Editor’s Note: On Tuesday March 24th, 2015 a discussion was held in the New Brunswick Legislature during question period. It seems that the government is floating a trial balloon on the introduction of “means testing” as opposed to “income testing” for seniors who need nursing home care. A means test is a determination of whether an individual or family is eligible for government assistance based upon whether the individual or family possesses to means to do so without help. The catch is that means testing takes both income AND assets into account, including the family home in its value which could mean seniors will have to mortgage or sell their home if one partner needs financial help for nursing home care. Conversely, income testing takes into account the individual or family’s income – using all streams of available income but leaving assets like the main family home in place.
In Canada means tests for public health insurance were once common but are now illegal, as the Canada Health Act of 1984 requires that all provinces provide Universal Healthcare coverage to be eligible for subsidies from the federal government. Long-term care services like home care and nursing home care are placed in a category called “extended services”, which are not insured services under the Canada Health Act. Extended services continue as part of the Canada Health Act, ‘subject only to the provision of information and recognition of the federal transfer’ as set out in section 13 of the Canada Health Act and therefore availability and access widely from province to province.
Means testing is one of the major factors that results in differences in long term care service access from province to province. In addition, there are numerous other provincial differences in the way provincial long-term care has evolved, including different service amounts, types, and eligibility criteria. Differences in eligibility criteria and means testing may result in Canadians being denied services, or denied funding for services, in one part of the country that they would be able to obtain in another.
Those who support means testing will say that it is a mechanism for allocating scarce healthcare resources and stretching healthcare dollars. Each province must determine how to best serve its population with the resources it has at its disposal. One of the major difficulties is that when different criteria are applied in each jurisdiction, inequality of access can result.
Means testing can also create a “poverty trap” whereby the system keeps people in poverty by removing social support as the person attempts to escape poverty and by create a disincentive for savings and efforts. The effect of a person being disqualified from the savings they amassed in their home so that they can put their partner in care is that they will likely only have to become increasingly dependent on social supports.
Canadians have embraced the medicare principles of universality, comprehensiveness, accessibility, portability and public administration as the hallmarks of Canadian health care. Although these requirements are currently limited to insured services like diagnostic and hospital services, many studies, reviews and public consensus emphatically underscore the fact that this narrow application may be out of touch with the current needs of our ageing population and with the desires of Canadians – hence the impetus for healthcare reform and CARP’s “One Patient” policy proposal.
As it stands our health care system is fragmented, complex, and often difficult to navigate, and it is resulting in unnecessary costs within the system and poorer health outcomes for Canadians – Why is it so hard to connect the dots? CARP’s “One Patient” Brief creates a big picture of a care continuum that emphasizes integration, effective navigation, and formal communication. Within a person-centric system, patients should be able to smoothly go from one stage to another to meet their full spectrum of health needs, and it does not need to be costly.
ORAL QUESTIONS March 24, 2015 – TRANSCRIPT/HANSARD OF THE NEW BRUNSWICK MEANS TESTING DISCUSSION
Mr. Fitch: The Auditor General’s report on the Atcon file came out this morning at eleven o’clock, much to the embarrassment of many of the present ministers who were there during the Atcon decision. That file is going to be around for a long, long time, and that file is going to be talked about for many days in the Legislature. We will have some questions on that later today.
However, there is an urgent, urgent file right now that is causing many, many people in the province a lot of concern, a lot of heartache, and a lot of discouragement. As mentioned by the member for Saint John East, it is disgraceful that the government has floated a trial balloon to say that we are going to increase the conditions of the contribution to long-term care. Can the Premier rise today, apologize to the seniors of the province, and say that this is not on the table in this budget? Thank you.
Hon. Ms. Rogers: I would like to be clear about a couple of things. First of all, the only place from which I have heard anything about a cancellation of the Home First Strategy has been from the members opposite. The priorities have not changed with this government. Our priorities are job creation, getting our fiscal house in order, and protecting vulnerable families, and seniors are a very important part of our families. We will continue to invest. In fact, half of our budget goes toward long-term care and taking care of seniors.
Mr. Fitch: I appreciate the minister’s getting up and trying to defend the government’s trial balloon, and I would suggest to the minister that the question of where the money went in Home First is very similar to where the money went in the Atcon deal.
I remember the Premier of the time, Bernard Lord, being in Albert County and sticking a sign in front of a senior’s house and the word “protected” being on that sign. That policy of protecting seniors’ homes and assets was followed through in the next two successive administrations in New Brunswick. However, it is shameful today that this particular government wants to spend millions of dollars on pavement rather than protecting the assets of seniors who have contributed so much to the people of the province.
Now, we are hoping that this was a trial balloon floated out before the budget in order to gain favour. Is it a trial balloon, or is it the reality?
Hon. Ms. Rogers: I would like to be even more clear about the Home First Strategy and where the money has gone. In fact, there are a lot of insinuations being made about money being lost or not used. I would like to remind everyone that, a couple of weeks ago, the Daily Gleaner reported about an interview with former Social Development Minister Madeleine Dubé, who acknowledged that the Home First Strategy had many details yet to be decided. Had I spent the money without having a full implementation plan or a design strategy, this would have been very irresponsible. We want to be very careful about the use of our valuable resources.
Mr. Fitch: The minister admits today that the money was available and that the choice was made not to spend it. The words that are being used here today are very telling. The Minister of Finance got up and said that we are going to look at the means test for seniors, and the minister across the way wants to talk about Home First. They want to deflect from the real issue. There are many, many seniors who are concerned that the assets that they have accumulated over their lifetimes will be taken by this government. That is deplorable when you think of the time and effort of the seniors coalition and the people who have fought time and time again to protect the assets that seniors have accumulated over their lifetimes.
I am giving the Premier an opportunity to stand up and defend the seniors in New Brunswick, the most vulnerable, from this situation of their assets being under attack by this Liberal government because the government has made choices to spend money elsewhere—on pavement and on its political friends. Will the Premier defend the seniors of New Brunswick? Will he get up today and say that this a trial balloon and that it will not be considered in this budget?
Mr. Speaker: Time, member. Hon. Ms. Rogers: The direct answer to that question is: Yes, this government will defend the seniors.
Mr. Fitch: Can the minister be a little clearer on that? We have seen many times that the government’s words and its actions do not line up. What they say and what they do are two different things, and we have seen it happening here today. The minister stands up and says that the government members will defend the seniors, yet their actions are this—they are not going to spend the money on the Home First program. With $7 million in their budget, they came up the other day and talked about a pittance, a small percentage of that.
Today, we have the Finance Minister not standing up and defending the fact that he stood up in the media and said: We are going to look at the asset accumulation of seniors, and we are going to look at that as a contribution to their long-term care. Will the minister stand up and clarify the statement that she just made in the House? How are you going to look after the seniors? So far, you have attacked them. That is all you have done.
Hon. Ms. Rogers: The problem with the last government was that many things were attempted to be rushed as announcements but were not actually implemented. Our government is absolutely committed to the Home First approach. However, we are looking at this in the whole spectrum and context of long-term care for seniors.
Mr. Speaker: Order.
Hon. Ms. Rogers: We cannot continue to build silos and work at it piece by piece without looking at the context, so we are going to be an evidence-based government. We are going to move forward as we engage New Brunswickers. I have been meeting with stakeholders, and they have been telling me about specific problems that they had with the beginning of the design of Home First approaches. We are implementing some of the stakeholders’ input, and we are moving forward on this. I am looking forward to the main estimates, when we can describe some of our . . .
Mr. Speaker: Time, minister.
Mr. Steeves: I find myself feeling sorry for the Minister of Social Development today. I know what a qualified and caring person the minister is. I know that she cares very much about seniors, just as all of us do, I am sure.
First, we have the cancellation of the Home First Strategy for seniors. The $7 million for this program has disappeared. I know that they say it is still there, but I would like to know where it is because we have not heard any details. I know that the minister must have found this troubling. Now, we have a minister in charge of the blame-the-people tour suggesting that seniors will be targeted for more revenue for the government.
My question is—I am sure there are some speaking notes from the Premier there somewhere—for the Minister of Social Development. I am sure that she feels badly for the seniors. I would ask the minister to go ahead, though, and recite the speaking notes that the Premier has given her in this case.
Hon. Ms. Rogers: I am sorry, Mr. Speaker, but I did not pick up a question out of that. Mr. Steeves: We assumed that there would be an answer from the Premier. The Premier seems
to be giving speaking notes to everybody.
I would like to reference an excellent article, an editorial from today’s Telegraph-Journal. It reads in part:
Governing is the art of juggling priorities and the Liberal government should take a hard look at its list before targeting seniors.
It goes on to say:
We fail to see the logic behind spending $30 million in new provincial money to twin a road while we ask our most elderly citizens to sell their houses or dip into their RRSPs to help pay for their care.
After contributing to our province and paying taxes for decades, our seniors deserve to be more of a priority than asphalt.
The article says: “our seniors deserve to be more of a priority than asphalt”. I have a very simple question for the minister. Does she agree with that—that our seniors are actually more of a priority than asphalt?
Hon. Ms. Rogers: Seniors are a priority of this government. All vulnerable people are a priority of this government. Again, nothing has changed with regard to our priorities of creating jobs, getting our fiscal house in order, and taking care of families.
I have reiterated that the Home First approach has to be looked at in the whole context of long- term care. Seniors are very, very important. We have a system that has to be sustainable. We are acting to make sure that the system is there for all people who need it, when they need it, and with the right levels of care.
Mr. Steeves: There is a system that is sustainable, as long as you are part of the big red machine. It sustains them very well.
The Liberal election platform, on page 31, states in big, red letters: “We will help seniors live independently at home and receive the healthcare they need.” It is the first step of the first pylon, the first pier, of this Home First situation about which we are talking. It is $7 million to keep seniors in their homes and to get them an assessment of what they need in their homes so that they can continue to live there. The first move that this government made concerning seniors, despite what we heard this morning, is, effectively, to cancel the Home First program for seniors. To add insult to injury, the government is talking about taking more money away from seniors who need it in the long term.
Once again, I must ask this of the minister: Which disappoints her more? Is it the cancellation of the Home First Strategy for seniors—I guess she will not admit to that—or is it the latest insult of announcing a possible money grab by her government for our seniors?
009 13:25 Mr. Speaker: Time, member.
Hon. Ms. Rogers: Our budget has not been announced yet. Our budget will be announced on March 31, and we will be doing the main estimates after that and going into details. Nothing has been decided yet for next year’s spending.
Mr. Speaker: Order.
Hon. Ms. Rogers: We are in discussions. As we have said, our fiscal house is in rough shape right now and we are putting everything on the table to look at how we can govern better and have sustainable social programs for the people of New Brunswick.