For many, many years now we have not had a long-term care facility in small communities funded. There were long-term care facilities built by the Housing Corporation and I do support what Member Beaulieu said, for example, that we need to work to make those rooms available to our elderly and other people who need those rooms in our communities as assisted living facility, which is what it was meant to do. So I don’t think there’s much change in what we are doing, what we have been doing in the Territories for the last 10 years.
What is different with the recent work that we have done is that the Department of Health, along with DPW, have done a long-term care planning, and the deputy minister can go into more detail on that.
I do understand that the NWT is different and unique and we need to do everything we can to support our local people to take on some of those jobs. We would like to do that. But we need to balance that with the risks and the other factors that we need to adhere to. It’s not something we have an option on. What we need to do is make sure that we can do a lot more to provide support and strengthen our system and resources in small communities so that our people take on those jobs to take care of our own local people, because the demands are just going to get more severe 10, 20, 30 years from now. We need to plan and we need to work harder to build the local resources. They don’t necessarily have to be a 24/7 long-term care facility. We need to do things differently to support our elderly and people who need our care.
Thank you, Ms. Lee. Next on my list I have Mr. Ramsay.
Thank you, Mr. Chairman. Just getting back to the discussion we had earlier on whether or not either one of the Fort Smith or Hay River centres is going to be deemed to be the regional centre. It was a bit confusing for me. Are there not requirements like staffing and programming levels in a community that would suggest you spend $28 million there? If that is the case, maybe the Minister has stats or figures on what the staffing level is at the facility in Hay River and the one at Fort Smith.
Thank you, Mr. Ramsay. Ms. Lee.
Thank you, Mr. Chairman. The part of planning study would have included the programs that would be offered in these facilities and planning on what the staffing makeup would be. I’d ask the DM to give more information on that.
Ms. Meade.
Thank you. They’re both little C facilities and have connections with long-term care, so some of the staffing is the same. At this point there’s more diagnostic capability at Hay River, but in the future we will need to expand that. For example, currently for both staffing and water issues we’re not doing dialysis at Fort Smith, but given our population of diabetics and the need for dialysis, this will be expanded. So current staffing and what will be required will depend on those populations. For example, with diabetics, they fluctuate on dialysis. So we feel that we’re going to need the ability at both sites. Sometimes they may not be running full dialysis at Fort Smith. We have wait-lists on colonoscopies, mammographies and a few others, so we want to expand these out from Stanton and Inuvik. Hay River is doing some, but we think Fort Smith can take on more.
The population and the travel routes make those the best two sites for us to take a lot of pressure off Stanton. Inuvik is already pulling most of the North and that will keep Stanton to be doing the more specialist review and some of the more in-depth procedures. There is a difference and we’re going to need both, as far as the ability and flexibility on diagnostics and day surgery.
That’s nice and that’s good to hear, but I’m just again trying to understand. Okay, so currently how many registered nurses and resident doctors are there in Fort Smith and in Hay River? Does the Minister have that information?
Thank you, Mr. Ramsey. Minister Lee.
Thank you, Mr. Chairman. I don’t have that number handy. I think Smith is budgeted for five doctors.
We don’t need them because we’re going to use the...
Yes, I don’t think we have the exact numbers of nursing positions there, but we could get back to the Member on that.
Thank you, Minister. Mr. Ramsay.
I want to relate this back to us spending millions and millions of capital dollars. Is it the department’s intention, if we are going to build up these facilities in close proximity to each other, are we going to have a resident doctor or doctors in Fort Smith and Hay River? Is that the intended purposes here? If that’s not the case, then maybe we need to rethink some things here.
Ms. Meade.
We actually just recruited a permanent physician to Fort Smith, but we’ve lost them already to a better offer in B.C. So this is a constant. It’s more about how we can keep them. So if you add this to the work we’re doing on community call coverage, if we can lessen and use more of the physicians in the Territory, it will reduce the number of nights. Currently in Hay River or Fort Smith you would have to be on call every second night and that doesn’t encourage anybody to come and be a permanent doctor. We are using the nurse practitioners effectively, especially in Fort Smith, so we think that first of all if we pool the physician resources, we’ll be able to recruit the numbers that we need and have more permanency.
The advantage that we do have right now is we’re starting to get more long-term locums. It’s the same people that are coming up. That’s the first way of starting to attract permanently.
I guess that’s my point, is that if you are building up the health care infrastructure in communities like Fort Smith and Hay River, we had better have the horsepower or the manpower to back up the programs and services that residents in those communities are going to be deserving. It doesn’t make a lot of sense to spend $28 million on a facility that you can’t staff and you can’t have programs in. That’s my fear. If the Minister’s confident that spending this money on the facility in Fort Smith is the right thing to do, to me it’s still, I’m not 100 percent sold on this. They’re too close to each other and I don’t understand how they could both serve as Level C communities within an hour and a half by highway. That’s something I’d like the Minister to respond to, whether she’s confident that those two communities we’re going to be able to get staff in there that are going to have programs and take the pressure off Stanton here in Yellowknife.
Ms. Lee.
I see the Member’s points, especially when we’re talking about the overall financial pressure on our system. The fact is that I think we only have three resident doctors outside of Yellowknife in the NWT. We don’t know that it’s going to get better in terms of being able to recruit and retain physicians in communities outside of Yellowknife. Yellowknife has been highly successful in recruiting and retaining doctors.
Now, what we need to do, and the things that we are grappling with in the Department of Health and Social Services is that we need to have a system-wide plan on how we are going to provide services to our residents. What we are building is a facility where likely, probably visiting physicians, mobile teams, nurse practitioners, or any other specialist services can move into any of the B-C level facilities and provide care to our residents so that it will reduce the need for medical travel, will reduce the workload at Stanton so that Stanton can do what it should be doing, that people feel confident that when they go to Hay River or Smith or Simpson or Norman Wells that in combination with technology and the visiting professionals that the service they get there is good, that they can rely on that. This is what we need to build for the future.
I know $28 million seems like a lot of money, but when you’re planning a 20- or 30-year facility, I don’t believe that’s too enormous. The fact is our people expect to be able to get services at least at the regional level and if we have any hope of having a territorial-wide system and avoid everything being done at Stanton, we do need to build some support. Not that I don’t think things should be done at Stanton, but we need to have a hierarchy, so to speak, of health facilities so that we specialize and decentralize at the same time wherever possible. With technology we can do that. With modernization we can do that. In future I see our facilities and programs being delivered in a very multi-faceted and multi-sided way and that’s the future of health care delivery.
Thank you, Ms. Lee. Thank you, Mr. Ramsay. Next on my list I have Mr. Abernethy.
I just want to follow up on some of the questions my colleague Mr. Ramsay was asking. It got a little confusing for me, but to sort of put it into perspective, I was wondering if the Minister could tell me what a Level A health and social services station is responsible for.
Thank you, Mr. Abernethy. Ms. Meade.
Level A is basic health care nursing coverage. Tulita can do very few diagnostics or labs. As you move up to a Level B it would be Fort Providence. Again, I know that the levels were handed out to standing committee when we presented our prototypes for long-term care. When you get into C you’re able to do day surgery and diagnostics we were talking about, at least diabetic education, more of the laboratory work, and they will have the ability to have much more interaction with specialists through technology. As you go up each level you can handle more diagnostics and also levels of acuity. Hay River and Fort Smith, then, are at the next level, Inuvik, then followed by Stanton. So each level allows for greater levels of acuity and management and usually much more diagnostics.
It’s my understanding that Level A is a health station with no nurse. It’s my understanding that a Level B is a community health centre, which does have nurses but is more specific to providing services in that community. It’s my understanding that a Level B-C facility is a regional health and social services centre, which does have regional outreach responsibility to Level A and B communities. It’s my understanding that a Level C is also a regional health and social services centre but with a greater degree of diagnostic capabilities and some additional services, which is, I think, the point that my colleague Mr. Ramsay was trying to get at, is when you look at a map, you’ve got only two Level C facilities in the Northwest Territories and they’re both in the South Slave. In fact, they’re right next door to each other. If you think about regional outreach, which is what I understand a Level C is supposed to have, clearly Hay River is going to get outreach from Fort Res and Hay River Reserve and Enterprise and Kakisa, but I’m not sure what regional outreach Fort Smith is going to get. So we spent all this money renovating and fixing this facility in Fort Smith, adding some additional capacity, and I’m hearing you talk about additional capacity, but by the definition provided by the department, it must have regional outreach to be a Level C facility. So if there’s no regional responsibility for this particular health centre, I’m curious why we have two Level C facilities.
I hear the deputy minister saying, oh, well, we’re going to add all these services. Who are the clients? Where are the clients coming from? Are they coming from all over the Northwest Territories? Is this going to be a place where we can bring people from anywhere in the Northwest Territories to? Can we bring somebody from Fort Res here? Can we bring somebody from Deline here? Can we bring somebody from Paulatuk here for the services that are apparently being expanded in Fort Smith? How do we justify two Level C facilities right next door to each other? That’s, I think, the point that my colleague Mr. Ramsay was trying to get at, and I didn’t really hear an answer as to the justification for two Level C facilities next door to each other.
Thank you, Mr. Abernethy. Ms. Meade.
Certainly the Member is correct, and one of the issues is regional outreach. But for times when we have to have surge capacity or when we have a population requiring certain diagnostics, then the beds and the services are quite specific. We also know that we’ve had greater luck in keeping and retaining the specialists. It’s also close to Stanton when you have to have mobile teams. A bed is a bed right now.
As Alberta is really full and Stanton these days is often close to capacity, a bed is a bed. If we can do a procedure somewhere else or move somebody temporarily, we will have to do that. It’s centralized bed management we have to move to.
We also have a population south of the lake that while we have high diabetes everywhere, the dialysis use is high, and it may be an hour and a half drive between the facilities, but we need to expand dialysis to Fort Smith. If you’re doing dialysis three times a week and looking at that kind of drive, that’s quite significant. We know we will have to bring some patients in. Certainly, we’ve already done that. When we had a greater wait-list on mammograms and colonoscopies, we used Hay River to take from different places besides their close region. That’s the flexibility we have to build into this system.
For clarity, the answer is yes, we’re going to be bringing people from any community and every community in the Northwest Territories to Fort Smith and Hay River as the need exists and as programs are available. I think it’s a simple yes or no answer. These two facilities are going to be used for everywhere in the Northwest Territories. Is that right? Yes or no. No explanations. Yes or no works for me.
Yes, as the ability to take the pressure off Stanton, certainly, every type of case, when we need them, would be used.
Thank you. Next I have Mrs. Groenewegen.
Thank you. I wasn’t going to speak to this, but I need to jump in here.
I understand the rationale of the questioning of my colleagues; however, Fort Smith and Hay River, first of all, are not right next door to each other. They may both be in the South Slave, but we’re really stretching it to say an hour and a half. You’d have to be driving about 150 miles an hour to get there in an hour and a half.
As far as being back up or taking pressure off of Stanton, it’s a flight of about 30 minutes to get between Hay River and Yellowknife and it’s probably a flight of about 50 minutes between Fort Smith and Yellowknife, so I suppose you could make an argument for all three hospitals would kind of be right next door to each other. Most people who are seeking medical attention are not probably driving. Most of the people who come to Yellowknife, for example, for medical attention are flying over here and it’s about a half-hour flight.
As to the order in which and the magnitude of the capital projects that are on the books for Fort Smith and Hay River, these two projects were, for lack of a better way of saying it, neck and neck for a long time in which one would go first and what kind of planning needed to be conducted, what kind of groundwork needed to be laid for these projects going ahead. Hay River is the second largest community in the Northwest Territories. It does have a service area surrounding it. When we talk about Hay River’s population, we have to include the Hay River Reserve, Enterprise, Kakisa, Fort Providence, Fort Resolution to the other direction, to the east. It is a centre for some degree of commerce and services and makes a lot of sense, in my opinion, for medical services.
Whether or not Hay River has been able to recruit and retain and whether Fort Smith has been able to recruit and retain resident physicians is also a bit of a red herring. The fact is there is enough interest from locum physicians to fill these positions. Maybe it is not ideal and it’s certainly probably not the most cost effective for the department, but the services are there, the locums are there, the people can be treated, examined, hospitalized in their own community. We’re hoping that the ability to recruit and retain physicians will improve as medical institutions have increased the number of seats they have available and as we still are in this long pulling out of the reduced number of seats for physicians in Canada. That was a bad mistake and we’re still paying the price for it. We’re hoping that as time goes on, that the situation is going to be improved.
As I said, Hay River has a population of around 4,000 and a service area of closer to 8,000 to 10,000, and a facility like what is proposed, I think, will also go some ways towards facilitating, as the Minister said, the locums, the specialists, the itinerant teams that will come in and deliver services in the communities. You still have to have a facility to operate out of and, hopefully in the long run, doctors who will want to practice medicine there and have a hospital to do it in.
I don’t think the government wants to pay to have everybody from Hay River transported to Yellowknife everytime they require the services of a specialist or a procedure like a colonoscopy or a mammogram or a… You know, all of these services and specialists clinics that are all now currently operated out of the hospital that’s there. I don’t think the government wants to start to quantify the cost of bringing a population the size of Hay River and the needs of a community the size of Hay River to Yellowknife for service, or to Fort Smith, for that matter, if you want to talk about them being close by each other.
I can’t explain the rationale. I mean, that’s not my job to explain the rationale for two facilities, one in Fort Smith and one in Hay River, but I know that the one in Fort Smith did make significant progress on their planning and was able to get started on that.
I can tell you that we are looking forward to the Level C facility in Hay River as well. It has been on the books for a long time, practically as long as I have been an MLA. We will make sure it gets used. I don’t know what my question is. Thank you.
Thank you, Mrs. Groenewegen. Committee, we are on page 6-6, the Department of Health and Social Services. Mr. Krutko.
Thank you, Mr. Chairman. I would just like to get clarification from the Minister in regards to when we go through the briefing for this particular department. It came to our attention that there was information that was being provided that the long-term care facility in Norman Wells will replace the Joe Greenland Centre in Aklavik. I would just like clarification from the Minister. Is that the case?
Thank you, Mr. Krutko. Minister Lee.
Mr. Chairman, we have already established that that is not the best way to describe that project. Long-term care facility and wellness centre being built in Norman Wells stands on its own. Thank you.
Mr. Chairman, I would like to ask the Minister what is the plan for the Joe Greenland Centre in light of this new information to establish these long-term care facilities elsewhere in the Northwest Territories. More importantly, what is the transitional plan in place for the residents of the Joe Greenland Centre? More importantly, the status of the employers, the individuals who work there so that we can give them some comfort that there will be a transitional period that they will transition out, that basically there will be more research and development done to really look at the potential of the facility which served the Northwest Territories for some 40 years. I would like to know exactly what is the transitional plan for this facility in the Department of Health and Social Services.
Thank you, Mr. Krutko. Mr. Krutko, I am going to ask that we hold off on that until we get to community health programs, if you will and stick with this. It starts to get a little bit into program. So, committee, if we can just confirm on page 6-6, the health services programs, activity summary, infrastructure investment summary, total infrastructure investment summary, $15.491. Does committee agree?
Agreed.
Thank you, committee. Mr. Krutko.
Thank you, Mr. Chairman. The information that I’m talking off of was information that was provided on the particular line item which is before us, which is the Norman Wells Health Centre and long-term care facility, which basically clearly stipulates that long-term care facility was going to be to replace the Joe Greenland Centre from the information that we received in the briefing that was given to us. So that documentation is the department’s documentation and it is dealing with that particular capital item that is presently before us. Thank you.
Thank you, Mr. Krutko. It is clearly related, Mr. Krutko. I am going to allow that question here. Minister Lee.
Thank you, Mr. Chairman. As I already stated, the regional health centre/wellness centre/long-term care in Norman Wells stands on its own. It is the only region in the Territories without a Level C care facility for all the reasons that the deputy minister mentioned. The 48 repatriation rule that is under effect from Alberta facilities, the surge capacity, the need for us to use technology more and to have facilities in place where our local travelling specialized staff could go to different places and provide services, we just don’t have that in the Norman Wells facility.
That facility, I think, was built in the ‘60s. It is really a mobile home. They really cannot provide the kind of services that they need to do in that region. That project stands on its own.
Joe Greenland Centre will remain the way it has been for what it was meant to be, which is assisted living facility for elders, and the Housing Corporation has agreed to renovate the facility and to create additional capacity and additional bed spaces for elders in Aklavik that are desperately needed.
We will be able to use the money still to enhance the home care services in Aklavik and I believe that would provide opportunities for elders to be provided in the communities. Thank you.
Mr. Chairman, for the sake of progress, I will agree to ask my question on the next page.
Thank you, committee. Part of Health and Social Services, activity summary, health services programs, infrastructure investment summary, total infrastructure investment summary, $15.491. Agreed?
Agreed.
Thank you. We will move to community health programs, pages 6-8 through 6-10. Mr. Beaulieu.
Thank you, Mr. Chairman. I just wanted to discuss a little bit with the Minister and ask the Minister questions on long-term care and what seems to be the general philosophy of the department to regionalize long-term care.
As indicated by my colleague Mr. Krutko many times in this room and in committee, we talked about the need for the communities to care for their elderly, their seniors, and most of us are affected. I don’t want to get into a long story, Mr. Chairman, but at one point, when things were a lot simpler, the elders and the seniors got to stay in their communities in what was referred to as a senior citizens home that was owned by the NWT Housing Corporation, and a service was provided by Health and Social Services in kind of like a variety of scope sort of setting where there were some people that needed more care than others. When some seniors needed more care than others, that care was provided to that senior. We had provided service through that system as a government to people in wheelchairs, to people who were in fact even to a point where people were bedridden. That allowed the communities to retain their elderly in their last days.
Now, when the policy changed and Health and Social Services withdrew from some of those smaller centres, smaller senior citizens homes that didn’t have enough beds to warrant that type of base expenditure, it left some of these homes empty. I know this is a capital discussion. I am going to get to capital. I am wondering if the Minister looked at the feasibility of putting some capital into some of the homes that at one time did provide long-term care. I am specifically referring to Our Great Elders Facility in Fort Resolution. Has the Minister looked at putting some capital into that home to make it possible for the people that are in long-term care from Fort Resolution in Hay River or Fort Smith to repatriate those people into the community and allow, too, the variety of programs that they used to care for those elders in their last days, if that was something that the Minister would consider or if that is something that the department has considered to date. Thank you.
Thank you Mr. Beaulieu. Minister Lee.
Thank you Mr. Chairman. The policy or however you want to call it, the work that we are doing in the Department of Health and Social Services is pretty much in line with what has been there for as long as I have been here, I believe.
I know the Member is right, there are some facilities in the communities that were built by the Housing Corporation in at least three or four communities, but those were not meant to be long-term care as Department of Health and Social Services know it. When we are talking about long-term care, we are talking about acute care or more intense care. I believe there is room for those other facilities in the communities as we go forward, to look after the people who need more assistance, but that can be done outside of the acute care that the Department of Health and Social Services is responsible for.
We really need to invest in home care and wellness workers so that we can support our elders in the small communities, or small community or anywhere, even in Yellowknife, we do need to do more home care, or in bigger centres, so that we keep our people in their homes, supported by resources that are not 24/7. I could ask my deputy minister to speak to you more about why there needs to be a minimum level of service for us for when we talk about acute care health and social services facility of long-term care and why we need to have certain makeup of staff and a certain number of patients.
With the advancement in pharmaceuticals and treatments and many things, a lot of people can live in their home with support and we need to keep people who need more intense care in long-term care facilities, and there is a certain specified staffing makeup that we have to have there.
This is, I think, a fairly simple problem and can be resolved fairly simply, but it has... The policy is in the way. It is kind of an odd situation, because, previously, there were people in these homes, they remained in the homes until their very last days. Health had some involvement in there. Home care was providing some service directly in these facilities and that is all that we are asking for, nothing greater than what was already there, nothing greater than what was there prior to the withdrawal of the program by the Department of Health and Social Services. We are not asking to bring people back into the community that would require the department to have a nurse on full time, anything like that. There is nothing more than what was already there. The people in Fort Resolution fail to see or understand how could something that has worked without any problem whatsoever no longer work because of something that happened on paper, a policy change. The same people, the same service people will be there, they will sit in there and reactivate the home.
Essentially what is happening is there are no seniors in that home living there, so the seniors that do come in don’t even feel like it is their home. Even if they come from next door and it is a satellite unit, they don’t feel like the facility belongs to them. When the four people were actually living in there, the community felt like that facility belonged to them, the elders, the seniors, and it was a very good feeling to go in there. There was lots of activity, so to speak, and now it has kind of dwindled away to nothing more than a place for the select few elders that are eligible to go in there and have a lunch.
I want to go to the extreme end; I just want the department to see a common, sensible approach to this and say we can provide a limited amount of service, maybe a little bit of additional service, a little bit of extra capital to accommodate the residents that would live there. I am trying to get the department to see that this is a policy-driven decision that has caused problems in the small communities or the facilities.
I know that a place shut down in Deline and I know that they are targeting Joe Greenland in Aklavik, and Fort Resolution was shut down as well. What I am saying is, let’s get something in between with support. Discuss it with the community, find a way to bring people back and let’s just let people live there and provide support to them, not necessarily 24 hour nursing care.
I have had that discussion with the Member and I have undertaken to work with the Housing Corporation. It is the Housing Corporation unit. I know the Member is saying we are not talking about 24/7 level 3-4 care, can we not work together, where the Housing Corporation provides those units available to elders and we have home care and more support there so that elders could use that facility to the extent possible, and I am willing to look at that and I believe that we could do that under the existing policy. Thank you.
