25 June 1998

10:30 A.M.



Chair: A. Munter

Members: D. Beamish, W. Byrne, L. Davis, C. Doucet, D. Holmes, H. Kreling, A. Loney, M. McGoldrick-Larsen



That the Community Services Committee confirm the Minutes of the Meeting of 4 June 1998.




councillor Holmes stated that the Province had announced a number of changes to housing; devolving some responsibilities to the Region, such as the "hard-to-house" segment including Options Bytown and Daybreak and others, or assuming funding/ partial funding for other aspects of housing through the Ministry of Community and Social Services and Ministry of Health. She requested staff prepare a report on the implications of these changes for the Region, for the 16 July 1998 Community Services Committee meeting.

2. Councillor Kreling asked if there was a revised target date for the Region to assume administrative responsibility for land ambulance services. Chair Munter stated that a report providing an update on assumption of land ambulance services would be coming forward for the 16 July 1998 Community Services Committee meeting.

Councillor Davis asked if there had been any discussions to date about operating efficiencies. Chair Munter explained that the rationale for early assumption of responsibilities for land ambulance services was to take control of those types of matters. He stated a Transition Task Force had been established, comprised of ambulance operators, unions, Ministry of Health staff, regional staff and himself, as a representative of the Community Services Committee, to look at the issues and report back to the Committee. Chair Munter confirmed that there would be an opportunity for Councillor Davis to have input, based on her recent personal experience with the land ambulance service.


Chair Munter stated his inquiry referred to a Motion approved by Regional Council (25 Jan 96) to defer the implementation of a policy to prohibit all tobacco advertising on Regional property pending federal legislation. He stated the Federal government’s intent has been clarified and he would like the Health Department to prepare a report for the Committee for September 1998.



- Commissioner, Homes for the Aged report dated 9 Jun 98

Staff Presentation

Garry Armstrong, Commissioner of Homes for the Aged (HFTA), presented the reports for agenda items 1& 2 together, as the issues are interrelated. He stated that Alzheimer Disease is the leading cause of dementia. This disease is not a normal part of aging, and at this time, there is no known cause. There are currently approximately 7000 people in Ottawa-Carleton with Alzheimer Disease, about half of these people will require long term facility care. It is projected that there will be 9000 more cases of dementia by the year 2021. In addition, Ottawa-Carleton has the fastest growing elderly population in Ontario and will therefore face special challenges in providing services. The ‘over 85 years’ population, the most likely to require institutionalized care, will double in the next 20 years.

Commissioner Armstrong stated the stakeholder community in Ottawa-Carleton sees a role for Regional government in providing a Forum for identifying community priorities for dementia care, and for making recommendations to the Ministry of Health and District Health Council. The staff report proposes a Forum to be organized this Fall, in collaboration with the Alzheimer Society and other community partners.

The Province has set up a process for submissions of proposals for the 320 beds allocated to Ottawa-Carleton. To date, there are over 10 agencies and organizations bidding for all or some of the beds. The HFTA Department has worked with the Alzheimer Society in preparing a bid for a 48 bed dementia care facility to be an integral part of the Peter D. Clark Centre. In total, the HFTA Department will be bidding for 90 beds, and he reminded Committee that this is a very competitive process.

The capital budget, as previously presented to Council, is $16 million. Commissioner Armstrong stated he did not expect this amount to be exceeded in terms of the total cost of the beds. The operational savings from the replacement of Island Lodge, plus the additional funding from the Province and resident revenue may reduce the capital and operating commitment from the Region. If the beds are awarded, the HFTA Department will request a formal approval from Committee and Council.

Questions to Staff

Commissioner Armstrong reviewed the capital and operating funding formulas. The Region’s share of the capital will come from a debenture that will, with provincial subsidy, resident revenue and operational savings, be no more than the $16 million already committed in the capital budget.

Councillor Loney asked about the Region’s contribution. Commissioner Armstrong stated that the Region’s share would not be more than the $16 million already committed and the current net operating budget of $8,067,000 per year. Councillor Loney stated his understanding was that the $16 million was going to be covered by the savings in operations. Now, he understands that the Region will be paying the $16 million debenture, because it will be spending the money from the Province on the operating costs of the complex, including the additional beds. Commissioner Armstrong clarified that the proposal put forward indicated that there was a strong possibility that the capital costs associated with replacing Island Lodge would be offset through the operational savings. He iterated that a good piece of that will still happen; that the Region will be able to pay a significant portion of the $16 million through operational savings, resident revenues and increased revenues from the Province (figures to be confirmed and available in the Fall).

Councillor Loney stated he did not want the quality of care jeopardize and that he was cognizant of the level of care required for dementia clients. He reiterated his concern of the potential increased costs associated with the additional beds, largely designated for people with dementia. Councillor Loney expressed concern about the ongoing operating costs and how much, above the per diem from the Province, the Region will have to pay on the property tax base. Commissioner Armstrong stated that if the beds are awarded, the Department will come back to Committee with a detailed budget, identifying what the costs will be on an annual basis, and how it will be funded. He assured the Committee that it was unlikely the Department would come back to Council for additional funds. He also stated that the rising care needs of clients on an annual basis will result in more money coming from the Province. He added that one of the advantages of working with the Alzheimer Society will be the ability to conduct research and provide proof of the higher costs associated with caring for dementia clients.

Public Delegations

Kathy Wright, Executive Director, Alzheimer Society of Ottawa-Carleton (ASOC). Ms. Wright explained that recently the ASOC has been focusing on two initiatives: the need for long term care facilities devoted to people with Alzheimer Disease, and the need for dementia-specific training for all health care professionals working in long term care facilities and in the community.

Ms. Wright stated there is a world wide trend towards the development of small, residential-style facilities designed and especially programmed for people with Alzheimer Disease and related disorders. The ASOC Board is committed to developing such a facility, modeled after a one in Tasmania. The model is increasing in popularity and is seen as a viable option for dementia residents and fulfilling an urgent need in this Region. Integrating this new style of dementia care residence into the Peter D. Clark Centre is a way for the Region to continue in a leadership role in long term care. The ASOC sees a partnership with the Region as a means to addressing three priorities in Ottawa-Carleton: to add 48 beds in to the system; to fill an identified gap in providing service to the dementia population, and; to benefit other providers and planners in the Region for the research, evaluation and training components.

Ms. Wright stated that families are desperate as they try to cope day-to-day while on lengthy waiting lists for respite care or long term care. The ASOC believes the time to plan is now and strongly supports a Forum on Dementia Care.

In response to a question from Councillor Loney, Commissioner Armstrong stated that the design now meets all the Province’s standards, including flow through of clients as their condition deteriorates.

Dr. Marie France Rivard, Clinical Director, Geriatric Psychiatry Division, Royal Ottawa Hospital. Dr. Rivard expressed support for the Forum on Dementia Care and the partnership between the ASOC and HFTA in providing long term care for dementia patients. She stated that members of Geriatric Psychiatry have recognized the growing needs of the dementia population and have advocated for proper community and health care resources through the support of existing resources, and planning for additional services. Actively support the HFTA Department initiatives to provide quality care. She noted that in addition to the increase in cases of dementia within the aging population, the Region also faces the impact of hospital restructuring. There will be a significant decrease in the availability of longer term psychiatric beds for geriatric patients. These patients cannot be looked after in traditional long term care settings because they need a special environment that minimizes the type of deficits they are experiencing. This proposal addresses those needs from a structural point of view.

Dr. Carole Guzman, President, Alzheimer Society of Ottawa-Carleton. Dr. Guzman spoke of her experience of having a family member with Alzheimer Disease and the lack of special care facilities for people with Alzheimer Disease and the lack of support systems for families. She explained that the decision to move a family member into a long term care facility is a painful and difficult decision for the family. Family members experience guilt, frustration and anger towards a system that does not provide support. Dr. Guzman expressed her support for the partnership of the ASOC and the HFTA in developing an innovative dementia care facility.

Marg Eisner, Manager, Contract Training Services, Health Sciences Sector, Algonquin College. Ms Eisner stated that health care workers need training on how to care for someone with memory loss, an understanding of the disease process, specific skills to build on strengths of clients with dementia, and an understanding of issues facing those with dementia, including ethics and legalities.

Ms. Eisner noted that the incidence of dementia is rising and the strain on family members and health care workers is heavy. Algonquin College has developed and received Ministry approval for two post-secondary programs; Working with Dementia Clients Multidiscipline Program and the Dementia Studies Multidiscipline Program.

Ms Eisner believes that collaborative efforts between health agencies, educational institutions, government planning bodies in the field of dementia enhance the programs and services. She stated her support for the dementia care project developed by the ASOC as being innovative and able to serve as a model for Ontario and Canada.

Moved by A. Loney

That the Community Services Committee recommend and Council approve the following:

1. The RMOC organize a Forum on Dementia Care in Ottawa-Carleton to provide an opportunity for community input into the development of priorities for dementia care;

2. The results of the Forum be forwarded to the Minister of Health, the District Health Council and other planning bodies identified by the community to assist in planning for the future.



- Commissioner, Homes for the Aged report dated 9 Jun 98

Committee Discussion

Councillor Loney reiterated his concern about the Region picking up more health care costs on the property tax base. His concern is not with the capital costs of the project, but rather the ongoing operating costs which continue to be partly subsidized by the property tax base. He stated there is a lack of assurance that, as the caseload requires more service, the money will be there, unless more is provided through property tax resources. On that basis, he cannot support the recommendations. He also cautioned that the land ambulance service is going to cost more than previously anticipated. Therefore, he stated his reluctance to approve another program which he believes should be federally and provincially funded.

Chair Munter clarified that the Province is asking for bids on the 320 beds for Ottawa-Carleton. At this point, an expression of interest is required to begin participation in the RFP process. The municipality is in a similar situation to a charitable organization having to do fundraising, or a private operator having to raise capital. These are elements that will emerge later in the RFP process. The Committee and Council will need to receive from the HFTA Department a more detailed analysis of how the additional operating costs and financing costs for the 90 beds will be offset by the additional provincial funding and resident revenues. He also stated that more information was needed about the care of dementia clients, and this proposal will allow the long term care sector to develop the skill and expertise, in collaboration with the ASOC. The reinvestment of the 320 beds, by the provincial government, fills a need in the Ottawa-Carleton and he opined that the Region should take advantage of the opportunity.

Commissioner Armstrong reminded Committee that in the past 20 years, the Department, with the exception of one year, has not exceeded its budget, and that many the surpluses have gone into the general capital reserve fund. The Department has made appropriate adjustments that have resulted in significant savings in operating costs. He does not anticipate an increase in the operating budget, should the Region be awarded the new beds.

Councillor Byrne agreed that there will be an increased need for services for dementia care. She believes the Region has a role in long term care, and does not see this proposal as taking on new responsibilities but rather refocusing dollars into another faucet of long term care. On that basis, she supports the recommendations.

Councillor McGoldrick-Larsen stated she would not be supporting the recommendations in light of the fiscal challenges faced by the Region. She does not support expanding the long term care program at this time. The estimated $2 million from savings in operating costs can assist the corporation in meeting the $50 million shortfall in next year’s budget. She stated her priority is to maintain current level of services versus expanding services.

Councillor Holmes stated her support for the recommendations. She believes it is important for the Region to continue to play a role in providing housing to people with dementia. She expressed disappointment in learning that the annual operating savings have gone into the general reserve fund. She would like to see a 20 year plan for health and social services including how annual savings can be reinvested into these same services. In supporting the recommendation, she will be holding the Commissioner accountable for not exceeding the current net operating budget.

Councillor Doucet stated that the Region should not be bullied into not funding needed services in the community because of what it will do the property tax. He noted that the Region is continuing to build roads, despite Provincial downloading. He stated his support for the recommendations, even if it costs additional funds.

An amendment to the recommendation #1 was put forward by Councillor Loney, that the proposal shall require 100% cost recovery for operating costs from the Province of Ontario and resident revenues.

Commenting on the amendment, Commissioner Armstrong reiterated that the HFTA Department will not exceed the existing net operating budget. He stated he cannot operate a facility with $100 per day and if that is what the amendment requests, then he cannot do that since the Province will not support the proposal.. He reiterated the savings that will come out of the operating dollars of Island Lodge, the additional revenues from the Province and resident revenue will allow the Region to build these projects and operate them with no additional net operating costs.

Councillor Holmes put forward an amendment that the wording "within existing net operating dollars" be added to recommendation #1. Commissioner Armstrong agreed it would be achievable.

Councillor Kreling asked if placing conditions on the RFP would be interpreted negatively by the Province and jeopardize the Region’s bid. Commissioner Armstrong responded that any concerns raised publicly about the proposal, that might indicate to the Province that there is not full support, could indeed affect the chances of the Region’s bid. He stated that with respect to the two amendments, he could not put forward a budget that would show the operation of a facility substantially lower than the current operating budget. It is his intention, in the RFP process, to show operating costs at not exceeding the existing net operating budget. Councillor Kreling stated his support for the recommendations, because the Region is already involved in the care of seniors, and there is a need for the type of facilities that can respond to the needs of this population. He concurred with Councillor Loney that health care should not be put on the property tax base.

Chair Munter stated he was astonished to hear that savings in the long term care budget went into the general reserve fund, and not into meeting the growing demand for these services. He expressed support for the Holmes amendment.

Councillor Loney clarified that he believes the HFTA Department has delivered a very good service over the years however, the costs are health care costs and should be paid 100% by the federal and provincial governments. The savings is only from not having to pay the deficit that belongs to health care, and not the property tax. He suggested putting in the proposal that the cost is X dollars, and the Region expects a per diem of X dollars to flow to the Region to cover the operating cost. He is not asking the Province to amortize the capital costs, but rather to pay the operating costs, on an ongoing basis, through the per diems.

Moved by Councillor Loney

Add to Recommendation #1: That the proposal shall require 100% cost recovery for operating costs from the Province of Ontario and resident revenues.


YEAS: A. Loney, M. McGoldrick-Larsen

NEAS: D. Beamish, W. Byrne, L. Davis, C. Doucet, D. Holmes, H. Kreling, A. Munter


Moved by Councillor Holmes

Amend Recommendation #1 by adding "within net existing operating dollars ($8,257,000)."


Moved by Councillor Holmes

That the Community Services Committee recommend and Council approve the following:

1. Submission of a Request for Proposal to the Ministry of Health for the RMOC to build and operate 90 new long term care beds within net existing operating dollars ($8,257,000);

2. Incorporation of the dementia care project developed by the Alzheimer Society of Ottawa-Carleton into the Peter D. Clark Long Term Care Centre;

3. Development of an Advisory Committee for the dementia care facility project in conjunction with the Alzheimer Society of Ottawa-Carleton to provide a mechanism for community input on the facility program and to oversee the development, implementation and evaluation of research and education initiatives in the field of dementia care.

CARRIED, as amended



- Commissioner, Social Services report dated 9 Jun 98

Staff Presentation

Commissioner Stewart briefly explained that the costs outlined in the report are another example of the downloading of responsibilities by the Provincial government to the RMOC. The Social Assistance Reform Act required that the municipalities provide social assistance to all sole support parents under the new Ontario Works Act, and that the transfer take place by 31 December 1998. The report outlines the preparatory work required to implement and complete the transfer by the end of the year. The Department is obliged to negotiate with the Ottawa Area Office of the Ministry of Community and Social Services (MCSS), and discussions have been ongoing since early 1998. A plan for the transition must be completed and approved by the Province, and must include consideration of human resources, transfer of files, physical space and technology. The principle objective of both parties is that there be no disruption of service during this transition period.

The report recommends additional staff resources for the Social Services Department. Commissioner Stewart stressed that this requirement stems from the need to provide service to an additional 4800 clients. In addition, as of 1 May 1998, the Ontario Works Act mandates sole support parents to participate in the OW program, provided their youngest child attends school (i.e. 6 years or older). The Department estimates 5,250 cases are required to participate in the mandatory employment activities. The Department’s service model calls for an enhanced level of service to support those clients to meet those obligations. Commissioner Stewart emphasized that the additional staff requirements are legislative realities and not initiatives of the Department.

In reference to recommendation #3, Commissioner Stewart clarified that the Department has estimated a net increase of $2.2 million for the 1999 annualized budget, to be offset by the MCSS chargeback. Since 1 January 1998, the RMOC has been paying 50% of the cost of the FBA administration and benefit costs. The RMOC has allocated $5.65 million net in the 1998 budget for the FBA Administration chargeback. The MCSS chargeback will be reduced by at least $1.42 million in 1999, however the Department is requesting it be reduced by more. Therefore, the Department is requesting a net increase, in base 1999 budget, of $700,000 ($2.2 million less the $1.42 million).

In response to a question from Councillor Beamish, Commissioner Stewart stated it would take more RMOC staff to provide the service (than Ministry staff) because it was a dramatically different job (i.e. a labour force adjustment program versus a benefit program). The FBA benefit program operated with a staff:case ratio of 1:450. The Department will operate the employment program with a ratio of 1:120 cases.

In response to comments by Councillor Holmes, Commissioner Stewart stated that the Department has attempted to clarify with the Ministry what the most important objective is: a fraud-proof benefit system or an active labour force adjustment program. Commissioner Stewart opined that the Ministry could not achieve both objectives.

Councillor Holmes asked how long the Region would go along with the Province’s conflicting Regulations. Commissioner Stewart referred to Item 4, as a start to addressing the inconsistencies of the Ministry. He stated a Departmental Work Group has been established to systematically review the Regulations to determine how they would be implemented and what degree of discretion the Department had in implementing them. Commissioner Stewart cautioned that there will likely be few exceptions made in implementing the Regulations because the Department risks a clawback of the 80% Provincial subsidy.

Councillor Holmes asked if there was legislation to protect the Provincial employees. Commissioner Stewart clarified that this legislation is a transfer of cases, not employees. The rationale for having local negotiations was based on a request from the Province to acknowledge any employment opportunities available for Provincial employees. A Human Resource Protocol is being drafted to meet the obligations of the Region’s collective agreements and accommodate Provincial employees.

Councillor Byrne asked if the Province was providing corresponding child care space for sole support parents. Commissioner Stewart stated that there is a child care budget within the OW budget. He stated there were currently 1000 children in child care, and that there has been a fairly high level of interest in the OW Program among sole support parents. The Province has recently announced additional money for the child care within OW, which the Department is currently negotiating for a portion. Commissioner Stewart stated that if child care is not available, the Department will not obligate a sole support parent to participate in employment activities.

Merv Sabey clarified that in determining staff requirements, the calculation is based on budget impositions. In reality, the caseloads are higher than the mathematical ratios. He stated that the Assured Support pathway has higher ratios because there are not employment support activities. He noted that the report outlines a plan to increase the number of Verification Specialist positions to assist in effective service delivery.

Councillor McGoldrick-Larsen questioned the adequacy of one additional Human Resource Officer for 81 new positions. Commissioner Stewart stated that the Human Resource Service Bureau of the Department is understaffed, and that the addition of one Human Resource Officer recognizes that need.

Moved by Councillor Byrne

That Community Services Committee and Regional Council approve:

1. The Joint Transition Plan for the transfer of service delivery responsibility for sole support parent and foster care cases from the MCSS local FBA office to the RMOC Social Services Department, as described in this report, subject to final approval by the Minister of Community and Social Services;

2. The establishment of staff positions and the recruitment of staff as described in this report in order to provide services to sole support parents and foster care cases in accordance with the requirements of the Ontario Works Act;

3. The inclusion of the annualized budget estimates in the amount of $4,414,232 gross, $2,207,116 net (minus the reduction in the FBA Administration chargeback), in the development of the 1999 Social Services Department budget, and;

4. The acquisition of required space at 170 Laurier Avenue, beginning January 1, 1999, to be negotiated by Property Services and the Social Services Department, subject to final approval of the lease by Corporate Services Committee and Regional Council, in accordance with usual procedures.


(dissent D. Beamish, M. McGoldrick-Larsen)



Staff Presentation

Commissioner Stewart opined that the legislative reform of the social assistance system has not resulted in a simpler, more streamlined system as promised. As previously indicated, this is a legislative framework that will have social implications and increase administrative costs. He stated that the majority of administrative costs are towards the benefit component. He had hoped there would be more direction toward the employment support component. The report addresses the new Regulations and amendments to the legislative framework that need attention.

Commissioner Stewart briefly discussed some of the issues identified in the report. The new Regulations require that money is not paid directly to 16 and 17 year olds, but rather paid to a trustee. He stated there are some significant implementation issues associated with this Regulation.

The previous legislative framework acknowledged that 60 - 64 year olds were not expected to be active participants in the labour force and would automatically receive a Provincial benefit. The new legislation does not categorically exempt this age group therefore, they are required to participate in the OW program. Commissioner Stewart stated this was not reasonable, and the Department will attempt to deal with it on a case-to-case basis.

Referring to the equity value of automobiles, Commissioner Stewart stated that previously, if the value of a car exceeded $10,000, applicants were required to dispose of the asset. According to the new Regulations, OW participants may own automobiles of a maximum equity value of $5,000 and the directive is that if there is a second car owned by the family benefit unit, the applicant is not eligible for assistance.

Referring to earning exemptions, Commissioner Stewart stated that for the past 10 years, recipients were able to retain some of their earned income, and be better off working even if they could not achieve financial independence from the welfare system. Under the new Regulations, the percentage of earnings that a participant can retain will decrease from 20% to 0% after 5 years. He opined this was a disincentive for taking employment.

Addressing a question by Chair Munter, Merv Sabey clarified that clients with multiple barriers will not be exempt from OW, but are expected to participate in some kind of employment activity. Temporary deferrals can be given where there are exceptional circumstances that would prevent an individual from participating on a temporary basis (i.e. lack of child care). Deferrals are not acceptable for a long period of time. Commissioner Stewart cautioned that the caseload of 60-64 year olds is expected to rise.

Commissioner Stewart stated that the Regulations under the Ontario Works Act will take an inordinate amount of the Department’s administrative resources to meet the regulatory obligations to determine the benefits. These resources are taken away from supporting clients towards employment.

Moved by Councillor Doucet

That the Community Services Committee recommend Council urge the Minister of Community and Social Services to reconsider / amend the new Ontario Works Regulations in a manner that will more effectively support the employment objectives of the Act.


5. 1998 per diem and administration rates for community child care agencies

- Commissioner, Social Services report dated 4 Jun 98

Staff Presentation

Ms. Gail Preston explained that this is an annual report that the Department prepares on rates for the purchased child care agencies, group centres and home child care. This year’s review of budget submissions identified two issues. The first issue was uncontrollable costs; a recurring issue resulting from the lack of across-the-board cost-of-living increases. Agencies are faced with increasing costs such as rent and catered food, and need some increase in rates to cover costs. This year a number of the uncontrollable costs were offset by program changes. The rates included in recommendation #1 include the $80,000 in uncontrollable costs.

The second issue was salary increases. Since 1993, there has not been an across-the-board cost-of-living salary increase. Regional staff received a 2.2% salary increase and many agencies have requested a similar increase for their staff. The cost to the Region would be $700,000 to cover all agencies that provide purchased service. Staff did not feel the increase could be covered by Regional funds and Provincial cost-sharing has not been confirmed. Department staff has recommended an 2.21% increase for home child care providers and for the for-profit group centres. The total cost of the increase is $225,000.

Ms. Preston noted that these two groups were identified because they are not eligible for provincial pay equity grants. The Province has verbally indicated they will make retroactive pay equity payments, however they have not done so yet, and there has been no date confirmed. There is genuine concern among the agencies that they are not going to receive the payments. As well, the Province has not confirmed the calculations of the amounts. Legislation requires 1% per year (1% for 1997, 1% for 1998). The staff recommendation is based on the assumption that the money is forthcoming from the Province for the not-for-profit sector.

Questions to Staff

In response to a question from Councillor Loney, Ms. Preston stated that the Province has indicated that they have some reservations about continuing with the wage subsidy program which includes pay equity. Such a decision would have tremendous implications for all programs.

Commissioner Stewart reiterated that the basis for the staff recommendation is that the Province will make the pay equity payments for 1997-98. There is uncertainty about the Province’s commitment to make those payments for 1999 and beyond.

Ms. Preston clarified that the private centres are required to adhere to the pay equity legislation but are not entitled to the provincial grants, and the home child care providers are not covered by the pay equity legislation.

Councillor Holmes opined that the report is equating pay equity with cost-of-living increases. Commissioner Stewart responded that the recommended 2.21% cost-of-living increase is an amount similar to what is anticipated from the Province through pay equity. He added that he is unable to give an estimate of time for when the Province will come through with the pay equity payments.

Public Delegations

Suzanne Dugas, Sylvie Lasalle & Louis Doyle, Regroupement des services de garde de langue francaise d’Ottawa-Carleton. Ms. Dugas expressed concern about the 2.2% increase being limited to only certain types of services. She stated that in the 1980s, the RMOC made a commitment to pay equity and was attempting to bring community agencies up to the level of municipal centres. Even if the pay equity is received from the Province, there remains a difference of between $2,500 and $9,000 in annual salaries between people working in community agencies and those in municipal child care agencies.

Ms. Lasalle (Director, garderie Tunney’s) asked for the 2.21% salary increase for all the early childhood educators (ECE) who have not received an increase in over five years. She stated that at garderie Tunney’s, salaries were decreased in 1993, because it was too costly for the RMOC and in 1996 the budget was reduced by 2.1% to maintain the Jobs Ontario spaces. Increasingly, staff are asked to participate in fundraising activities to subsidize the budget, and do more work for less money.

Mr. Doyle (Board President, garderie Sur un nuage) stated that he is asked fundraise for the employees’ pension fund, and every year the Centre relies on a small number of non-subsidized parents to provide its employees with group insurance. He argued that municipal centres are provided with public funds to pay employee benefits, yet non-profit centres are denied funds. To attract clients, they established lower rates, with the consequence of having to offer lower salaries than those of municipal or unionized centres. He argued that garderie Sur un nuage is required to meet pay equity obligations, without any financial assistance. He requested that all centres be treated equally.

Enrique Roman, The Little School Day Care Centre. Mr. Roman stated that the pay equity legislation requires 1% per year since 1994, not 1997 as previously mentioned. He observed that pay equity with municipal centres will never be achieved at the rate of 1% per year. He noted that ECE workers in non-municipal centres work as hard as employees of the municipal centres, but are not being paid the same. His centre approved a 3% salary increase for staff after 3 years of no increases, but have been denied regional funds to cover the increase. He stated the 2.2% increase approved for regional staff widens the salary gap, and more funds need to be allocated to salaries for non-municipal day care centres. He stated a comparison of operating costs clearly shows that the Little School can provide a comparable service to the municipal centres, at 28.75% less cost. This is mainly due to lower salaries. He requested Committee approve the increases requested for this year, and look at long term solutions for the inequities that exist.

Lori Bonsall & Shellie Bird, Co-Presidents, CUPE 2204. Ms. Bonsall stated that the staff recommendation is blatantly unfair because it goes against the Region’s long standing commitment to wage parity between regional child care workers and those in the non-profit sector. She urged Council to work towards raising the wages of workers in for-profit centres with those of workers in the not-for-profit and regional centres. She noted that, overall, workers in the child care field are grossly underpaid. The child care community should be entitled to wages more in line with the high value of service it provides. Early Child Care Workers are trained professionals who have not received a wage increase since 1992. It is important that child care is seen as a viable career choice. In order to facilitate this, the child care community must be able to offer wages and benefits which retain and attract new people into the field.

Ms. Bird argued that the staff recommendation ignores the original intent of pay equity when it suggests that the non-profit sector be denied a cost-of-living pay increase because it will be receiving pay equity adjustments. Pay equity adjustments are calculated on the base rate of pay. If the base rate continues to fall behind the cost-of-living, it will no longer be able to achieve pay equity. She urged Committee to support a 2.21% increase to all sectors of the child care community.

Mandy Hamlon, ABC Day Care. Ms. Hamlon proposed a flat-rate per diem system, similar to a system that exists in other Ontario municipalities. It sets a fixed rate for a purchase of service of child care programs within a geographical area. She argued that a fixed rate would eliminate the discrepancies that exist between centres. She pointed out the difference in per diem rates within programs: infant program rates vary 50%; toddler program rates vary 102%, and preschool program rates vary 69%. Standardizing the budget would eliminate the need for, and costs associated with, the extensive budget review by the Department. The savings could go towards more subsidized child care spaces.

Councillor McGoldrick-Larsen asked staff to comment of the differential in per diem rates. Commissioner Stewart stated that more than 80% of a centre’s costs are wages, therefore the difference in per diems largely reflect the different wages, and to a lesser degree the difference in occupancy costs and economies of scale. He stated the principle in determining rates is that they reflect actual costs, and there are actual cost differences between centres.

Commissioner Stewart acknowledged that a flat-rate per diem would relieve the Department and the centres of an inordinate amount of administrative work. However, he cautioned that there are as many problems associated with the fixed per diem system as with the current system.

Sam Bhergava. Mr. Bhergava noted that during the last five years all centres have experienced great financial pressures, with virtually no increases in per diem rates. He identified three issues. The first is that wage subsidies need to be equalized. The present system is not fair to staff who receive less than other centres. There are over 30 centres in the Ottawa Area Office of MCSS that do not receive any wage subsidies.

The second issue is the perceived conflict of interest as the Region expands to inspect, monitor and license agencies in 1999, while operating their own centres. The third issue is the per diem rates doe not reflect the true costs . Private sector centres are at a disadvantage as they are required to comply with all Regulations applicable to the non-profit sector but are not treated at par with them in funding. There is a legal obligation for pay equity, yet there has been no provisions made in the budget process. Depreciation of buildings and equipment is not allowed, and there are no provisions for the operator’s salary or profits.

Mr. Bhergava argued the rate setting procedure is time consuming. He recommends that wage subsidies be equalized, that per diems be standardized, and that a there be a level playing field in funding decisions.

Cindy Magloughlin, Ottawa-Carleton Child Care Association. Ms. Magloughlin presented a timeline for the pay equity process and estimated it will take until the year 2014 before pay equity is achieved. She argued that without the cost-of-living increases, pay equity is pushed further away. She was outraged to learn that the commercial and regional centres were receiving a 2.21% increase. She believes that the 2.21% increase should be across-the-board, for all staff, for 1998, and that the public funds be fully accountable. She wants to ensure that the money goes towards staff salaries. She acknowledged that the rapport between the child care community and the Department had been damaged, and she hopes that the proposed review of the range of salaries, wages and benefits is an opportunity to find a mutually agreeable solution to the existing inequities.

Daniel Bourdeau, Gloucester Child Care Services. Mr. Bourdeau stated he did not support the staff recommendations. He concurred with the previous presenters and noted that historically cost-of-living increases have been distributed equitably by the Region. He reminded Committee not to confuse pay equity with cost-of-living increases. He made four recommendations: that the staff recommendation be rejected, and instead an across-the-board wage increase be approved, that the proposed wage review be fast-tracked and. that the allocation of subsidized spaces to commercial centres be reviewed.

David Erickson. Mr. Erickson presented a petition signed by parents associated with the Barrhaven Child Care Centre. He stated that for a parent, this is not a wage issue, but rather a child care issue. Staff are historically underpaid, have not received an increase in 6 years, and are still waiting for pay equity. He argued this kind of treatment undervalues child care workers.

Kathy Yach & Joanne Hunter, Child Care Council (CCC). Ms Yach stated that the CCC supported the staff recommendations. She urged the Committee to reconsider an increase for the non-profit sector for the reasons already identified by the previous presenters and also because many employees do not have pension plans.

Ms. Hunter reminded Committee that there have no wage increases and in fact a 1.5% wage decrease to preserve the 707 jobsOntario spaces. Regrettably, this issue has caused division within the child care community. The salary increase for regional centres puts all other agencies behind in their ability to recruit and retain good staff. She suggested an open forum, through the RMOC, for sharing salary and benefit details, and parental contributions to the child care system. She suggested that the strategic planning exercise was a good opportunity to find creative solutions.

Julie Cavanaugh, A-Z Day Care. As a private owner, she emphasized that in last 10 years her centre has not made a profit. She is grateful for any additional subsidized spaces, and additional funding as recommended for pay equity. She argued that all centres should be treated equally.

Councillor Holmes asked what the advantage was of being a private operator. In response, Ms. Cavanaugh stated that she was not in it for the money but rather for the love of children, and the pride of owning her own business and providing a quality service.

Commissioner Stewart stated that all day care centres are licensed under the same Act, have the same obligations under the Act. There are differences in operating costs, in terms of wages. Private centres tend to have a higher percentage of full fee paying spaces and there is considerable pressure to keep their rates affordable.

Mary Lou James, Home Child Care Network. Ms. James explained that licensed home child care services about 40% of subsidized children in the Region. She supports the 2.21% increase to home care providers. She noted that these providers are self-employed, with out-of-pocket expenses from the rates received. She urged that the increase to home care providers not be held up by decisions around pay equity. She confirmed for Councillor Loney that rate adjustments have been for administrative costs only.

Elaine Stevens, Ottawa-Carleton School Days Nursery. Ms. Stevens represented the 16 centres which were formerly the OBE-facilitated centres. She expressed concerned that the non-profit centres have been excluded from the 2.21% wage increase. She argued the need to offer fair and good wages to retain staff, maintain high morale and standards.

Committee Discussion

Councillor Loney opined that decent wages should be paid to the child care sector, and the Region has been trying to work towards that for many years. He stated the Region should continue to meet its 20% of the funding formula, and hold the Province to its 80% portion. As long as the Region picks up more than its share, the Province will continue to let it do so.

Councillor Byrne concurred with Councillor Loney that the Region could not afford to pick up the Province’s share of funding. However, she could not support the staff recommendations because of her concern that the cost-of-living increase was being replaced by pay equity, and that pay equity for the non-profit centres is still an outstanding issue. She suggested the recommendation be deferred until there is some definite action on the provincial pay equity.

An amendment was moved by Chair Munter that the matter of an increase in salaries for all child care worker be referred to regional staff for a report in September, with more information on the Province’s funding/cost-sharing intentions and any other relevant material. Chair Munter moved out of the Chair, and turned it over to Vice-Chair W. Byrne, to speak to his motion.

Councillor Holmes opined that the disparity between wages of regional child care worker and workers at other centres is related to the fact that regional employees are unionized. The union is doing a good job on behalf of their members. She opined that there is not enough pressure being put on the Province to meet obligations of pay equity and to partner with the Region to provide wage increases. She supports the Munter amendment and requests that Councillors and regional staff meet with the Province to discuss pay equity and the funding formula.

Councillor Munter clarified that all regional employees, not just child care workers, received a 2.2% increase. He opined that all child workers should receive the 2.2% increase, however that is not possible right now because it was not anticipated in the 1998 child care budget. He recommended referring the issue to regional staff to prepare a report to clarify the pay equity, cost-sharing, and national child benefit issues.

Councillor Kreling stated he would like more information about the large variance in per diems and salaries included in the staff report, and based on that information have a discussion of the whole issue. He supports recommendation #1 and the Munter amendment.

Councillor Davis suggested that a discussion of adequate funding for the day care community should be held at Regional Council. She believes there is money in other areas of the corporation that can be found and used towards this issue. She also suggested a corporate policy that ensures that agencies, from which the Region purchases service are paying their employees a fair and reasonable wage. She would like to know what is a decent wage, and what percentage of agencies are falling below that rate. Ms. Preston responded that type of in-depth analysis was possible but may not be available for September.

Councillor Beamish stated he supported a deferral until the Province came through with pay equity, but expressed concern that the staff would not be able to provide anymore information in September than available at present.

Councillor McGoldrick-Larsen suggest that the information requested by Councillor Davis might be included in the Strategic Plan time frame of early 1999. Ms. Preston stated the Department could come back in early September with some definite timelines.

A motion was put forward by Councillor Doucet that Council increase salary at not-for-profit centres by 20% of the 2.21% (i.e. .445%) and request that Province to add the balance of this cost-shared program.

Moved by Councillor Munter

That the matter of increase in salaries for all child care workers be referred to regional staff for a report in September, with more information on the Province’s funding/cost-sharing intentions and any other relevant material.


(dissent D. Beamish, C. Doucet)

Moved by Councillor McGoldrick-Larsen

That the Community Services Committee recommend Council approve:

The per diem and administration rates for community child care agencies as presented in the column entitled 1998 Recommended Rates in Schedule A retroactive to 1 January 1998.

CARRIED, as amended


6. Strategic Plan for Child Care System

- Commissioner, Social Services report dated 1 June 98

That the Community Services Committee recommend Council approve:

1. The outlined process for a strategic planning exercise with the child care community, and;

2. An expenditure of up to $20,000 for the strategic planning exercise including up to $15,000 for external consultants to assist with the process.




- Commissioner, Social Services report dated 29 May 98

Public Delegation

Hope Adams, Children’s Castle Day Care. Ms. Adam expressed concern about actual costs not being charged to fee paying parents, and that fee paying parents in other centre’s are subsidizing fee paying parent in regional centres. Full fee rates have not increased at Children’s Castle since 1993, despite having to pay taxes, maintenance costs, receiving no wage enhancement or pay equity. The report states that raising fees to the actual costs would probably result in losing fee paying parents. She argued that this is a challenge for all centres. They cannot raise their fees higher to give salary increases to staff. She requested full disclosure of costs, a complete overhaul of the budget, openness and cooperation to develop a budget that works for everyone. She requested fair consideration for the subsidized spaces the Region purchases, and receive enough money to cover the actual costs associated with those spaces.

Committee Discussion

In response to a question from Councillor Beamish, Ms Preston explained that when the regional centres were established, funding covered 80% of operating costs and there was no question of how the rates were set. In the 1980’s, the Province requested rates be set according to actual costs. Regional Council decided that if rates were kept at a more moderate level, the centres would be able to maintain full fee payers. If the centres loose fee payers, there would be loss of a substantial amount of funding and could result in centres closing. Subsequently, rates have been set similar to the average paid for purchase of service. The report identifies $181,000 as the regional cost to bridge the gap between actual costs and full fees paid. The Province provides wage enhancement funding to the non-profit centres that is not included in rates. There is no provincial subsidy available for full fee spaces, the Province cost-shares 80% of subsidized spaces. For fee payers, the Regional covers the gap between actual costs and the rate.

Councillor Holmes inquired about the accusation of a lack transparency of information. Ms. Preston stated the budgets for the regional centres are a part of the Department’s budget and that information is available, upon request, to the public. Councillor Holmes suggested that a detailed budget for one of the regional centres be included in the staff report.

Moved by Councillor Byrne

That the Community Services Committee recommend Council approve increases in the rates charged to full fee payers in child care centres operated by the Region, effective September 1, 1998, as outlined in report.



- Commissioner, Social Services report dated 4 Jun 98

That the Social Services Department report back in September with a plan for reinvestment of net savings resulting from the National Child Benefit System (NCBS). The reinvestment plan will be consistent with the objectives of the NCBS.


9. Review of Aphasia Centre

- Commissioner, Social Services report dated 8 Jun 98

That the Community Services Committee recommend Council approve:

1. That a one time grant in the amount of $47,400 be allocated for 1998 to maintain the services for people with aphasia and their families and caregivers;

2. That the grant be funded out of the proposed reduction of the Supplementary Aid/ Special Assistance budget, as proposed by the Motion on April 23, 1998, for 1998 only;

3. That in 1998 the Social Services Department and the Aphasia Centre identify a cost effective service delivery model for the counseling component of the program, for example by working collaboratively with existing counseling agencies and Community Health and Resource Centres, and;

4. That in 1998 the Health Department support the Aphasia Centre to identify and access resources within the provincial health services/Long Term Care or other appropriate sources to sustain the health component of the program.


10. priorities for social services grants

- Commissioner, Social Services report dated 4 Jun 98

That the Community Services Committee approve the following priorities for the 1999 and 2000 allocation of project grants:


1. Partnerships that help create employment initiatives;

2. Community projects that help people cope with insufficient income and the effects of living in poverty, and;

3. Services to ethnic and racial minorities and aboriginal groups.



- Medical Officer of Health report dated 9 June 98

That Community Services Committee recommend and Council approve the following recommendations:

1. That the $25,000 for Insight Theatre from the Health Department’s sustaining grants be transferred to the Healthy Sexuality Program budget;

2. That a Purchase of Service Agreement for $33,000 (Annex A) be made with Planned Parenthood of Ottawa-Carleton for enhanced Insight Theatre and Théâtre des lueurs production and presentations targeting all grades 7 through 9 within the English Public, French Public, French Private and French Catholic Boards;

3. That a Purchase of Service agreement for $64,000 (Annex B) be made with Planned Parenthood of Ottawa-Carleton for counseling, information and referral programs required to meet the Mandatory Health Programs and Services Guidelines.




- Response to Motion CSC No. 07 (98)

- Commissioner, Social Services report dated 25 May 98

Staff Presentation

Commissioner Stewart explained that the Province has determined that the elderly, disabled and working poor, not receiving OW or ODSP, are categorically ineligible for these discretionary benefits. The Provincial government has also indicated that items previously eligible for cost-sharing are no longer eligible. he staff report cites the type of services/benefits, that the Department is no longer able to administer on a cost shared basis, and the cost of providing these services at 100% regional cost.

Commissioner Stewart clarified recommendation #3 by stating that the cost of continuing to provide items/services for non-social assistance clients, retroactive to 1 May 1998, would be $450,750 net for 1998 ($601,000 annualized). It has been a challenge for the Department to separate the benefits provided to people who are on another form of benefit other than social assistance. This explains the incongruity between the figures in recommendation #3 and the last Table of the report. Commissioner Stewart asked Committee members to disregard the $874,000 amount, as he is confident that $600,000 - $650,000 is more accurate.

Councillor Beamish asked if was Committee being asked to approve an amount greater than previously approved during budget deliberations. Commissioner Stewart clarified that staff had been directed to make recommendations of how the Department could assist those individuals that had been categorically ineligible for these benefits. As a result of the budget debate, $380,000 was set aside for this purpose. He confirmed that the recommendations before Committee were to continue to provide the same level of benefits for 1998 at a cost of $450,750, and to contemplate the continuation of such at a annualized cost of $601,000. Commissioner Stewart iterated that recommendations 1 & 2 are also very important, because the Region should not be paying these health care costs without advocating to Ministry of Health for funding health related items and services.

Commissioner Stewart stated the approved 1998 budget for Special Assistance, based on the old cost-sharing formula, was $12.5 million gross/$4.9 million net. The actual budget for 1997 was about $11.5 million gross/$4.2 million net. The underexpenditure was related to staff not approving tuition and training costs early in the year. He clarified that that portion of OW budget for transportation, clothing, and skill training was inadequate and the Department uses Supplementary Aid/Special Assistance for additional funds.

Councillor Beamish asked if staff had identified other strategies to fill the gap, other than adding more money to the budget. Commissioner Stewart responded that in other municipalities, where these benefits are not provided, people rely on charitable organizations for assistance. He emphasized that staff attempt to identify other financial supports before relying on this benefit program. He opined that it is inappropriate to challenge the charitable organizations to meet the need or to have these costs on the property tax base. He stated these are the legitimate costs of public policy; of having people convalesce and/or age in the community versus institutionalization. He believes there must be some way within the health care system to assist low income people.

Commissioner Stewart emphasized the full cost of providing the benefits is as outlined in the report, and if the direction of Committee and Council is to stay within $380,000, then the staff will adjust the menu and de-list some items. He reminded Committee that the Region has an obligation under other legislation to provide funerals and burials for indigent persons.

Councillor Holmes stated she would like all applicants to know that this may be a temporary funding situation and that the funding has been cut off by the Provincial government.

Public Delegations

Réne Raiche. Mr. Raiche expressed concern about cuts to Supplementary Aid/Special Assistance. He relies on Special Assistance to provide diabetic supplies, maintenance for his scooter, Home Care twice a week, and a Para Transpo pass. He is 60 years old and relies on a meager monthly pension through FBA. He stated he cannot afford to pay for these items that allow him to live independently.

Commissioner Stewart confirmed for Councillor Beamish that a recipient of ODSP had previously relied on Supplementary Aid for financial assistance for maintenance of a wheelchair or scooter. There is currently no provision within the benefits of ODSP for maintenance of assistive devices. He stated that the range of benefits under ODSP are significantly higher than those available under OW, however the Department had provided a top-up for many items under the Assistive Devices Program. To continue to do so will be at a 100% municipal cost.

Lani Fairchild. Ms. Fairchild stated she is an ODSP recipient. Over the past several years, she has received assistive devices for the bathroom, orthopedic sandals, eyeglasses, a hearing aid, homemaking services and a wheelchair through Supplementary Aid. Without these supports, she would most likely be living in an institution. Ms. Fairchild stated Supplementary Aid has helped her to maintain her independence and a reasonably good quality of living

Bernadette Pichette. Ms. Pichette read letters from Mde. Jeannine Lorocque, Mde. Laine, Ms. Beverly Marrion and Msr. Leopold Therese Champagne.

Stephen Arbuckle, Royal Ottawa Health Care Group (ROHCG). Mr. Arbuckle stated that many of their patients require the support of Supplementary Aid to cover essential needs. He stated that the ROHCG supports the report recommendations and recognizes that this is bridge funding for 1998 to ensure that access to service is maintained for this vulnerable population, while advocating for the provincial government to finance these services through other funding programs. The ROHCG commends the Region for their efforts and leadership, and is interested in working with the Region to advocate for an adequate quality of life for this population by securing renewed provincial funding for future fiscal years.

Kevin Kinsella, Coalition for Social Action. Mr. Kinsella opined that the Ontario government is preparing to shift people who are disabled onto the OW Plan. He opined that by assisting the working poor, through Special Assistance, the Region will save money in the long run. Currently, people are contemplating having more money taken off their cheques so they can be eligible for some sort of benefit, quitting their jobs because they feel need support to do things such as repairs to scooters and wheelchairs. With assistance, people can keep their jobs, their dignity and independence.

Mr. Kinsella agrees that the Ministry of Health cover 100% of the cost of various items however, he notes that the Ministry has not provided enough funds. For example, the Ministry will pay $1186 for a wheelchair, which actually does not cover half the cost of a wheelchair. The Region needs to cover the remaining costs for people on social assistance, he argued, otherwise people are stuck on ODSP. As a disabled person, he wants to be productive. He concluded by asking Committee to approve the extra funding.

Committee Discussion

Councillor Holmes put forward an amendment to the staff recommendations that all recipients of Essential Health and Social Supports be sent letters at the time of payments stating that the provincial government has stopped funding and that the funding is now 100% Regional and that the Regional property tax base is inappropriate for this funding, and that these supports should be funded by the Provincial Ministry of Health.

Commenting further, Councillor Holmes inquired about adult dental care and asked if there was other dental repair work done other than extractions. Commissioner Stewart responded that the Emergency Plan has limited provision for other courses of treatment beyond extraction for adults with pain and suffering.

Councillor Holmes stated that the Region has been cutting services successively since 1993, that keep people living independently. She stated she would not condone an another budget cut that would place people in a more precarious position than they already are. She stated she wanted to make it clear to residents that it is the Province that has cut them off and that the Region will be temporarily funding this program.

Councillor Loney added that the letter should also encourage people to contact their local MPPs to let them know how important this benefit program is to residents. There is a limit to what the Region will be able to provide, and if there is a threat of loss of service then pressure needs to be focused on the Province. If the Province is telling the Region that it cannot provide services that have historically been available in this community, then the Region needs to fight for it by providing funding on interim basis and ensuring that the focus remains on the Province to recover the funds.

Councillor McGoldrick-Larsen stated her support for the staff recommendations, adding that it is unconscionable for the Provincial government to make these cuts. She opined this was an opportunity to sustain a quality of life for the elderly and disabled, and to prevent further health care costs associated with their cares and needs.

Councillor Kreling indicated his support for the staff recommendations and the amendment. He opined that there should be some stability with this particular program so that Ottawa-Carleton residents recognize that there are certain things that will continue to be funded yearly. He opined that further discussion was needed on the Region’s policy on Essential Supports.

Commissioner Stewart confirmed that there has been discussions, presentations, reports and decisions made by successive Committees and Regional Councils from the mid-1970s, when the framework for Special Assistance/Supplementary Aid was formed. An increasing caseload and costs led to reductions in the range of services, in the early 1990s. Each of the reductions was accompanied by a report and decision resulting in policy direction given by Regional Council. On the issue of dis-entitling people to Special Assistance, there has been no policy discussion because it has just recently emerged as an issue.

Moved by Councillor Holmes

That all recipients of Essential Health and Social Supports be sent a letter at the time of payments informing them that the Conservative Provincial Government has stopped funding, and that funding is now 100% Regional. The regional property tax base is inappropriate, and these supports should be funded by the Provincial Ministry of Health. Recipients are encouraged to contact their provincial representatives.


Moved by Councillor Holmes

That Community Services Committee recommend Council:

1. Authorize and direct the Chair of the Community Services Committee to forward a letter to the Ministers of Health and Community and Social Services requesting their consideration of funding health related items and/or services formerly funded under the Special Assistance and Supplementary Aid Programs for non-social assistance clients under the Ministry of Health;

2. Authorize and direct the Chair to extend an invitation to the Ministers to attend a meeting of the Community Services Committee to allow the Region the opportunity to formally express their concerns on these changes, and;

3. Approve the continuation of the provision of items/services for non-social assistance clients using the Ontario Works Act, Asset and Income Level Guidelines, and for excess costs for Assistive devices for social assistance recipients, for which cost-sharing has been discontinued by the Province at a cost of an additional $450,750 net in 1998 ($601,000 annualized).

CARRIED, as amended


1. Internal Audit: Social Services Department

2. 1998 Project Grants for Health and Social Services

3. Healthy Babies, Healthy Children: June Update


The meeting adjourned at 5:00 p.m.


16 July 1998




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