Doctor shortage, low worker wages could undermine success of dementia care bill, opposition MPPs say

EDITOR’S NOTE: This article originally appeared on The Trillium, a Village Media website devoted to covering provincial politics at Queen’s Park.

Opposition party members generally voiced support for a Progressive Conservative bill aimed at improving dementia care in Ontario, but they pointed to the family doctor shortage, lower wages in home and community care and the need for more caregiver supports as things that could hinder its success. 

The Standing Committee on Social Policy held hearings on Tuesday on Bill 121, the Improving Dementia Care in Ontario Act, that two PC MPPs — Natalia Kusendova-Bashta and Laura Smith — proposed in June 2023. 

The bill, if passed, would require the health minister to "develop a provincial framework designed to support improved access to dementia care" and table reports on the framework and on the state of dementia care in the province. 

A spokesperson for Health Minister Sylvia Jones said the minister "supports the steps outlined as part of Bill 121 to improve access to more connected and convenient dementia care.”

The bill would also require the Ministry of Colleges and Universities to review the “Personal Support Worker Standard” to determine whether any additional training should be added, including "in-depth learning about person-centred dementia care," placements that involve working with people living with dementia, and learning about de-escalation and other techniques. 

"This bill has one simple but profound goal — to improve the lives of families and patients who are affected by dementia and Alzheimer's. The aim is not simply to treat the disease, but to see the individual behind it, their needs, their experiences and their dignity," Smith, one of the bill's co-sponsors, told the committee. 

"By implementing a framework, we will better equip health-care providers, care partners and families with the skills and knowledge necessary to offer compassionate, effective care."

Smith shared her personal experience as a caregiver to two close family members with dementia and learning that dementia care is not a "one-size-fits-all circumstance."

"Like so many other caregivers, I ask myself every day: am I doing enough? How am I going to be in a position to stretch myself far enough to take care of all of these people?" she said. "We need a complete care network, early diagnosis, access to resources and personalized care to truly support those living with dementia and their caregivers."

Smith said the steps included in the bill would also "relieve pressure on our hospitals and long-term care facilities" by enabling more people to live at home through their dementia journey.

Aislinn Clancy, the Greens' deputy leader, raised concerns about overworked and underpaid personal support workers (PSWs), asking how the government would ensure the success of the bill given workforce challenges. 

Kusendova-Bashta, who is also the long-term care minister, noted the government's move to raise the minimum wage for PSWs from $15 to $18-an-hour, adding that the average wage in long-term care homes is higher than that. But Clancy chimed in saying the "living wage" in several regions is higher than the minimum wage. 

"I think in order for your bill to be successful, we need to at least get to living wage," she said. 

NDP MPP Lise Vaugeois agreed, saying she'd like to see "equalized wages between hospital and home and community care workers performing equal work."

"I'm basically in support of the bill, glad to see a conversation about dementia taking place, but I do have some pretty significant concerns about access to actual care," Vaugeois said. "What was happening in home care is that they are the lowest paid ... it's not a living wage."

She also asked whether the two MPPs proposing the bill would support a caregiver tax benefit, as NDP MPP Wayne Gates has raised in the legislature, though they didn't directly answer the question. 

"We are here to talk about Bill 121," Smith said, with Vaugeois cutting in: "And we're here to talk about how to actually make it possible for people with dementia to get the care that they need. We know that that is one crucial element of how they get that care."

"I know that we're being critical here, but we want your bill to be successful," chimed in Clancy when she was given the floor to speak. "We all want good dementia care, and we want to be sure that all aspects of seniors' care is considered, and home care is a big part of that."

Clancy also raised concerns about the lack of family doctors across the province, stressing that the government needs to do more in the short-term to address the shortage.

"My concern is that we want to have early detection ... part of the success of your bill is that we can catch family members early on, and part of that has to do with equipping primary care with the right tools," she said. "I know you're going to give me money, you're going to give me stats, you're going to talk about new positions, but we know that that's not going to translate for five years."

Some of the other presenters at the committee on Tuesday morning included representatives from the Ontario Long Term Care Association, the Alzheimer Society of Ontario and the Alzheimer Society of York Region, all of whom support the bill. 

Adam Morrison, senior director of public policy and partnerships for the Alzheimer Society of Ontario, said there are an estimated 315,000 Ontarians living with dementia and the number is expected to triple by 2050. 

"The trajectory is different for everyone. What's similar, unfortunately, are the things that we hear in focus groups: it's scary, it's life-changing in a bad way, uncertain, unco-ordinated, terrifying."

A lot of this, he said, comes down to "fragmentation and lack of coordination" for dementia care in Ontario — something he hopes Bill 121 could start to address.

Morrison said this is key if Ontarians want to benefit from "disease-modifying therapies" that Health Canada is reviewing. 

"We're very excited about potentially improving the trajectory of people living with dementia and their families. That's not going to happen if we don't have a co-ordinated system that's looking at what's required for screening, that's looking at what's required for diagnosis, potentially eligibility for treatment and care," he said.

"At the same time, a great many people, because of how long it takes, in part, to get a diagnosis of dementia, will not be able to access disease-modifying therapies even when they are approved," Morrison added.