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£7 an hour, receives an extra £1 an hour for a night shift and £2 an hour for weekends.

"The NHS encourages you to have these NVQs, all this training, improve your knowledge, and then they [private care companies] come along and it all comes to nothing.

Care UK expects to make a profit "of under 6%" by the end of the three-year contract

£700,000 operating profit in the six months between September last year and March this year,

In 1993 the private sector provided 5% of the state-funded services given to people in their homes, known as domiciliary care. By 2012 this had risen to 89% – largely driven by the local authorities' need for cheaper ways to deliver services and the private sector's assurance that they could provide the answer. More than £2.7bn is spent by the state on this type of care every year. Private providers have targeted wages as a way to slice out profits, de-skilling the sector in the process.

1.4 million care workers in England are unregulated by any professional body and less than 50% have completed a basic NVQ2 level qualification, with 30% apparently not even completing basic induction trainin

Today 8% of care homes are supplied by private equity-owned firms – and the number is growing. The same is true of 10% of services run for those with learning disabilities

William Laing

report on private equity in July 2012

"It makes pots of money.

Those profits – which are made before debt payments and overheads – don't appear on the bottom line of the health firms' company accounts, and because of that corporation tax isn't paid on them.

Some of that was in payments on loans issued in Guernsey, meaning tax could not be charged. Its sister company, Silver Sea, responsible for funding the construction of Care UK care homes, is domiciled in the tax haven of Luxembourg

Bridgepoint

.voterDiv .ob_bctrl{display:none;} .ob_pdesc IMG{border:none;} .AR_1 .ob_what{direction:ltr;text-align:right;clear:both;padding:5px 10px 0px;} .AR_1 .ob_what a{color:#999;font-size:10px;font-family:arial;text-decoration: none;} .AR_1 .ob_what.ob-hover:hover a{text-decoration: underline;} .AR_1 .ob_clear{clear:both;} .AR_1 .ob_amelia, .AR_1 .ob_logo, .AR_1 .ob_text_logo {display:inline-block;vertical-align:text-bottom;padding:0px 5px;box-sizing:content-box;-moz-box-sizing:content-box;-webkit-box-sizing:content-box;} .AR_1 .ob_amelia{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_16x16.png') no-repeat center top;width:16px;height:16px;margin-bottom:-2px;} .AR_1 .ob_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_67x12.png') no-repeat center top;width:67px;height:12px;} .AR_1 .ob_text_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_text_logo_66x23.png') no-repeat center top;width:66px;height:23px;} .AR_1:hover .ob_amelia, .AR_1:hover .ob_logo, .AR_1:hover .ob_text_logo{background-position:center bottom;} .AR_1 .ob_org_header { border-top: 10px solid #D61D00; display: block; font-family: georgia,serif; font-size: 14px; font-weight: bold; padding-bottom: 10px; padding-top: 5px; } More from the guardian Rogeting: why 'sinister buttocks' are creeping into students' essays 08 Aug 2014 Theatre's decision to ban Jewish film festival is 'thin end of wedge' 09 Aug 2014 Sir Paul Nurse: 'I looked at my birth certificate. That was not my mother's name' 09 Aug 2014 Adventures in contraception: eight women discuss their choices 10 Aug 2014 Child prison deaths 08 Aug 2014 [?] .voterDiv .ob_bctrl{display:none;} .ob_pdesc IMG{border:none;} .AR_2 .ob_what{direction:ltr;text-align:right;clear:both;padding:5px 10px 0px;} .AR_2 .ob_what a{color:#999;font-size:10px;font-family:arial;text-decoration: none;} .AR_2 .ob_what.ob-hover:hover a{text-decoration: underline;} .AR_2 .ob_clear{clear:both;} .AR_2 .ob_amelia, .AR_2 .ob_logo, .AR_2 .ob_text_logo {display:inline-block;vertical-align:text-bottom;padding:0px 5px;box-sizing:content-box;-moz-box-sizing:content-box;-webkit-box-sizing:content-box;} .AR_2 .ob_amelia{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_16x16.png') no-repeat center top;width:16px;height:16px;margin-bottom:-2px;} .AR_2 .ob_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_67x12.png') no-repeat center top;width:67px;height:12px;} .AR_2 .ob_text_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_text_logo_66x23.png') no-repeat center top;width:66px;height:23px;} .AR_2:hover .ob_amelia, .AR_2:hover .ob_logo, .AR_2:hover .ob_text_logo{background-position:center bottom;} .AR_2 .ob_org_header { border-top: 10px solid #D61D00; display: block; font-family: georgia,serif; font-size: 14px; font-weight: bold; padding-bottom: 10px; padding-top: 5px; } /* updated via mysql on 2014-04-08 */ .AR_2 .ob_what { display: block; } /* added via mysql on 2014-06-20 */ .OUTBRAIN:hover .ob_what a { text-decoration: underline; } .ob_box_cont.AR_2 { padding-bottom: 5px; } /* end mysql add */ /* added via mysql on 2014-07-14 */ .AR_2 .ob_org_header span { color: #999; font-family: arial; font-size: 11px; font-weight: normal; display: block; } /* end 2014-07-14 */ More from around the webPromoted content by Outbrain http://paid.outbrain.com/network/redir?p=0iZOm4XuGW6R5uuT6ZFciNevzJlIfmxs0SRwpiMrH7gWrMXoPie4vIA9PlhaEW%2BXNi57pCgl9j8yOE3HuJT75pwCLNj4n18v3EKQDEV0YFQjOBxc46mOs

Oberle said he has also ordered a review of all of the facilities operated by the contract care provider

the incident came in the wake of a fatal scalding of a 35-year-old Calgary man in October 2011

the government has spent $2 million installing more than 2,000 temperature control devices in care homes

It’s the eighth known case of a serious scalding in a care facility in the province since 1980

Following Holmes’ Nov. 26, 2011, death, the province said it was looking at more tightly regulating contracted facilities and providing more funding to pay workers better.

opposition critics suggested chronic staffing shortages in Alberta care facilities may turn out to be a factor in the tragedy

And user fees? Even a Senate committee that had been warm to the idea of charging patients each time they saw a doctor changed its mind when faced with the evidence.

But the real problem with two-tier medicine, as former Saskatchewan premier Roy Romanow noted on the same CTV show, is that it simply shifts costs.

Manning made much of the fact that Quebec’s government devotes proportionally less of it provincial budget to health —30 per cent of program spending as opposed to about 40 per cent in Ontario. He appeared to attribute this to the fact that Quebec, unlike Ontario, allows physicians to opt out of medicare and bill patients privately. But the real reason why the Quebec government spends less in proportional terms on health care is that it spends more in absolute terms on everything else. Provincial government program spending per capita in Quebec is $11,457. In Ontario, the figure is $9,223.

total health spending in Ontario represents 11.9 per cent of the province’s gross domestic product. In Quebec, the comparable figure is 12.4 per cent

The Germans, Dutch and French, all of whom are praised by two-tier fans, spend more of their gross domestic product on health care than we do.

Surely it’s more productive to build on what we have — a successful, publicly funded, universal health insurance system that covers doctors and hospitals. It could be improved or even expanded. But it works. That’s why Canadians keep fighting for it. Over and over and over again.

"Rotund, funny and occasionally pompous, Dr. Porter was everyone's friend and nobody's confidante, the life of the party and an agile dancer, both in political circles and around a ballroom floor. A member of Air Canada's board of directors, he travelled the world free. His former friend Prime Minister Stephen Harper had him sworn in as a member of the Privy Council so he could serve as chairman of the Security Intelligence Review Committee, or SIRC, the country's spy watchdog agency. "And he was close to Quebec Premier Philippe Couillard, a relationship that began in 2004 when the politician, a neurosurgeon by training, was provincial health minister. Like many of Dr. Porter's friendships, theirs ended with the news of the hospital's megacost overrun and a $22.5-million fraud inquiry connected to the MUHC's decision to award the construction contract to a consortium led by the Montreal-based engineering firm SNC-Lavalin Group Inc.

""In a way, Arthur was like Icarus, who came crashing down to earth when his wax wings melted because he flew too close to the sun," Jeff Todd, an Ottawabased journalist who first met Dr. Porter in the Bahamas and co-authored the memoir, said. ""He told me that if he did anything wrong, it was to go way too fast," Mr. Todd continued. "There was never a peak he didn't want to climb and if there was a huge challenge, he always thought he would simply fly over it. But he couldn't always do that." "The first indication was in November, 2011, when the National Post revealed he had signed a commercial agreement the year before with Ari BenMenashe, a Montreal-based Israeli security consultant and arms dealer, all while he was head of both the MUHC and Canada's spy watchdog. Mr. BenMenashe was to secure a $120million grant from Russia for "infrastructure development" in Sierra Leone. In return, a company called the Africa Infrastructure Group, which was controlled by Dr. Porter's family, would manage what he wrote were "bridges, dams, ferries and other infrastructure projects" built with the Russian money.

"Within days, he was gone from SIRC. Less than a month later, he resigned from the MUHC, departing on the grounds that he had accomplished what he had set out to do in 2004: bring together a private-public partnership and get a long-dreamed-of facility built. "Unbeknownst to the public at the time, under his watch, a planned project deficit of $12million had somehow escalated to $115-million. "The following year, fraud charges were laid, but by then Dr. Porter was on to other projects and living in a gated community in the Bahamas, where he had maintained a home for years. After Interpol issued a warrant for his arrest, he and his wife, Pamela Mattock Porter, were detained June, 2013, by authorities at Tocumen International Airport in Panama City. "Despite claiming he could not be arrested because he was on a diplomatic mission for Sierra Leone, he was soon confined to overcrowded quarters in a wing reserved for foreigners in filthy La Joya prison. Toting an oxygen tank, he became known there as "Doc," ministering to inmates who included drug dealers and murderers. The man who had begun his ascent to the top as a doctor beloved by his patients would end at the bottom as a doctor beloved by his patients again.

"He was smart, perhaps too smart for his own good, and affable, with an ability to zero in on the most powerful person in the room with laser-like focus. His long-time friend and former teacher Karol Sikora, who partnered with Dr. Porter in a Bahamian medical clinic and is also the medical director of their joint private health-care company, Cancer Partners UK, said he was uncannily good at getting people together everywhere he touched down, even if they had opposing views. ""People like that are rare and they are very good at running big institutions," Dr. Sikora said. ""Arthur reached the peak of his career in 2010, when he was all glowing and bigger than sliced bread. Then it all went wrong." "Although Dr. Porter claimed the money from SNC was payment for other consulting work he'd done for them, his friend opined that the truth will probably never come out now. ""I'd like to think Arthur was never part of this monkey business, but we'll never know," he said.

"Others were not so kind. Responding to news of his death, the MUHC issued a terse statement that extended condolences to his family and offered no further comment, while Mr. Harper suspended the protocol that would have seen the Peace Tower flag fly at half-mast to mark the death of a Privy Council member. "In prison, living in unsanitary surroundings and denied proper treatment in a hospital for the cancer that many doubted he had, Dr. Porter, who leaves his father, sister, wife and four daughters, was outwardly still full of bravado until near the end. ""I just have to survive and make do," he told CBC reporter Dave Seglins in a phone interview in March that revolved around his treatment at the prison and his successful complaint to the United Nations torture watchdog that his human rights were being trampled on. ""[The] water, food, bedding and the fact that one has to urinate in a bucket shared by about 50 to 100 people ... for someone who has an illness and needs treatment, it was pretty obvious, I presume, the UN clearly found in my favour." "In addition, Dr. Porter continued, his raspy voice rising, he had not had a single court hearing in 22 months.

"I've never left here to go into the city. I have no idea what the inside of a courtroom looks like, not in Panama, Canada, the Bahamas or anywhere," he cried. "I've never been to court in my life." "In the end, though, he seemed to be aware that the stain on his reputation would not be erased, not even in death. ""My entire life has been devoted to climbing, winning and succeeding," he wrote in his memoir. "But with the end drawing near, it is inevitable that I, like anyone else, wonder if what I have accomplished truly matters. I wonder how I will be remembered." "To submit an I Remember: obit@globeandmail.com Send us a memory of someone we have recently profiled on the Obituaries page. Please include I Remember in the subject field.

"In his memoir, Dr. Porter said his life was 'devoted to ... winning.' " "Arthur Porter, left, chats with Stephen Harper at Montreal General Hospital in 2006. The Prime Minister had Dr. Porter sworn in as a member of the Privy Council.

September 2008.

Brian Sinclair's death

By the time Sinclair was discovered lifeless, he had been dead for at least a few hours and rigor mortis had set in. He was rushed into the resuscitation room, but was declared dead within a minute.

Sinclair died from a treatable bladder infection caused by a blocked catheter. Manitoba's chief medical examiner has testified Sinclair needed to see a doctor for about half an hour for a simple catheter change and a prescription for antibiotics.

The inquest has heard the emergency room was overcrowded and short-staffed — operating without a key triage nurse — when Sinclair came in seeking care.

"An opportunity for stroke prevention was missed, and a stroke that might have been prevented turned out to be quite bad," said Ontario neurologist Bryan Young, who reviewed the case.

Stephen Budd has been diagnosed with post-traumatic stress disorder (PTSD). It took years of going back and forth with doctors to get the diagnosis. He was abused as a child, leaving him to cope with mental and emotional issues. 

The 52-year-old lives with his golden Labrador retriever in a cluttered and crowded bachelor apartment. He works as a wood carver, making furniture when he can. He says his job earns him a reasonable income when he is working, but admits he has a hard time staying focused. 

Long waits in remote areas

Japan is far from alone. Dementia is increasing across the globe - 47 million people already live with the disease, with more than 130 million projected by 2050. But the first waves have crashed over Japan. When it comes to dementia - a group of disorders affecting memory and cognition, for which there is no known cure - age is the greatest risk factor. No country has gotten older faster than Japan, the world's first "super-aged" nation. In the early '60s, Japan was the youngest of today's G7 countries. Now, it is the oldest - a dramatic shift fuelled by plummeting birth rates and the world's highest life expectancy, according to the World Health Organization, with an average of 84 years (in Canada, it's 82).

A quarter of Japan's 128 million people are already elderly, meaning over 65. By 2060, the elderly will make up 40 per cent of the population. Many will spend their dying days addled by dementia, which already affects 4.62 million Japanese. Ten years from now, an estimated 7.3 million people in Japan will have dementia - more people than live in Hong Kong, Rio de Janeiro or the entire GTA. "The impact will be so huge," said Dr. Koji Miura, director general of the Ministry of Health, Labour and Welfare's bureau for the elderly. "The burden on younger people is very rapidly increasing. If we don't do anything, society will be in trouble." Last year, more than 10,700 people with dementia went missing in Japan. The vast majority were found - some dead - but 168 were not. Violent crimes fuelled by kaigo jigoku, the Japanese term meaning "caregiver hell," are increasingly making headlines.

In July, 83-year-old Kyuji Takahashi was accused of stabbing his wife. He allegedly told police: "My wife has dementia and I am worn out from looking after her." Right now, these stories are still the exception, but Japan's challenge is to stop a public health crisis from unspooling - while battling the world's highest debt.

There is little any government can do about changing the course of dementia. The only thing Japan can change is Japan. "We see the crisis point as 2025," said Mayumi Hayashi, a research fellow with the Institute of Gerontology at King's College London. "And to cope with that crisis point, Japan is trying to create a society where everybody contributes and people with dementia have a better experience and quality of life." Grassroots efforts play a leading role in building this new society, with volunteers spearheading efforts to increase awareness and to form networks to find wanderers - those who go missing after becoming disoriented or confused.

Over the past 15 years, Japanese policy-makers have also changed everything from the social welfare system to the very word for "dementia." Before, the commonly used term was chiho, meaning "idiocy" or "stupidity," even in medical literature. In 2004, the government made an unusual announcement: chiho would know be known as ninchisho, meaning "cognitive disorder." "After the change of the name, the knowledge and acceptance of dementia has spread widely all over this country," said Dr. Takashi Asada, a psychogeriatrician who was a member of the renaming committee.

Japan's all-hands-on-deck dementia strategy - introduced in 2012 and revised last year - involves not just the health ministry but 11 other ministries and agencies. The strategy funds research but also prioritizes early detection, training front line health workers, support for caregivers and creating "dementia-friendly" communities. But the single most important - and radical - change Japan has made to improve dementia care came in 2000, when the government introduced mandatory long-term care insurance.

A primary goal was to help seniors live more independently and reduce the burden on relatives - particularly women, who are often the caregivers. So unlike long-term care insurance in countries like Germany, which offer cash, Japan's system offers services - and consumer choice. The scheme works like this: at age 40, every Japanese resident pays a monthly insurance premium. When they turn 65 - or get sick with an aging-related disease - they become eligible for a range of services: everything from dementia daycare to lunch delivery and bathing assistance. Depending on income, users also pay a 10- or 20-per-cent service fee - a measure that discourages overuse. This system also created something crucial in the field of long-term care: a market.

"Lots and lots of services developed very rapidly," said John Creighton Campbell, a University of Michigan professor emeritus and expert on Japan's long-term care system. "Without the long-term care insurance system, they wouldn't be conceivable." Campbell believes Japan is "better than any other place in the world for dementia care." Of course, Japan's unique and complicated system won't necessarily translate in other countries and significant issues remain, particularly when it comes to financial sustainability; the number of Japanese using long-term care has more than doubled since the program began, with 5.6 million people accessing it in 2013. Japanese families also continue to demand institutionalized care for their relatives and caregiver burnout is still a growing problem. But Japan's trials and errors are instructive for other nations, marching their own paths toward the destination of super-aged. The country is already living the future that countries like Canada are bracing for.

In September, national anxiety followed Statistics Canada's announcement that, for the first time ever, Canada's elderly population had surpassed its population of children. Japan hit this same milestone - in 1997. Clearly, there is good reason to keep an eye toward the Land of the Rising Sun, the Lancet medical journal recently suggested. "How Japan addresses the challenges - and opportunities - posed by a rapidly aging society will become a model for other countries facing their own demographic time bombs."

Dementia by the numbers 61,568 Japanese centenarians today 153 Japanese centenarians in 1963 1 in 5 Elderly Japanese who will have dementia in 2025 1 million

Nurses and care workers needed by 2025 to deal with dementia 40% Percentage of Japan's population that will be over 65 in 2060 15,731 Number of over-65 Japanese abused by families or relatives, according to a 2013 survey 14.5 trillion yen

Cost of dementia on the Japanese economy in 2013 6.2 trillion yen Estimated cost of informal care for de

24.3 trillion yen Estimated cost of dementia in 2060

Elderly people work out with wooden dumbbells in Tokyo to celebrate Japan's Respect for the Aged Day in September. A quarter of Japan's 128 million people are over 65. By 2060, that figure will be 40 per cent. • Nobuko Tsuboi runs a seniors daycare, covered by Japan's long-term care insurance. • Tomofumi Yamamoto is staying fit in hopes of warding off dementia.

This has gone too far. BGH has built and is still adding to its "Taj Mahal" at the expense of Trenton and Prince Edward County hospitals

The theory offered to offset the loss of beds in Trenton and the county is that there will be home-care and doctors' home visits; that's pie in the sky.

availability of such services is not there

There are still shortages of spaces in nursing homes for people who need 24/7 care.

They could lower their expenses greatly from needing to fight in-house bugs by employing full-time cleaning staff who have personnel available to ensure maximum cleanliness everywhere in the hospital at all times.

This includes the prompt cleanup and sanitizing of any area where a mishap may occur; such things are frequent in any nursing facility. Such staff should not be on a contract basis but full-time employees with benefits

Reinstate in-hospital food preparation and hopefully a full cafeteria offering healthy locally grown food to patients, staff, day patients and visitors.

After decorating Halloween cookies together, Han brings his own masterpiece, smothered in smarties and sprinkles, to Clark and encourages her to try it. Few words are exchanged, but smiles and giggles are constant at the intergenerational program at Youville Residence, a long-term care facility for seniors in Vancouver. Han Jr. is among a half dozen children visiting this day from the Montessori Children's Community - a daycare located on the same site as Youville, at 33rd and Heather.

Montessori Children's Community administrator Kristina Yang said it's a win-win situation. "Even if there is not a lot of communication with words you can see the beautiful smiles on everyone's face. Many of the children come to know a lot of the seniors and when they pass by our window they'll be excited waving and saying 'Hi ,'" Yang said.

Youville occupational therapist Sheralyn Manning said the children's visits are a big part of the seniors'day. Besides planned events, such as doing crafts together, every so often the children will visit when the weather is bad and they are not able to play outdoors. Manning pointed out the friendship between Clark and Han has been particularly touching to watch and Clark has a recent craft project Han gave her prominently displayed in her room. When most people think of nursing homes the image that comes to mind is a stand-alone building offering residential care only for the aged.

It's a place seldom visited unless you are a family member, friend or volunteer. But these days more homes are trying to build bridges to the wider community. Of B. C.'s 460 government and private nursing homes, only a handful have daycares or doctor's offices on site, said Daniel Fontaine, CEO of the B. C. Care Providers Association, which represents 60 per cent of the privately-operated homes. But none are attached to a facility that offers a large variety of community services. One of the best Canadian examples of a nursing home that achieves just that, said Fontaine, is Niverville Heritage Centre, near Winnipeg. It is home to 116 seniors but is also a gathering place for major community events.

The centre hosts 100 weddings each year. As well, about 50,000 visitors drop in at the centre annually to access their doctor's office, dentist and pharmacist or visit the full-service restaurant and pub. "We found seniors don't want to be retired to a quiet part of the community and left to live out their lives. They want to live in an active community and retreat back to their suite when they want that peace and quiet ," said Niverville Heritage Centre's CEO Steven Neufeld.

Before the centre opened in 2007, he said, members from the non-profit board that operates the centre visited traditional nursing homes and discovered that the lounges that were built for seniors were seldom used. "I remember going to one place where there was a screened-in porch that was packed. The seniors were all there wanting to watch the soccer game of the school next door ," he said. Having services like doctors'offices, dentists, a daycare, a full-service restaurant, and hair styling shop on site fulfil the centre's mission of being an "inter-generational meeting place which fosters personal and community well-being." Fontaine said it's worth noting that Niverville was able to "pull all of this together in a community with a population of less than 5,000 people." He hopes more B. C. nursing homes follow Niverville's lead.

Elim Village in Surrey, which offers all levels of residential senior care on its 25-acre site, is on that track. There are 250 independent living units, 109 assisted living units and 193 traditional nursing home beds. The village also has a 500-seat auditorium, located in the centre of the village, that hosts weddings and is available for rent for other public events. Elim Village also rents out space in one of its 10 buildings to a school, which allows inter-generational programs to take place easily between students and seniors. Another "continuing care hub " at Menno Place, in Abbotsford, has a public restaurant called Fireside Cafe, popular with staff from nearby Abbotsford Regional Hospital and Cancer Centre. There's also a pharmacy and hairdresser on its 11-acre "campus " site but these services are available only to the 700 residents and staff. "We purposely try to involve the community as much as possible ," said Menno Place CEO Karen Baillie. "It's Niverville on a smaller scale." She said Menno Place partners with high schools and church groups and hundreds of volunteers visit regularly. "Seniors are often challenged with isolation and fight depression. That's why we have different programs to encourage them to socialize ," she said.

Research shows 44 per cent of seniors in residential care in Canada have been diagnosed with depression, and one in four seniors live with a mental health problem, such as depression or anxiety, whether they live in their own home or are in residential care. A 2014 report by the National Seniors Council found socially isolated seniors are at a higher risk for negative health behaviours including drinking, smoking, not eating well and being sedentary. The report also found social isolation is a predictor of mortality from coronary disease and stroke, and socially isolated seniors are four to five times more likely to be hospitalized.

Since more seniors now remain in their own homes longer those who move into care homes are often more frail and need a higher level of assistance, said Menno Place director of communications and marketing Sharon Simpson. Seniors with dementia, in particular, can be socially isolated as friends and family often find it more difficult to visit them as they decline, she said. But Simpson said an intergenerational dance program, run by ballet teacher Lee Kwidzinski, has been a wonderful opportunity for seniors with dementia to be connected to the community. The program is also offered in four other nursing homes in the Fraser Valley. "For them it's an opportunity to see children. You can see the seniors come to life, smiling and giggling at the girls'antics. It's very engaging ," she said. "Some may not be verbal but they are still able to connect. They feel their emotions and they know whether someone is good to them. They feel these girls and become vibrantly alive. It's one of the most powerful things I've ever seen."

Creating community connections is key as Providence Health begins its planning stage to replace some of its older nursing homes in Vancouver, said David Thompson, who is responsible for the Elder Care Program and Palliative Services. Providence Health operates five long-term-care homes for approximately 700 residents at four different sites in the city. "It's always been our vision to create a campus of care on the land ," said Thompson, of the six acres owned by Providence Health where Youville is located.

He said the plan is to build another facility nearby, with 320 traditional nursing home beds. One of the ways to partly fund the cost is to include facilities that could be rented out by the larger community, which would be a benefit to the seniors as well, he said. There is already child care on site, and future plans to help draw in the community include a restaurant, retail space and an art gallery. He said another idea is to partner with nearby Eric Hamber Secondary School by providing a music room for students to practise.

"Cambie is at our doorsteps. If you have people coming in (to a residential care facility) it brings vibrancy and liveliness ," Thompson said

Mr. Maillet's lawyer, Tim Gleason, plans to argue that the regulation violates his client's right to life, liberty and security of the person, and his equality rights, both of which are guarded by the Canadian Charter of Rights and Freedoms. "This regulation, in my view, is a relic," Mr. Gleason said. "It's a relic of a past that's rooted in ignorance and bigotry. This regulation treats transgender people differently than other people, exclusively on the basis of their gender or their sex ... it can't be justified." The Globe and Mail reported last month on the case of Mr. Maillet, who decided to extend his line of credit to cover the $7,401.50 cost of a double mastectomy he underwent on March 3, 2013.

The alternative - waiting months or possibly years just to be seen at CAMH - was not something he felt he could endure. "The applicant's wait for [sexreassignment surgery] during his transition caused serious suffering and hardship," the court application reads. "During this period, the applicant was isolated and suffered extreme depression." Nine months after his surgery, Mr. Maillet secured an appointment at CAMH and a retroactive approval from the clinic. But the Ontario Health Insurance Plan, and a quasi-judicial panel that reviews OHIP rejections, refused Mr. Maillet's claim because the regulation clearly states patients must obtain approval before, not after, their procedures. Ontario Health Minister Eric Hoskins said last month that his ministry is already looking into the possibility of expanding the number of sites that can approve sex-reassignment surgeries. He said he hoped to be able to move on the issue in the "near future." In the meantime, Mr. Maillet is hoping that his court case will eventually make accessing health services easier for other trans people in the future.

In March, after he spent a month in hospital following another dementia-related incident, he was moved into a local retirement home. However, it’s not a secure facility.

Lees has been in and out of hospital since moving into the home, in one case due to effects of being overmedicated.

In the Collingwood area with five long-term care homes, for example, wait times for nine out of 10 patients wanting a basic room vary from 78 days to 746 days.

Simcoe-Grey MPP Jim Wilson has taken up Lees’ case, raising it in May and June in the Ontario Legislature with the Associate Minister of Health, Dipika Damerla. At the end of July, Wilson wrote a letter directly to Premier Kathleen Wynne to plead Lees’ case.

The family estimates they’ve paid out about $5,000 a month for Lees’ accommodation at the retirement home, as well as for personal care services. The family was eventually able to get additional hours of personal care through CCAC.

“The first one we were offered was up in Gravenhurst,” Jim said, saying the family discounted it because of the distance. It would also take his father off the ‘crisis’ list, Lees said, where he has been since April.

Wilson puts the blame on the provincial government, saying it hasn’t developed any new long-term beds after more than a decade in power. In February, the government announced it would redevelop 30,000 existing beds in 300 homes over the next decade.

Four years ago, Wilson presented a private members bill that called on the government to build new long-term care beds in Simcoe and Grey counties. The bill was defeated.