Thank you, Mr. McLeod. The honourable Member for Tu Nedhe, Mr. Beaulieu.
Thank you, Mr. Speaker. I seek unanimous consent to return to item 21.
---Unanimous consent granted.
We will return to item 21, consideration in Committee of the Whole of bills and other matters: Bill 2, Forgiveness of Debts Act, 2009-2010; Bill 4, An Act to Amend the Child and Family Services Act; Bill 7, An Act to Amend the Summary Conviction Procedures Act; Tabled Document 62-16(4) NWT Main Estimates, 2010-2011; and Minister’s Statement 47-16(4) Transfer of the Public Housing Rental Subsidy, with Mr. Bromley in the chair.
Thank you. I’d like to call Committee of the Whole back to order and ask what the wish of committee is. Sorry; we have before us consideration of Bill 2, Bill 4, Bill 7, Tabled Document 62-16(4) and Minister’s Statement 47-16(4). What is the wish of committee? Mr. Beaulieu.
Thank you, Mr. Chairman. Committee will continue the consideration of Health and Social Services.
Thank you, Mr. Beaulieu. Does committee agree that we will continue consideration of Tabled Document 62-16(4), NWT Main Estimates? Agreed?
Agreed.
Thank you. We’ll start with a short break. Ten minutes.
---SHORT RECESS
I’d like to call Committee of the Whole back to order. We are considering Tabled Document 62-16(4), NWT Main Estimates, 2010-2011, consideration of Health and Social Services. I would like to ask the Minister if she’d like to bring in witnesses.
Yes, please. Thank you, Mr. Chairman.
Thank you, Minister. I’d ask the Sergeant-at-Arms to escort the witnesses into the House, please.
If the Minister would introduce her witnesses.
Thank you, Mr. Chairman. To my left is deputy minister of Health and Social Services, Paddy Meade; and to my right is director of finance, Mr. Derek Elkin.
Thank you. Committee, we are on page 8-29, activity summary, community health programs, operations expenditure summary, $85.067 million.
Agreed.
Ms. Bisaro.
Thank you, Mr. Chair. I have a question with regard to contract services. There is a rather large increase in contract services from the revised estimates of 2009-10 to the main estimates of 2010-11. We go from $8 million to almost $13 million. I wonder if I could have an explanation for that increase, please. Thank you.
Thank you, Ms. Bisaro. Minister Lee.
Thank you, Mr. Chairman. The increase is the southern placement of children contract for $1.3 million and $2.91 million for residential...$2.091 million for residential southern placement for adults. Thank you, Mr. Chairman.
Thanks for the information. I guess it leads me to then ask whether or not this is an increase that we can continue to expect. Our actuals in 2008-09 were about the same, $12 million. We then estimated quite a bit less in 2009-10 and now we’ve gone back up in 2010-11. So is $12 million or almost $13 million a better number in terms of our ongoing expenditures or is this a bit of an anomaly? I know it’s hard to predict how many kids we are going to have to send out, but is this an indication of a trend, I guess, that we’re going to continue to see?
This is an area where expenditures are made on the basis of need. We place children and adults as they are needed. I can advise the Members that the numbers of clients have stayed quite consistent over the last number of years. There is a little bit of up and down, but there’s not a general trend upwards.
What we have seen is an increase in costs of caring for these children and adults. Some of them are quite high needs and it’s the rates that some of these facilities are charging us and they have all been going up, especially across Alberta. Thank you.
That certainly makes sense. The other question I had is in program delivery details and there is a very large jump between last year’s revised main estimates and this year’s budgeted mains. We go from $20.5 million to just over $26 million for adult continuing care services. Is there a specific reason for that? Is it a number of factors? If I could have an explanation, please. Thank you.
I think I will ask the director of finance to explain that. Thank you.
Thank you, Minister. Mr. Elkin.
Thank you. The increase is primarily due to the incremental costs related to the territorial dementia facility and the Hay River assisted living facility, the ongoing costs.
Thank you, Mr. Elkin. That completes Ms. Bisaro’s line of questions for now. Ms. Bisaro, did you have anything further? Moving on to Mr. Ramsay.
Thank you, Mr. Chairman. Just a question for the Minister. Some of the numbers on the people we have in care in southern placements and some of the numbers that I have seen are quite alarming. They have gone from 27 in 2004-2005 to 56 now. I think some of them have been repatriated back to the Northwest Territories at the Hay River facility, but I was just wondering if the Minister can comment on what efforts the department is making to try to get those individuals that are in southern care back into the Northwest Territories so they can be closer to their families. So if we are spending in some cases in excess or $500,000 or $600,000 a year to house somebody in a southern placement, it only makes sense that we look at bringing them back here and keep that money in the North, whether it is training in a local provider service or bringing somebody in to do it here, so that the money actually stays in the Northwest Territories. I think that is something that we have to pay attention to, Mr. Chairman, so I would like to hear what the Ministers plans are in that regard. Thank you.
Thank you, Mr. Ramsay. Minister Lee.
Thank you, Mr. Chairman. As I stated earlier, the numbers of adults and children that we place in these institutional settings hasn’t changed that much and I could give Members figures on that. I remember seeing that most recently. It is the cost of providing those services that has gone up.
With respect to the Hay River assisted living facility, we have, I believe, about 20 residents there and the department has worked very hard to look at all the people we have in southern settings to see who are eligible and who can be moved up and that depends on the person’s care needs as well as the family’s needs. So there have been case management meetings happening on each of those situations and we have been successful in moving some of the people in southern jurisdictions to Hay River assisted living facility as well. Some of the other ones that have moved into Hay River are those ones who would have gone south if we didn’t have the place in Hay River. So there is a cost avoidance there.
So the answer to MLA Ramsay, I want to tell him that we do constantly review the cases of our residents we have in southern placements. Some of them are long term, some of them will probably never be able to come home. But I think there is about half of them, there are some who are more short term and we constantly review them to see if we need to send them south, because obviously we want to keep them north and keep them closer to home and be able to place them in our own setting.
I guess I am not supposed to say where I saw those numbers, but I saw them yesterday in a committee meeting. It was 27, I believe, in 2004-2005 and there was 56 this past year. That number of 56 has fallen somewhat; to, I believe, 49, as five or six of those individuals have been placed in the Hay River assisted living facility. So the numbers, I know the Minister says they are not going up, just the costs, but if we have gone from 27 to 49 in a span of five years, that is a pretty big increase and I think we need to realize that if there are any of these individuals that we can bring back to the Northwest Territories, we have to do that. Get them back here and keep the money in the Northwest Territories. Thank you.
Thank you, Mr. Chairman. I take the Member’s point and I stand to be corrected. I don’t have the information from five years back, but I do have the information in front of me for 2008 and 2009 compared to this upcoming year. We had 51 adults in 2008-2009 for 15,000 bed days and for this year we project to have 52 for 11,900 bed days, so we are having about 4,000 less but the cost will be higher because of the costs going up per bed. For children, we had 49 youth in southern facilities, we expect to have 48 this year. Last year we had13,629 bed days and this year we expect to have less, 9,100, but once again the cost will not substantially go down so it is the cost per bed that is driving up the cost here. Thank you.
Thank you, Minister Lee. Next on my list I have Mr. Menicoche.
Thank you, Mr. Chairman. I just wanted to ask a couple of questions on the current strategy for homelessness as well as emergency shelters. Of course, I am from a riding that has many small communities and these issues are raised, they are just as serious as the larger communities. I think I saw something in the Foundation for Change documents, something about addressing homelessness, even emergency shelters in the communities. Perhaps the Minister can fill me in on some of the details on how they are going to address these in the regions. Thank you.
Thank you, Mr. Menicoche. Minister Lee.
Thank you, Mr. Chairman. The department is responsible for two areas in this regard. One is family violence shelters, which is not necessarily a homelessness shelter but that might be the area in which you have seen some increase in funding as a part of our Strategic Initiatives committee and that money funds family violence shelters in Yellowknife, Hay River, Tuktoyaktuk, Inuvik.
The homelessness programs in the department, we have three. We have two under homelessness. One is Homelessness Assistance Fund and small community homeless fund. Small community homeless fund, we have about $200,000. Well, not about. We have $200,000 for that and we assist communities to make minor renovations in places where they feel that they could have a homeless, not 24/7 shelter, but somewhere homeless people could drop into. This is done on an application-by-application basis and it gets fully subscribed very quickly. Homelessness Assistance Fund is used to assist those people who migrate into Yellowknife and they would like assistance to get back home. We use some of that money to address homelessness that way, because if they go back to their own homes and communities, then they do have a better support in terms of housing. Also we have emergency shelter funding under the department and we fund the Inuvik homelessness shelter, Centre for Northern Families day shelter and the SideDoor under that program. Thank you.
I thank the Minister for providing some of those details and I was just wondering, like the community of Fort Simpson, I know that homelessness funds are used to purchase or assist clients in apartments, et cetera. I am not quite aware of emergency shelter and/or family shelter as well. That is something that we can certainly work towards. Combining all three in a larger building would certainly make sense and in a place like Fort Simpson. Has the Minister seen any plans with regard to that for Fort Simpson being a regional community? Thank you.
Mr. Chairman, in that issue, I think it would be helpful if the Member could… We have not received a proposal, that I am aware of, from any group or community government. We understand there are not as many NGOs in communities outside of Yellowknife so we do accept and consider applications from community organizations, community bands, the municipal governments. If they want to submit a proposal, we could work together with the organizations, perhaps through also the Deh Cho Health and Social Services Authority so we could discuss more on that and we could give him information on how they could access and start putting a proposal together. Thank you.
Thank you, Minister. Next on my list I have Mr. Yakeleya.
Thank you, Mr. Chairman. The document I am going to make reference to is put out by the Department of Health, 2006-07 document at my office here. It talked about the age group of 60 years and older as the fastest growing demographic in the Northwest Territories, this population here. Certainly, from 1996 to 2006 the population of seniors in the Northwest Territories increased by 46 percent.
Mr. Speaker, I want again just to speak to the Minister in terms of the care for seniors, or I refer to them as elders, in terms of the health policies in regards to having seniors come out of our communities in terms of good care, someone is taking care of them. The Minister and I are working on an issue here that I think she is going to look at something like this, but I have heard from numerous incidents where our elders were not given the proper care as, I think, I assume they would. However, I stand to be corrected on that.
I want to ask the Minister if she would review the policy for travel for elders, that it be mandatory to have someone escort them or to travel with them, someone who speaks their language, someone from the community, preferably, and that these elders do not leave on their own when they come to either Yellowknife or Edmonton to seek medical care.
Thank you, Mr. Yakeleya. Minister Lee.
Mr. Chairman, the topic that the Member is bringing up is the medical travel escorts. I think that is primarily what the Member is speaking to. As the deputy minister mentioned yesterday, that program is under in-depth review. The government spends about $26 million a year on medical travel. It is one of the highest costing programs we have. It is in our interest to make sure that it works, it does what it is supposed to do, that the people are served well. Our government has a policy that says that elders over a certain age and those who need physical support, mental support in that defined area and language support can have an escort. That is the policy. Sometimes applications of the policy get complicated.
I think our review should also look at how we make this program better in terms of escorts, because sometimes we have escorts come down and they kind of go missing in action too, so we need to make sure that we properly provide information to escorts as to what the expectations are and that they have to take their role seriously too. We are in the process of reviewing that. I would be happy to share that information with the Member, but I think what he’s talking about is not necessarily the policy but the application of it. Thank you.
The Minister has indicated certainly some good points there in terms of the medical escorts into our health care system in terms of language, physical. I think that it needs to be stated very clearly, loud and clear, to the health centres to know that if an elder walks in and they are required to go to Yellowknife, Inuvik or Edmonton, that the first question on the list of questions, we’ll have an escort for you who can work with you, not if you understand English or can you travel alone in snow. It should be with the elders, especially with the second language as English, that we are going to have someone there. Maybe I got my words mixed up, but I think that is a something that is mandatory that the elders are given an escort to take them to a community. I think we are going to deal with a lot of these headaches that we are dealing with right now in terms of the people are travelling on their own to large centres. So I do appreciate the Minister saying in terms of the in-depth review. I hope that we can come out of the in-depth review and say this is what we have that’s clear marching orders for the health centre. I think that would put a lot of relief to people in our communities, knowing that this issue here is taken care of. I will work with the Minister in terms of how we go about this. It is very important and very critical. I hope that by the end of this Assembly, the Minister will bring forward a policy or strong marching orders.
Mr. Chairman, I want to also say that in terms of the Sahtu health authority, in terms of the administration, she talked on really good the application of programs and services under the Health and Social Services. The application of the program sometimes we have a different view of how things should be applied to and what application should apply to the program should be done. I’m starting to hear rumblings. Maybe I need to work with the Minister on this in terms of how the application of certain programs in the Sahtu health authorities are administered and if there’s… One is to look at some of these issues before they get to a critical point of he said, she said and we are at a standstill as to how we deliver programs. I have received a phone call that wasn’t too good this morning in terms of our health board. I haven’t had a chance to talk to Members of the health board, but I think I’m getting more phone calls in terms of our operations. So I want to see that we work with the Minister in terms of how we deal with these issues face on. The Minister could provide me with some ways as to how we could do this here. I know there are some suggestions. I would like to talk to her about it. However, it is unfair to me to say it right now because I have not yet had that in-depth discussion with her.
Mr. Chairman, it is absolutely fair for you to raise any issues you like. I am happy to respond to them here.
Mr. Chairman, I think it is really important to remember that, for the last four days, we have been talking about the importance of making sure that we use our Health and Social Services dollars wisely. We have a $326 million budget. The needs and demands are endless. On any given day, I have at least a million dollar ask on my desk that I cannot meet. We do spend about $1 million a day. It is a high cost business. We do a very good job, so when I say it is about application, it means we have programs set up and, as good as it might be, we do have hiccups.
But we have to remember that we are serving 40,000 people and I think for the vast majority of cases people are happy with our service, because I do get notes and letters from people who are thankful for the services they receive. I tabled two documents earlier this week, which is the satisfaction survey for hospital service and health centres. I would like to encourage the Members to look at that because there is some real grading from our public saying that they are, generally, getting good support. So when I say to Members it’s about application, of course, sometimes people feel that they weren’t treated as well as they have been. They have questions about what kind of diagnosis they had. They want to know what happened to their family. So we need to have a mechanism to make sure that those are responded to. I’m totally happy to be working and continue to work with the Member to improve our system, but that’s what I mean when I say that.
The other thing is escorts for elders. We need to talk about who… We want to use medical travel in the best way possible, and some elders may not want an escort. I think MLA Bisaro mentioned that she’s an elder already and I don’t know if she would need an escort. Our elder population is the largest population and it’s the highest growing population. What’s important is we use our money for those people who need it. We may need who’s not an elder who needs support. We may have an elder who’s able and they don’t need an escort. It is important that when we are reviewing this service, that it is essential for the delivery of our health care that we look at what the needs are. That’s what we mean when we say the right service for the right people at the right time. We generally support the elders, but we shouldn’t be so inflexible that just because you’re 60 but you speak English and you don’t need an escort, you’re going to get one. Then somebody who really needs it couldn’t get it. I think that’s always the adjustment we need to make. Thank you.
Thank you, Minister Lee. Just before I go to the next one, I have one comment from the chair. For the record, I believe it was Mr. Jacobson suggesting that Ms. Bisaro was, perhaps, an elder. Next on my list I have Mr. Beaulieu.
Thank you, Mr. Chairman. Mr. Chairman, currently the Standing Committee on Social Programs is undertaking a review of the Child and Family Services Act. I’m looking at the budget in this area and from our meetings that we’re having so far with the stakeholders and staff, it’s apparent that stakeholders don’t feel that there’s enough money in the system to help all the people that come to them. And it’s fairly evident that social workers are handling too many cases at one time and it’s causing, certainly causing some problems for the delivery of services that are necessary for family and children in the Northwest Territories. I don’t see any substantial increases in the budget for community services, where I think most of our review will fall under the authorities and agencies, social workers and so on. Also, in the foster care where we hear a lot about the foster care. Again, there is no increase there, although the department has indicated there has been a little bit of a shift to where they’re getting more aboriginal households to become foster parents. So that may be more of a shift there than an increase in cost, although there is a good thing about some extra money going into prevention and promotion.
So, I guess, just a question for the Minister is: does the Minister have a contingency plan for any of the recommendations that may fall out of the Child and Family Services Act review, which is scheduled to be tabled this fall?
Thank you, Mr. Beaulieu. Minister Lee.
Thank you, Mr. Chairman. That review is being undertaken by the motion of this House. I understand from just hearing from the committee members that they’re having a very good review of this whole area and obviously the committee will report back to the House on their findings. Our department’s approach, and my approach with the deputy minister, has been that we are there to assist in any way, provide whatever information and resources that you may need. I am looking forward to what the committee has to recommend and at that time we will have to work together to work out the plan on how the recommendations can be implemented. Obviously, where there are dollar requirements, that will be the will of the House and we have to have that wide conversation here about how we go about making changes as recommended by the committee. I am looking forward to seeing the results and I do appreciate the committee’s invitation to have more dialogue in that area. Thank you.
I thank the Minister for that response. I just want to touch on a couple of areas of homelessness, near homelessness or whatever. I just wanted to group these two issues together and ask the Minister two questions. On the whole issue of homelessness in smaller communities, I think that we’re continuing to have difficulty identifying homelessness in small communities. There is no provision in small communities for people that are homeless. So if you are homeless in a smaller community, essentially you just sleep on someone else’s couch. It’s not like an issue of being able to go somewhere into some sort of residence that is specifically built or designed for homeless people. I’m wondering if the Minister will be looking at the strategic initiative on homelessness maybe with the lens from the perspective of some of the smaller communities where homelessness may not be a visible thing, but it’s very apparent in the small communities as people that don’t have anywhere to go live with people where they’re not very welcome, actually, but it happens anyway.
Also, as far as emergency family shelters… Just a second question, Mr. Chairman, if that’s okay, or if you prefer I get a response and go to a second question.
It looks like Minister Lee is ready to respond. Should we give her the opportunity there? Minister Lee.
Thank you, Mr. Chairman. As I indicated earlier, the homelessness budget we have is really popular. We usually get more applications than we have the money for. I think it is an area that we need to look to see how we can address that. I am talking to the Minister of the Housing Corporation to see how we can partner and put some energy into smaller communities. Yellowknife has been able to build a continuum of services for homelessness, but also… So that’s an area that we need to do. But I need to say that our budget, if you notice, as we stated in the opening statement, has almost… I know it’s a big money department and it looks like it had the biggest growth, but actually most of the growth is going to labour contracts; it’s going to the employees. But if you look at line by line, our money is not growing, really, in any areas. It’s sort of staying in the same except for the dementia centre and assisted living. I mean, those are the highlights because those are big ticket items. This is why, once again, I need to tell you that we need to work together in how we change the way we deliver health and social services so that we can move the money around, because we understand that it’s hard to find new money and the demands will not go down. I don’t know if that answers MLA Beaulieu’s question, but we just need to keep on working to see how we do what we do better because the money... There is always more demand than money available. Thank you.
