Thank you, Mrs. Groenewegen. We are on page 6-10, Health and Social Services, directorate and corporate services. Mr. Roland.

Thank you, Mr. Chairman. Just a little further on the addictions side, I am aware from the previous Assembly that there was a bit of work done on the reprofiling of the treatment facilities and the programs and services that were run by the department, but there is nothing that really came back to say it was completed, what was done. Instead, we are hearing another launch into another area.

Can the Minister inform us as to what occurred there? Is this tagged onto the existing work? Thank you, Mr. Chairman.

Thank you, Mr. Roland. Just for the record, we are still on general comments. Mrs. Groenewegen.

Thank you, Mr. Chairman. Mr. Chairman, much of the planning that went into what would be reprofiled and what structures would be in place and facilities that would be available for programs was under the alternative programs initiative. There was an assumption made with that planning that there would be certain access to facilities. As it turned out, we have not concluded, I guess, or successfully accessed some of the infrastructure we thought would be available.

As Mr. Krutko mentioned, the Dettah facility has been designated and is being used for inmates through Canada Corrections. It would be difficult to find programs that we might be able to use that facility for that would complement that particular activity in Dettah.

We have had to turn to other initiatives, such as the Women's Mobile Treatment Program, the Women and Children's' Post-Trauma Healing and Recovery Program, because as I said, the infrastructure we thought we would have access to has not panned out. At this time, we do not have access to the Dettah or the Franklin Avenue facility, which I am sure the Member is familiar with. Thank you.

Thank you, Mrs. Groenewegen. Mr. Roland.

Thank you, Mr. Chairman. Just in general, one concern I have had is, in the department for years now and in government overall, we seem to be focusing on putting out fires, and a small portion goes towards prevention. With that in mind, it is something we need to focus on as a government overall to try to change the focus here.

We continue to fight the blazes that are out there. We will never win if we continue to provide services as we see it. There has to be some change. I think we have to be clear on how we are going to do it and try and reach some goals we can stand up and point to in the long run. I truly believe that if we are going to continue to deal with the cure side of things instead of the prevention, this department will continue to grow as it has in the past by forced growth every year, because we just cannot continue to keep up with it.

Even though, in a sense, the potential for development in the Northwest Territories is great, along with that usually comes a bit of a negative side. The Beaufort Delta went through that in the late 1970s and 1980s. We hear some comments about other places. We have seen a large influx of cash into their areas, communities and regions. If we are not ready to be proactive, we will find ourselves coming back for more dollars, trying to run the existing programs we have.

Hopefully, with some of these strategies that are coming out, we will see some solid results focusing on prevention rather than focusing on another strategy to deal with the situation we find before us. With that, Mr. Chairman, I will save the rest of my comments and questions for detail. Thank you.

Thank you, Mr. Roland. Mr. Bell.

Thank you, Mr. Chairman. Mr. Chairman, as indicated in the committee report, we have some concerns about the general aging of the population and the lack of palliative care in the Northwest Territories. I think all other jurisdictions in Canada, save for Nunavut, have palliative care legislation and a strategy for dealing with people who need support and care, terminally ill patients. We do not. I think we have maybe a couple of beds at Stanton here in Yellowknife sort of dedicated to that purpose, but we do not have any sort of hospice facility where a terminally ill patient may be stationed with some nursing help and their family can move in with them for a short-term arrangement.

I am wondering if the Minister has any plans to look into this area, because I think it is something that is very important, not only for Yellowknifers here, but for a lot of people from the regions when they are sick, who come to Yellowknife for the services. They are brought away from their families. The last few months of their lives they spend in isolation here in the capital while their family is still back home in the communities.

I know there has been a trend to allow people to spend their last few months in the home. One of the concerns we have here in the North, especially given the high rates of illiteracy, when we send people back to the home to be looked after, we may give them directions and medication. There is some hope that pain management will be managed correctly. I do not know if that is always a given.

I am wondering if the Minister can talk a bit about the department's strategy for palliative care. Thank you.

Thank you, Mr. Bell. Mrs. Groenewegen.

Thank you, Mr. Chairman. Mr. Chairman, Mr. Bell is right. We do need to plan for the inevitability of the growing, aging population we will have here in the Northwest Territories. Certainly a part of that planning needs to address how we will take care of people in the last parts of their lives.

We do have a variety of competency and specialized training available in the different areas in the North for people that require palliative care. We do have some expertise which is held by homecare nurses. The needs of a person certainly vary with their illness and with the desire of the individual person as well.

Certainly, for those who do require hospitalization and choose that option and want that, we do need to have the facilities available for them. When we look across the various regions in the different boards, in Stanton for example, the regional health board, we have 50 nurses who have extra training and education in palliative care and one physician who has formal training. Others have taken courses and workshops.

As we go through each of the regions and communities, there are varying levels of expertise available to deal with palliative care issues. However, like I said, the needs vary from person to person and the wishes of the patient vary from individual to individual as well.

Yes, the Member raises a good point and the department will need to undertake planning, not only for palliative care, but certainly for delivery of other services as well for our population as it ages for long-term care in many instances. Homecare, when possible, is a viable solution depending on the circumstances, for elderly or also just for people who are sick. Not everybody that gets sick and requires palliative care is elderly either, unfortunately.

I do recognize that there are no developments in this area all the time and we do need to keep on top of them to make sure that our residents have access to the latest information and services that are out there. Thank you.

Thank you, Mrs. Groenewegen. Mr. Bell.

Thank you, Mr. Chairman. Given our fiscal situation, I am wondering if the department has analyzed what it costs for us to keep a terminally ill patient in the hospital at Stanton?

As Mrs. Groenewegen mentioned, we have 50 or so trained nurses, but I am wondering if there has been a comparison done between what it cost us to keep somebody who is terminally at the hospital as compared to what it would cost to have somebody in that situation maybe in an apartment unit, in a hospice near the hospital, where a nurse could look in and give direction to the spouse or the relative who is looking after the sick person. I am wondering if a cost comparison has been done.

Thank you, Mr. Bell. Mrs. Groenewegen.

Thank you, Mr. Chairman. I have approximate numbers. For a person to stay in a hospital, it is between $1,000 and $1,200 per day. If they are in a long-term care facility, it is approximately $300 per day. That is the difference.

Certainly there are a number of contributing factors that would come to play in assessing whether a person needed to be in an active care hospital, depending on the type of illness they have, the level of pain that needs to be managed, whether they have access to long-term care facilities in their region or their community. When you consider other options, whether or not they have family support, things like that.

Each case is individual, but certainly as a department and as a service provider, we need to ensure that there are various options and the best solutions available to the northern residents.

Thank you, Mrs. Groenewegen. Mr. Bell.

Thank you, Minister, for that cost comparison. The numbers are staggering. The difference between what it costs us to keep somebody in the hospital and certainly some people would need to remain in hospital, there is no other option that require that level of care. For someone who is terminally ill and they are spending their last few months with their family, I am wondering if they have another option?

If they are not from Yellowknife and they need to be in the capital for a various level of service, but would not need to be at the hospital, is there any other option for them, or is it either Stanton or back in the community? Is that the choice that we have right now?

Thank you, Mr. Bell. Mrs. Groenewegen.

Thank you, Mr. Chairman. Mr. Chairman, there is one respite bed available at the Aven Centre, and depending whether or not it is available, that could be an option. Also, when we talk about the cost of long-term facility versus hospital, we also have to think about the availability of long-term care beds, because sometimes facilities are maxed out and are operating at capacity and sometimes there are vacancies available.

Unfortunately, they may not always be in the right community. We visited Fort Smith. We saw a beautiful facility there and some patients, elders, seniors, had passed on, and there were seven beds available in Fort Smith at that time. That may not help address the need if you have people who are requiring care in Inuvik. The option that would be taken advantage of would depend on the availability of beds. Thank you.

Thank you, Mrs. Groenewegen. Mr. Bell.

Thank you. I think it certainly makes sense for the department to look into some sort of situation, and not necessarily in isolation, but whether we look at hospice type arrangements or things like this that would allow somebody to spend their last few months with their family.

Certainly, there is not the room for the family at the Stanton Hospital, I do not imagine. I think that we can see that there is such a huge comparison or discrepancy in what it costs to take care of somebody at the hospital compared to a long-term facility.

I hope the department will look at this, because I think it is important for someone to spend their last months with their loved ones, preferably in their home community. If there was a situation where they needed to be in Yellowknife and there was some place for their family to stay with them as well, I think that is important. We are dealing not only with what is best for the person that is dying, but also it is a very difficult time for the family. I think this is something the department should certainly look into. I would like to see us getting our own legislation, given that we are one of the few jurisdictions without it. I hope the Minister will pursue this. Thank you.

Thank you, Mr. Bell. Mrs. Groenewegen.

Thank you, Mr. Chairman. The issues that the Member raises are very valid and certainly some of the suggestions such as a hospice or different alternatives for people that are in the last stages of their life will be addressed under the continuing care strategy that will be put together by the department in recognition of this increasing seniors population that we will be dealing with in the future.

The legislation is also a very good recommendation and we want to keep in step with what is happening in other jurisdictions and make sure our legislation is as comprehensive and up-to-date as possible. Those are areas we will look at, and again, we will seek input from the Standing Committee on Social Programs as to ideas. There are very many different ways of enhancing the services that are available to people. There are interesting and diverse initiatives that could be undertaken.

Thank you, Mrs. Groenewegen. Mr. Miltenberger.

Thank you, Mr. Chairman, just a quick comment on the issue of palliative care. First, it is an issue. I know in Fort Smith, the staff there have taken the initiative in terms of training and they have worked with homecare as well as the health centre, trying to provide the services in the system that now exists. I agree that it is something that we have to look at a little more formally.

I have a question for the Minister in regard to the Child Welfare League Study. In a letter dated June 5th, there is a commitment where the Minister responsible for Health and Social Services has committed to tabling the report in the Legislative Assembly during the June 2000 session. Copies of the report will be provided to the members of the Standing Committee on Social Programs prior to the report being tabled in the Legislative Assembly.

Given the fact that there are three days of session left, I wonder if the Minister could indicate the timeframe she has in mind for tabling this and giving us any kind of prior notice over and above minutes. Thank you.