC and move them to the long-term-care home of your choice. So we now have a whole lot of people who won’t have given consent to be assessed, that will have been assessed as requiring a long-term-care home, and all this without their consent. And then all we have to do is declare this hospital in crisis, and all of those people will be transferred to the first available bed. Then people say, “Well, even if you’re in the first available bed, you just have to wait until your turn comes.”

Let me talk to you about placement categories. There are four placement categories as in the wait-list to go into a long-term-care home.

Category 1 are people who need immediate admission to a long-term-care home and cannot have their needs met at home or are in hospital when the hospital is in crisis. What that means is that category 1, the first people—it doesn’t matter how long you have been waiting for long-term care. If you are in a hospital, declared ALC and the hospital is in crisis, you get the first bed. You get to go.

Category 2 are people who need to be reunified with their spouses. That’s something we have worked really hard on. One spouse is in one long-term care; the other one is in the other long-term care. As soon as a bed becomes available in the long-term care of your choice, you are category 2.

Category 3 are people waiting for services of a particular religion, ethnic origin or culture.

Category 4 are people who have high-care needs but can still be supported at home, or people in a long-term-care home seeking transfer to their first choice.

In Ontario right now, if you are not in category 1, you are not moving. Once we have transferred you against your consent to a long-term-care home that is not of your choosing, the minister has made it clear that he has no intention of changing the placement categories and that is not in the bill, which means that you will now be category 4, and in Ontario, nobody in category 4 ever moves anywhere. The only people who get placed are category 1. They are people waiting in our hospitals, labelled as ALC, or if there is a crisis in the community, they will qualify as category 1 and they will get the next available bed, hopefully of their choosing.

I want everybody to realize that under the bill that we have now, people will end up in long-term-care homes not of their choosing. Once they are there, they will be labelled as category 4, for placement into long-term care. That means the home that they want to go to, that home that the family has identified that they want to go to, they will never get to go there because there will always be someone in category 1, category 2 or category 3 that will be ahead of them on the wait-list. Their chances of ever moving from that long-term-care home that was not of their choosing are zero.

So here we have this More Beds, Better Care Act. I’m sure we have all read the explanatory note, which goes on to say, “The bill amends the Fixing Long-Term Care Act.... This new provision authorizes certain actions to be carried out without the consent of these patients. The actions include having a placement co-ordinator determine the patient’s eligibility for a long-term-care home, select a home and authorize their admission to the home. They also include having certain persons conduct assessments for the purpose of determining a patient’s eligibility, requiring the licensee to admit the patient to the home when certain conditions have been met and allowing persons to collect, use and disclose personal health information, if it is necessary to carry out the actions.”

Certain sections of the act “do not apply to these actions, and instead they shall be carried out in accordance with the regulations” that we have not seen.

So the explanatory note, as well as the compendium that I have quoted to you before, make it clear that it will now not be a physician who will decide if you are ready to go into a long-term-care home; it will be a placement coordinator that will determine your eligibility for a long-term-care home. That same care coordinator would be the one who will select the home and authorize their admission to that home, and the home—which they call the licensee—will be required to admit the patients to the home when certain conditions are met.

Do I think that our hospitals are overcrowded? Yes, absolutely. Do I think that people requiring long-term care should be in our hospitals? No. But do I think that they deserve respect? Yes, absolutely. And every single one of them will tell you the same story: They want to be supported at home. In order for them to be supported at home, we have to fix our home care system. Remember, when Mike Harris was there, we used to have a publicly delivered home care system. When Mike Harris was there, the Conservative government of the day convinced everybody that the crisis in home care could be fixed with privatization. Private home care companies were going to do things better, faster, cheaper. In 2022, does anybody believe that the private companies provide better home care?

I’m glad that the member opened up saying that we have huge challenges in our health care system. I fully agree with you. We do have huge challenges in our health care system.

The clinical assessment requires access to your personal information. For anybody to do an assessment of you, you have to give consent, but in the bill, the bill takes away the hospital patients’ right to say whether they want this assessment or not. The bill takes that away.

When it comes to sharing personal information, the assessments that are done before you can be transferred are quite thorough. Not only do they look at your activities of daily living, they also look at your cognitive function, they look at all of your sicknesses, they look at all of the medications you take. This is all personal health information that you have to give consent to share. The consent has been taken away in that bill. That personal information will be shared with the long-term-care home without your consent.

If you have cognitive impairment and cannot give consent, the health care system usually goes to the power of attorney, who would give consent on your behalf, but the bill is explicit that both the patients themselves or the power of attorney do not need to give consent. That right is taken away from you. They will do the assessment whether you consent to it or not.

Thank you, Madam Speaker. It’s an honour to see you in that chair today.

It is an honour for me to rise today to speak in support of Bill 7, the More Beds, Better Care Act, introduced by my friend the Minister of Long-Term Care. I’ll be sharing my time today with the member from Mississauga Centre.

I’d like to begin by thanking the minister and his parliamentary assistant from Lanark–Frontenac–Kingston, as well as the Minister of Health, for their work on this bill, and the five-point plan they released last week to provide the best hospital care to patients while also ensuring resources are in place to keep our province and our economy open. Bill 7 is an important part of this plan because it will help to fix Ontario’s ALC problem. Over 15% of hospital beds in Ontario are now occupied by patients who are ready to be discharged but need an alternative level of care, often in a long-term-care home.

In northern Ontario, up to one in three hospital beds is occupied by ALC patients. In Mississauga, Trillium Health Partners uses well over 100 hospital beds to care for ALC patients, beds which are not available for new patients. ALC patients are often stuck waiting in hospitals for months, or even years, when the long-term-care home they prefer has no available beds.

Speaker, it is important to note that this problem has grown worse over the last two decades because the previous Liberal government, with the support of the NDP, built only 611 new long-term-care beds. Between 2011 and 2018, as the number of Ontarians over 75 increased by 75%, the number of long-term-care beds increased by less than 1%.

When this government was first elected four years ago, there were over 37,000 seniors on a wait-list for long-term care, including over 4,500 in Mississauga alone. We had 20% fewer long-term-care beds per capita in Mississauga than the provincial average. Now, four years later, our government is investing $6.4 billion to build 30,000 new long-term-care beds and to upgrade 28,000 beds to modern design standards by 2028, and we’re on track to deliver on these commitments. That includes 1,152 new and upgraded beds in Mississauga–Lakeshore alone—more than any other riding in Ontario. This is the largest long-term-care building program in Canadian history.

Two years ago, on July 21, 2020, I joined the Premier and the former Minister of Long-Term Care, with Michelle DiEmanuele, who was then the president of Trillium Health Partners, to announce an accelerated build pilot project in Mississauga–Lakeshore. With rapid procurement, modular construction, and the use of hospital lands, this government is building new long-term-care homes many years faster than the traditional timeline. That includes 632 new beds at two new long-term-care locations on Speakman Drive in Mississauga–Lakeshore. The project will include a new health service building and the first residential hospice in Mississauga, operated by Heart House Hospice.

Trillium Health Partners is building another 320 beds through the Mississauga seniors’ care partnership with Indus Community Services and the Yee Hong Centre. There are projects like this planned or under way in communities right across Ontario. Many seniors and their families have already reached out to my office to help find a place in these new homes.

On November 2, 2020, I joined the Premier and the former Minister of Finance and Minister of Long-Term Care at Trillium Health Partners in Mississauga–Lakeshore to announce an increase in the hours of direct care for long-term-care residents, to an average of four hours a day, to help ensure they receive the best quality care in Canada.

Our government is investing $5 billion over four years to hire over 27,000 new long-term-care staff, including nurses and PSWs. That includes over $5.5 million this year for long-term-care homes in Mississauga–Lakeshore, and that will increase to $14 million in 2024.

By 2024, the Camilla Care community will receive $4.5 million more for staff each year; Chartwell Wenleigh will receive $3.5 million more; Sheridan Villa will receive $3 million more—and I could go on.

But these changes cannot happen overnight. Training tens of thousands of new staff and building new, modern facilities, even on accelerated schedules, takes time. And in order to prepare for what may be a challenging flu season, we know we need to do more now.

As the minister said—and I want to reiterate: Bill 7 would, if passed, help to encourage the transfer of ALC patients into temporary settings while they wait for their preferred long-term-care bed. It would not move ALC patients out by force, and it would not force people into homes far away from their families. There will be mandatory guidelines to ensure that all patients continue to stay close to their partners, loved ones and friends, and to ensure they won’t be out of pocket for any cost difference between their temporary home and their preferred home.

The intent of Bill 7 is similar to policies in many other provinces, like British Columbia, Alberta and Nova Scotia, which all encourage transfers of ALC patients into temporary care settings while they wait for their preferred bed.

Dr. Stephen Archer, the head of the department of medicine at Queen’s University, wrote about a local ALC patient who was stuck in a hospital bed for two years. The average hospital in-patient stay was about six days. So in the two years that this ALC patient stayed in the hospital bed, the bed could have supported the care of 120 other patients. He said, and I agree, that this debate is not about ALC patients’ rights to make their own health care choices; it is about balancing ALC patients’ rights against the equal rights of those 120 other patients, who may need treatment for heart attacks, strokes or ICU care, that can only be provided in our hospitals. And this is what Bill 7 does.

Dr. Kerry Kuluski, a research chair at Trillium Health Partners, makes another important point: While caring for ALC patients is obviously costly to their hospitals, it is also costly to ALC patients themselves, since more appropriate care settings, including long-term care, can better support their quality of life. In hospitals, patients who need acute care are rightly given priority over ALC patients. In temporary placements in a long-term-care home, ALC patients will soon receive an average of four hours of direct care per day, even if they’re not the patient’s first choice for cultural reasons or because the home is not close to their family and friends.

If passed, Bill 7 will help provide ALC patients with the right care in the right place and a better quality of life in more appropriate settings. It will also help free up at least 250 much-needed hospital beds in the first six months alone for patients who need them, and help to support a better flow of patients now and in the future.

Together with the construction of more modern long-term-care homes and the expansion of our health care workforce, this policy will help to lower wait times in our emergency departments and for surgical procedures. Ontarians will have faster access to health care and more health care options in their own communities.

Again, to conclude, I’d like to thank the minister and his team for their work on Bill 7. I encourage all members to support this important bill, moving forward..

This question is for the member for Mississauga–Lakeshore. He talked about ALC patients earlier. Could the member explain what measures will be taken into consideration when proposing appropriate long-term-care homes for ALC patients?

Thank you to the members across the floor for your comments on this bill. Recently, I had the opportunity to meet with nurses from ONA Local 83 of the Ottawa Hospital and ONA Local 84 of the Queensway Carleton Hospital about the health care crisis in Ottawa. We discussed the fact that there are beds available in Ottawa hospitals even though there are patients waiting in the emergency room.

The Queensway Carleton Hospital is only operating at 60% of its surgical capacity. The issue is not beds; the issue is a lack of nurses available to staff the beds. So I am deeply disappointed to see that the government’s response to the health care crisis is a bill that will not recruit or retain one single additional nurse to our health care system but does show incredible disrespect to seniors and persons living with disability and their right to provide consent regarding their care.

I’m wondering why the government feels that the most appropriate response to our health care crisis is to continue to show disrespect to our hard-working health care workers, while also adding a new level of disrespect—

Thanks to my colleagues from Mississauga–Lakeshore and Mississauga Centre for their presentations.

Speaker, a recent Globe and Mail editorial discussed our government’s five-point plan for staying open. They talked about emergency beds for the critically ill, and not for those waiting for long-term care. Speaker, patients requiring long-term care should be treated in an appropriate setting. As the member for Mississauga–Lakeshore mentioned in his remarks, many provinces across the country, such as British Columbia, Alberta and Nova Scotia, have in force available-bed policies similar to the one we are debating now.

My question to my colleague is, how would Bill 7 play a role in supporting Ontario’s broader health care system?

Madame la Présidente, imaginez une autre conversation, où M^me Smith arrive avec une douleur thoracique : « Madame Smith, vous avez besoin d’une chirurgie cardiaque. Madame Smith, vous avez besoin d’un lit de réadaptation cardiaque. Mais, madame Smith, on n’a pas de lit dans cette unité—on a juste un lit dans le couloir—car on doit attendre une décharge de l’hôpital des autres patients. »

Aujourd’hui en Ontario actuellement, il y a 5 000 patients—c’est l’équivalent de 11 hôpitaux communautaires—qui devraient être soignés pas dans les hôpitaux.

So my question to the member, if he opposes this policy: Are you suggesting that seniors are better off in institutionalized hospital-like settings—in the hallways, perhaps—rather in the home-like environment that long-term care offers?

As the member mentioned, in the explanatory note, it says, “This new provision authorizes certain actions.... The actions include having a placement co-ordinator determine the patient’s eligibility for a long-term care home, select a home and authorize their admission to the home.”

What do you think will happen to ALC patients in our hospitals after this bill is passed?