Committee of Supply
April 29, 2008 - Seniors & Community Supports Department
Ms Blakeman: I hadn’t prearranged this with the minister, but I am willing to do a 20-minute exchange and combine our times if she’s willing to do that. Could I get the table to set the timer for the 20?
Thank you very much. I appreciate that. I’m very glad to be able to be participating in the estimates debate for the Department of Seniors and Community Supports. Just a couple of things that have arisen as I work my way through the actual documentation. I’m referring specifically to the information in the document Budget 2008, ministry business plans, appearing on page 224. I notice that the government of Alberta goal as it relates to the ministry services includes “implement accommodation standards for supportive living and long-term care facilities” and, later, “encourage public, private, and non-profit housing sectors to develop supportive living options that serve identified community needs through approved capital funding.”
We’ve heard quite a bit of conversation about how we’re not asking questions that are under the ministry’s supervision directly, so perhaps the minister could enlighten us as to what “implement accommodation standards” actually means and whether “encourage public, private, and non-profit housing” actually means to develop the housing, or if it’s not, what is this? Some sort of cheerleading effort from the sidelines? One of my ongoing criticisms is that we have cross-ministry issues here, but I don’t see a lot of crossministry co-operation. I think that might be what’s happening here.
I will refer the minister to page 225 of the same fiscal business plan. Under the section Significant Opportunities and Challenges, number 2, New Technologies Increase Independence, it goes on to talk about how advances in medical equipment and more effective drugs can significantly improve the quality of people’s lives. But this runs counter to the experience that I think many MLAs have had in this House of a drug coming on the market and the expert drug committee through the Department of Health and Wellness refusing to fund it. So what is this department doing to influence or to raise the issues in a very concrete, identifiable, measurable way with the department of health to bring those two things together? On the one hand, this department, which is responsible for seniors and community supports, is supposed to be improving the quality of people’s lives, and the drugs are part of that, yet we have a different department that is turning down the insured coverage for the drugs.
Perhaps the minister could explain what appears to be something counterintuitive there. Actually, I’m going to let the minister respond to that, and then I’ll go on to the next section.
Thank you.
The Chair: The hon. minister.
Mrs. Jablonski: Thank you, Mr. Chairman. Thank you for those questions. The Member for Edmonton-Centre doesn’t disappoint me.
I’m going to start with your last question, which was the funding of the drugs and your reference to the special drug committee. We are having ongoing discussions with Health and Wellness. Once again, that’s their area, but we are supportive of those drugs that we are made aware of that are beneficial to our seniors in assisted living. So, once again, ongoing discussions as far as the drug part is concerned.
Through the ASLI program we have standards that once we give the assisted supportive living initiative grants, we have accommodation standards that anyone who receives a grant is required to meet in order to receive that grant. That’s part of the standards that we require when the grant is granted. That’s how we implement standards, and it is standardized across the province, once again, because we’re the central area where people who want those grants or need those grants apply, and those are granted from this area.
nce again on the drug issue, which is a Health and Wellness question, as you know, we are supportive of any drug that we feel is important for our seniors in assisted living.
The Chair: The hon. Member for Edmonton-Centre.
Ms Blakeman: Thank you. I think the point that I was trying to make is: what is the department doing that is measurable to an outsider around influencing the other department? While I appreciate the integrity this particular minister has, well, you know me. I always like to get a little bit of hard copy proof. I appreciate that this department is talking to the department of health, but how am I as a citizen or, indeed, the friends that have joined us in the gallery, who are pretty smart people, all of them, and who do follow through on things like this, able to measure that? They have no way of actually checking up. There’s nothing measurable for them to look at about how that is actually happening.
Ongoing discussions, quotation marks, are not measurable. I was looking for something a bit more concrete because it appears in your ministry business plans. You clearly understand it. You’re talking about it. It’s in your ministry business plans. It doesn’t say: no, no, not me; it’s them. But I can’t find anything that I can measure. I heard the minister earlier talk about the number of times that the rates have been raised for those that are on the assured income for the severely handicapped, commonly known as AISH. With all due respect, Minister, I’m not going to give this government a medal for four increases over the past couple of years considering that the last increase was about either $33 or $38, and I think they’ve had a total increase in funding on a monthly basis of about $150, and prior to this set of increases their last increase was about a decade ago. So, you know, although there’s been some attempt to catch up here, I cannot say that this government could be considered by anyone to be overly generous in this particular area.
It’s why people keep talking about indexing it, because there was not a consistent increase that came along that measured with cost of living. When you give them an increase in 1994 and you don’t do anything again until 2006, that money that they were spending in 2004 really had a value of, you know, 11 or 12 years earlier. I’m sorry; when they went to the store, they had to pay 2006 prices for their groceries. They couldn’t go: well, gosh, you know, if you discount for inflation, I really just have money from 1994, and if you’d please accept inflationary costs reduced, that would be great.
That doesn’t happen. So, you know, I’m not willing to give a medal because there were minor increases in AISH. I still think it needs to be indexed, and I think that overall there should be an increase over it. I mean, how does this government expect someone to try and live even in a pretty crappy apartment in downtown Edmonton in not a very great location when $850 is the going rate for a one-bedroom and they’re pulling down $1,050 in an AISH payment? I don’t know how you expect these people to live, put food on the table, buy a transit pass, pay for medicine that is not covered under other medical coverage, to pay for additional diabetic supplies for example, vitamin supplements, and things like that.
Moving on to a different subject, I’m wondering what efforts or concrete plans this department has done to work with the department of health around home care. We keep hearing that we want people to age in place, but I do not see a concerted effort across government departments to make sure that people can age in place. A major component of aging in place is home care if we’re going to keep people in their original family homes or even in a smaller unit they’ve moved to more recently, and the increasing difficulty in securing home care services is quite apparent to me. So, again, what is concrete and measurable that this department has done to influence the department of health around the funding for home care?
Another issue that has been brought up to me a number of times is an independent seniors’ advocate and a secondary advocate specific to assisted living and long-term care facilities. Is the department considering any moves in this direction? Are they bringing forward any legislation or looking at any programs that would establish an independent seniors’ advocate through this department?
I’m also noting in your strategic plan that the ministry is understanding, or purports to, under Significant Opportunities and Challenges, number 4, that “Strong Economy Drives Employment and Rising Costs.” Under that section, appearing on page 226 of the ministry plans, it does talk about the strong economy resulting in higher living costs.
Many of the Ministry's clients have relatively low or fixed incomes with limited capacity to adjust to the cumulative effect of rising costs . . . rapid escalation of costs for housing, food, utilities and transportation has been particularly challenging.
So the ministry is well aware of the issues that we keep raising. But I am particularly concerned about what efforts are being made on behalf of people with mental health issues, and I’d like to hear from the minister what she is planning to do in her department over the next year.
Three more issues. Dentures. Are we looking at improved denture coverage under seniors’ benefits for dentures? I have never understood how someone is expected to age and at the same time not have their mouths change for dentures. The way that the payment for dentures is set up right now I find quite cruel. You know, for people that don’t have the money to pay for this, being told you can have your dentures replaced every five years, every three years seems like an awfully long way away when you’ve just had a set, and you’re six months into it, a year into it, and they’re not fitting properly. So I’m wondering if there are any improvements being considered under the denture coverage.
You used to be able to apply under the – you have two funds: one is the seniors’ benefit, which is the cash benefit, and then there’s the second fund, which was around one-time only grants that were up to $5,000 extended seniors’ benefits. I’m sorry; I’m just not getting the right name of the program. We used to be able to apply for extra money there to pay for dentures, and that was removed a couple of years ago. I’m wondering if that could be restored or if there’s another way of people being able to get additional funding, because dentures are expensive. I mean, you’re looking at $3,000, $5,000, $6,000 for dentures, and most seniors don’t have that kind of coin lying around under the bed. So the dentures.
I’m wondering if the minister has any legislation coming forward this year at all. I’d be interested in hearing what that is.
Finally, when the minister was talking about “we” were doing unannounced checks in some of the facilities, could the minister explain who the we is? Is that the department? Is that the Health Facilities Review Committee? Who is the we? I would argue that the Health Facilities Review Committee has been . . . [interjection] Well, yeah, I don’t think they have a lot of credibility anymore, and I wonder how much emphasis is being placed on their work at this point in time.
he seniors’ issues that have been raised to me, I raised some of them today in my private member’s statement, around difficulty paying the 30 per cent of income, especially when utilities are not included in that, neither is telephone. But also they’ve raised issues around quality home care, affordable and accessible care facilities. Stop turning long-term care facilities into assisted living, create advisory councils in all seniors’ care facilities, and establish an independent seniors’ advocate: I’ve certainly covered some of those. So my questions were specific to home care, seniors’ advocate, mental health supports, dentures, legislation coming, and who the we is.
The Chair: The hon. minister.
Mrs. Jablonski: Thank you, Mr. Chairman. Something that I wasn’t able to say because I ran out of time but I’d like to say now for the benefit of our members is that for any answer that I’m not able to give a verbal reply to, we will provide a written reply to the members. We’ll get into the questions that the Member for Edmonton-Centre has asked in her last approach. The first thing she talked about when we were talking about the drug was that she wants something that’s measurable. She mentioned that ongoing discussions aren’t measurable, and I would agree with that, but we are paying attention to things that are measurable. At this time we might not have anything in place for the drug part, but as I explained before, we do have a website that shows what we’re doing in our inspections and who was inspected and what the results of those inspections were. So I would like to point out that we do believe that measurable things should be open and transparent, and we’ve started a website to deal with that.
Ms Blakeman: And the website address is?
Mrs. Jablonski: That website will be up in three months, and we’ll have the address for you then.
The other thing that the member talked about is AISH. I want to mention once again that it is the highest level of financial benefit in the country, that we have the most comprehensive health benefits available to our AISH clients. I also want to mention something I don’t think I’ve mentioned before that I think is really important, that we look at AISH clients as individuals and we do speak with them and have discussions with them to see what their individual needs are. There are areas in our program, as I mentioned earlier, that we have supports for on an individual basis.
When we talk about our AISH clients, I’ll just reinforce the fact that in addition to financial benefits our AISH clients are eligible to receive a comprehensive list of health benefits, including free Alberta health care insurance, prescription drugs, eye care, dental care, emergency ambulance, essential diabetic supplies, and the Alberta Aids to Daily Living with no copay fees. These benefits are not only available to the AISH clients themselves but to their spouses and any dependent children. This assistance is worth an average $350 per month per client. AISH clients who have less than$3,000 in assets may be eligible for assistance with additional expenses such as caring for service animals, travel to medical appointments, and school supplies.
The next question that the member asked is: what are we doing about home care with Health? As you know, home care does come from Health. That’s also an ongoing discussion that we’re having. We understand the importance of that. If we want our seniors to stay in their homes as long as possible, we know that that’s an issue. The Minister of Health and Wellness mentioned a plan that he called the 3-6-9 plan, and home care is mentioned in that plan. We have to stay tuned for his releases about that health care plan that he is putting into place.
You mentioned, once again, the seniors’ advocate. I would say to you that we do have a seniors’ information line and that 1,000 calls, on average, per day are answered. I have said that I’m interested in exploring that idea. I think that we have good representation through the Seniors Advisory Council, who travel throughout Alberta to meet with stakeholder groups to see what the concerns are so that we can hear what they have to say and address those concerns.
The ministry strives for good communication with our seniors. We have eight information offices throughout the province that seniors can walk into at any time. I’d like to tell you about the one that I know best, which is in Red Deer. I think that when the ministry did that a number of years ago, they were forward thinking in the fact that they did not put this seniors’ office in a place in downtown Red Deer where parking is difficult and not very accessible for our seniors; they put the seniors’ office right in the middle of our biggest seniors’ centre in Red Deer so that it’s very accessible for our seniors. You know, one thing I like about seniors is that they’re very supportive of each other. When they get together to chat about what their concerns and issues are, a senior could say to another senior: “Well, there’s this program. Don’t you know about this program?” And I’ve seen this in our centre where a senior can immediately go to the centre and speak with a consultant there. So I think that those eight centres are very important for communicating needs to our seniors’ programs.
Ms Blakeman: Thank you very much. I guess we’ll start another 20 minutes, although I don’t know that we’ll take it all because there may be others. But let’s start the back and forth. I’m pleased I got another opportunity to rise. The minister was not able to complete her answers to the questions I had put earlier, which were specific to mental health supports, dentures, was there any legislation coming, and who the we was when we talked about unsupervised visits.
A couple more questions that I will add to that. One is around the issue that I have raised repeatedly around having the cost of telephones – residential telephones, single lines, nothing fancy – included in the subsidized rate that seniors pay for their housing. Now, again, the minister is immediately going to say that’s not her department; it’s Housing and Urban Affairs. But this is part of my frustration, that lack of co-ordination on these cross-ministry issues. Has any work been done, or have any studies been done? Is there any pot of money that could be pulled from to look at either including the cost of a single-line telephone rental inside of that 30 per cent that seniors pay as a subsidized rate or some other kind of initiative that would assist low-income seniors or seniors living in subsidized residences to be able to cover the cost of the phone? My argument is that the telephone for these people is not an entertainment device; it is a lifeline. For those that still use those MedicAlerts – help me; I fell down; can somebody come and get me up? – they work through a telephone line. So if you can’t afford to have a telephone line as a senior, you can’t have one of those medical devices. Secondly, for a number of seniors a telephone is necessary to be able to order prescriptions and have them delivered. There are even grocery services. I think there’s a significant mental health component to being able to communicate with family and with others outside of your home for friendship, and this is an issue that has been raised consistently with me over the last 12 years. The private member’s statement that I made earlier today, in which I was essentially reading a letter to me from a group of seniors living in one of the seniors’ residences in my riding, at the end, you know, once again came back to this: with the competition between telephone companies today, they’re wondering if the government went to them, could they not negotiate some kind of a package that would make these single-line telephones very affordable? Why isn’t this something that the government could be doing on behalf of its elderly citizens, helping them negotiate such a package? The easiest thing, as I said, and the first thing that we recommended many years ago was to include the cost of the telephone inside of the 30 per cent that they’re paying. At this point that would accomplish what those seniors have been asking for overall, which is a reduction from 30 per cent to 25 per cent of their income being used to pay for their accommodation.
My final questions. On page 326 of the estimates, the general revenue fund and lottery fund document, the program that I was trying to remember before when I was talking about dentures is the special-needs program, so I wasn’t that far off. I notice that we now have it broken out, which may well be why you can’t get dental coverage under the special-needs program. Now it’s the seniors’ dental assistance program. The complaints I’ve had in my office are that, you know, it’s too restrictive and it’s not covering what they really need, which is often the replacement of dentures. I think the dental assistance is actually about teeth cleaning procedures and fairly straightforward procedures, again, not covering the dentures specifically.
I’m looking at votes 2.2.5 and 2.2.6, and there are increases in both of these. I’m wondering how many procedures are expected to be added. You’ve increased the money quite a bit, from $52 million in the forecast for ’07-08 – $54 million was the actual in ’06 – to $59.9 million. That’s a significant amount of money. How many more procedures does the ministry expect will be done, or how many more visits will be done under the seniors’ dental assistance program? How many more individuals? I don’t know how you qualify this, but how many more are you expecting to happen, whether it’s visits, procedures, or seniors that are assisted? As well, I’m noticing an increase in the seniors’ optical assistance program from $5.5 million to $7.1 million. Again, how many more individuals are we expecting will be helped? Is this a volume increase? As well, are there any changes in the eligibility levels for entry criteria into these programs? Is it just more people getting the same thing or is it more people getting a different, enhanced program or is it a completely enhanced program where the same number of people are getting additional benefits or access? Thank you for that opportunity to put those additional questions on the record. I think we’ve still got some time to hear the answers.
Mrs. Jablonski: Thank you very much for that. I’m going to start with the mental health supports. Clients who have mental health concerns can access the AISH program. I just want to point out, again, another anecdote of a facility in the central Alberta region that I visited. It is a facility for people with mental health issues. The facility was specifically purchased for people with schizophrenia to access. Speaking on the mental health issue, there’s a partnership in that facility between the David Thompson health region and the Schizophrenia Society and the Canadian Mental Health Association. What they do is provide affordable housing for I believe 40 units. They’re beautiful, brand new units. They’re not just living units; they have programs for people with mental health issues.
This is a community coming together to give supports to 40 people in order to train them in some things that we take for granted. For example, in this program not only do they give them a place to live, but they give them supports like teaching them how to make their own meals, how to catch a bus. They do some skills training as well. The counselling, you understand, of course, for mental health is under health care. I think that the supports that we’re seeing in our communities are very good for some of our mental health people, but we do have areas for improvement. Once again, they can access the AISH program.
In speaking about the dental program, I’m going to go to the question that you asked: who’s getting the increases? I would say to that that more people are accessing the program. Approximately 12,000 seniors access the dental assistance for seniors program each month. Approximately 29,000 seniors received assistance from the optical assistance for seniors program in ’07-08. The dental assistance for seniors program contributed $815,000 to the Alberta Dental Association and College toward a pilot project for two mobile dental units. These units will serve seniors that have difficulty visiting their dentist; for example, seniors living in longterm care facilities or remote locations. This was originally scheduled for the fall of 2006, and the delivery of the units has been delayed to 2008.
I want to also mention something notable with the scope of practice changes that we brought to dental assistants. Instead of having to practise in a dentist’s office only, we also have dental assistants who now go to our supportive living and long-term care facilities to help our seniors with their dental care. So I think that’s a great improvement.
You wanted to know why things like – I think you mentioned this – crowns are not covered. What I would say to you is that the dental program for seniors provides coverage for basic dental services that help maintain a reasonable level of dental health. In consultation with the Alberta Dental Association and College it was determined that a number of procedures, such as crowns and bridges, are not considered a basic dental service and that most dental plans that provide coverage for basic service do not include these procedures.
You spoke about dentures and the fact that people’s mouths can change so that the fit of the denture isn’t very good and the service which is provided once every three or five years, I think you mentioned, is probably not adequate, and what are we doing about that. I would like to take what you’ve said under consideration. I’m just becoming familiar with all these programs myself. I would venture to say that if somebody has a very serious need about the changes that have been happening to their mouth and their dentures, those are the kinds of issues that we would look at on an individual basis.
The other questions that you had?
Ms Blakeman: Legislation.
Mrs. Jablonski: Legislation regarding?
Ms Blakeman: Any legislation.
Mrs. Jablonski: Any legislation coming up. Well, as you know, last year we had the Personal Directives Act. We know that that’s excellent legislation that provides protection for people who have lost the ability to make decisions for themselves. The other place that that’s essential legislation is if you were in a coma and you lost the ability to make decisions for yourself. When you get back out of that coma, how do you take over the authority of your life again? I think that that’s well laid out in the protection of our Personal Directives Act.
Also, we have the guardianship and trustee act coming forward as well. I believe that the minimum that we will do with that act is have it read into the House prior to the summer. I think it’s very important to make that available for our standing committees over the summer and also available for the medical community and the legal community. So that will come forward prior to the House closing.
Ms Blakeman: Thank you.
Other Sections
Youth Voice
@ The Leg
Photo Blog