ARCH!TYPE Winter 1997 1

2 ARCH!TYPE Winter 1997

Editorial: Balancing the Disability Agenda 1ARCH!TYPE is published by ARCH, A Legal Resource Centre for Persons with Disabilities. It is read by disabled and non-disabled readers alike, including consumers/advocates, government, service providers, community organizations, employers, unions, professionals, families and others with an interest in disability issues.

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Cover Illustration: Steve Cartwright, April Rigg, Lisa Weitz

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ARCH is a non-profit community legal clinic which defends and promotes the equality rights of people with disabilities through litigation, law/policy reform and legal education. ARCH is directed by a Board of Directors comprised of elected representatives of member groups reflecting the disabled community.

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ARCH!TYPE Winter 1997 3

Who Loses What? The Impact of 2"MegaWeek" on People with Disabilities- Social and Community Health Services 7- Housing and Related Services 8- Health & Long-Term Care 10- Education 11- Municipal and Regional Transportation 14

Ontarians with Disabilities Act: An Update 16

Open Letter from Income Maintenance Group to Community & Social Services 20

A Review of the Proposed Reform of the Workers' Compensation Act 23

Disability and Work: Solutions for Canadians 25

Vocational Rehabilitation Services Under Review 29

Leaving Hospital for a Long-Term Care Facility 31

Ontario Building Code Proposals Released by Government 38

Accessible Buses Prove Themselves Overnight 39

How to File A Human Rights Complaint About Wheel-Trans 40

Supreme Court of Canada Hears Eaton Case 41

A Growing Challenge Facing Consumers 50

Death, Testimony and Inquest:A Critique 52

An Open Letter from the Council of Canadians with Disabilities [ Latimer] 54

Thumbs Up for Task Force on Disability Report 56

News in Brief 65

Bulletin Board 70

Advertising Rates 73

ARCH Member Groups 73

In this issue of ARCH!TYPE, we report in some detail on promising recommendations for federal disability policy reform. In the Federal Task Force on Disability Issues report, "Equal Citizenship for Canadians with Disabilities: The Will to Act", many wide-ranging recommendations are made to the Federal Govern-ment to promote a better future for Canadians with disabilities, including a Canadians with Disabilities Act (see p.56). It is hoped that the government will act on this.

The Provincial Government will hopefully be persuaded by individuals and organizations to take the concept of an Ontarians with Disabilities Act more seriously than it has in the past. These developments provide an opportunity to advocate both levels of government to take seriously the recommendations outlined in the Task Force's report.

But advocates must be vigilant to ensure that these Acts are not used by governments to disguise cut-backs which are taking away the most basic supports and services from people with disabilities. As we have documented in the last several ARCH!TYPEs, thousands of people with disabilities have lost or may lose disability income protection, education and training opportunities, accessible transportation, housing options, home care, assistive devices, health care, and the list goes on and on. The cuts are occurring through a range of strategies: from outright cancellation of programs (both the federal and provincial governments have cancelled their home accessibility renovation programs), co-payments, reduced funding, and through the redefinition of "disability" which redefines people formerly "disabled" as "non-disabled", making them ineligible for various disability-related services.

Ontario government cutbacks have been devastating to many individuals and families. Our coverage of Ontario's "Mega-Week"

addresses issues that people with disabilities will need to be concerned about. But the federal Government has cut just as deeply, through reduced eligibility for tax credits and reductions in the Canada Pension Plan, and especially through the Canada Health and Social Transfer which has taken away hundreds of millions of dollars from the Provinces and has virtually removed any safeguards that the money which remains will be spent on disability programs. People with disabilities have to continue to challenge and prevent further cutbacks.

Disability organizations, including ARCH, are trying to serve a diverse community. It's important, for example, to work to remove barriers so that those who want and are able to work have equal opportunities with other citizens.

It is also important to fight for those who can't work, or who aren't able to work just yet, and make sure that their basic supports aren't taken away by governments. Everyone has a common interest in these issues, but governments are increasingly approaching them as a "zero-sum game", in which they say that supports for some can only be met by denying them to others. This only serves to pit one group against another. Now is the time to be vigilant and ensure that the needs of all are being considered and addressed equitably.

WHO LOSES WHAT?

The Impact of "MegaWeek" on People with Disabilities in Ontario

During the week of January 13th-17th, 1997, the Ontario Government an-nounced a sweeping plan to restructure the management and funding of public services throughout the Province. The principal focus of "MEGA-WEEK" was a fundamental change in what services the provincial and municipal governments will have to pay for. The government also introduced legislation amalga-mating the six local governments making up Metropolitan Toronto into a new City of Toronto.

"MEGAWEEK" followed the release of the "WHO DOES WHAT?" report, written by a panel chaired by former Toronto mayor and federal Cabinet Minister David Crombie. The panel, which did not hold any public consultation, was asked to look at which level of government should pay for which services.

They made a number of recommendations dealing with reform to property tax, changes in the way education is funded and how services ranging from roads to welfare should be delivered and funded. While the panel was created by the government and is often referred to as the basis for the government=s proposed changes, in several important respects the ProvincialGovernmenthas chosen not to follow the advice of the "WHO DOES WHAT?" panel. Because the announcements of restruct-uring directly affects programs of major importance to Ontarians with disabilities, their families and supporters, as well as disability organizations, ARCH has prepared this analysis of the

implications of "MEGA-WEEK". After dealing with some general issues, we then deal specifically with three areas:

(1) social services and health (2) education (3) transportation.

The government has also announced changes to the property tax system which will not be dealt with in this article. Briefly, the government is proposing that the provincial government be fully respon-sible for funding education throughout the province.

It will also take over Children=s Aid and funding for shelters for battered women. In exchange, the government will be requiring municipalities to increase their contribution or completely take over funding for: General Welfare and Family Benefits (or new income

programs to replace them)

Public Transportation (in-cluding ferries and muni-cipal airports)

Long-term care

Roads

Public health

Child care

Social housingIt is important to note that the changes are not simply a

matter of who is adminis-tratively responsible for delivering a program, or even who writes the cheque. The municipalities depend on local property taxes for financing programs while the provincial government depends on income and sales taxes.

Historically, property taxes were intended to pay for those services directly used by the people paying the tax - sewers, snow removal and similar types of services.

Income taxes are generally used to pay for those programs which provide benefits such as health care to groups of people based on need rather than on where they live. The govern-ment's proposed changes signifi-cantly change the balance. Now, property taxes will be used to pay for social programs on a much larger scale.

The change in the type of tax funding is important. Property taxes are based solely on the value of the property you own or rent (renters pay property taxes through their rent to the landlord). People on fixed incomes, such as seniors, people with disabilities, or people whose incomes have fallen will still have to pay the same rate of property tax although their contribution through income taxes may decrease.

When reading this document, it is important to keep in mind that this is only a preliminary analysis, based on very general information released by the Ontario Government and an initial review of the two Bills introduced which implement parts of the proposals: Bill 104, the Fewer School Boards Act and Bill 106, the Fair Municipal Finance Act, 1997.

The "MEGAWEEK" plan was announced by the Ministers involved in only the most general terms. What we don't really know at this stage is probably more significant than what we do know. In addition to the general questions that follow, specific questions about different parts of the announcement are also raised below.

WHAT WE DON'T KNOW SOME GENERAL QUESTIONS

1] TIMING: When will the changes happen?

There is no clear time frame for implementing most of the major changes. The impact of the changes will depend, not only on how they are done, but on the order in which they are done and whether the municipal and provincial governments have the necessary staff and policies in place to deliver the programs effectively. The timing in relation to other reforms, such as hospital restructuring, for example, is also important since changes to the hospitals will have an impact on the demand and type of long-term care required.

2] STANDARDS: Will there be provincial standards for all of the programs to be delivered by the municipalities, and, if so, who will decide what they are and how will they be enforced?

In several instances, the Provincial Government has stated that programs entirely or partially transferred to the municipalities will be run according to provincial standards. They did not say whether these standards would be general or specific - requiring, for example, that a specific service must be delivered. They have not, however, made clear how those standards will be developed or enforced. Where municipalities are going to be responsible for funding 100% of a program out of property taxes it is not clear how the provincial government will be able to maintain provincial standards.

3] SERVICE LEVELS: If there will be limits or "caps" put on the services which municipalities can deliver.

This is the other side of the previous point. If the Provincial Government is setting standards, will these include cost controls on services or limits on the numbers served? Will the provincial government prohibit municipalities from providing additional services as some have in the past, such as supplementary assistance programs or limit the services where fees are permitted. If so, how will this be implemented?

4] ELIGIBILITY: Who will be eligible for services and programs?

An important component of the transferred services and programs will be the eligibility criteria. What will the criteria be, and who will decide about eligibility?

5] PROCESS: What will the process for implementation be?

Who will be responsible for the transfer of programs and services and their ultimate management and delivery, and who will they be responsible to? In some cases, unelected commissions will be given the power to make a number of key decisions. Who will be able to appeal decisions about allocation of funds? Who will hear appeals? Will appeals be limited to government or will individuals be able to appeal?

It is important to remember that the focal point of all of these changes must be the people who receive services - removing services or changing them without first making sure that new ones are in place will be harmful.

6] STRUCTURES: What will happen to agencies, municipal govern-ments and other existing service delivery organizations?

Some of the restructuring gives an important role to new or relatively new organizations or entities, such as parents' councils and the new long-term care agency as well as the Community Access Centres.

What will their role be? How will their decision-making authority and responsibilities fit together with the existing structures? How will they be accountable to the public?

7] OTHER CHANGES: How do the changes announced during "MEGA-WEEK" fit with other changes to services by the government?

For example, what will be the impact of the amalgamation of various towns and cities?

8] LEGISLATION AND PUBLIC DIS-CUSSION: What new legislation will be needed? If so, will there be hearings? How long will the hearings be? Will they be held

across the province? What public discussion will occur about the changes where no legislation is required?

Many of the changes will require no further legislation because they were authorized under Bill 26, the Omnibus Bill. There will be some new legislation, however, which will allow some public discussion or consultation. To date three bills have been introduced dealing with amalgamation of Metro Toronto, Education and municipal property taxes.

9] COST-SHARING: How will it really work?

Several programs are now going to be cost-shared 50/50 between the provincial and municipal levels of government. But how will this work in practice? Will the province be required to match municipal expenditures, or vice versa? Or will there be a fixed amount determined by both? Will the municipal share be determined on the basis of the number of individuals served in the municipality, on the basis of the level of expenditures in the municipality, or in some other way?

MORE INFORMATION AND DETAILED PLANNING IS NEEDED

As we analyze what we know to date we will be suggesting additional questions that need to be answered related to specific announcements. The lack of this information indicates the level of uncertainty that exists, even at the governmental level, not only about what changes will be made but how they will go about implementing these changes. In the public at large, there is obviously much more confusion.

Whether or not you agree with some or all of these changes, a clear implementation plan to ensure that the services will continue to be available when they are needed is essential. Once the legislative process has been completed and the final decisions are made the first priority must be to make sure that there is a clear plan for the transition and that no services are discontinued before new services are in place.

An important thing for persons with disabilities, advocates and organizations to do at present is simply to try and get answers to the types of questions listed above, with special emphasis on the disability implications. It would be wise to maintain a considerable amount of scepticism about "definitive" statements and analyses of the exact implications of the Government's plan, regardless of their source, because the information required to do a detailed analysis simply isn't available as yet.

Nevertheless, from the Government's announcement and public discussion so far, some central themes are emerging, and it is clear that the community of persons with disabilities will be deeply affected by the changes, and should be actively involved in the public debate about them.

SOCIAL & COMMUNITY HEALTH SERVICES

MINISTER'S ANNOUNCEMENT

The "MEGAWEEK" plan for social and community health services was announced by the Honourable Janet Ecker, Minister of Community and Social Services, on January 14, 1997.

The Minister stated that the new plan would "provide higher quality services at less cost to the taxpayer". It was described as "a simplified arrangement between the province and the municipalities". The following are the specific changes proposed to date (Jan. 22, 1997): Municipal governments will be responsible for the following:

1] Social Assistance and Disability

Income Programs

Municipalities will fund 50% of Ontario Works (including Workfare) which will replace both General Welfare as well as Family Benefits for sole support parents. Municipalities will fund 50% of the new disability income program which the government has committed to developing but has not been announced. That program will replace Family Benefits for persons who are "disabled" according to the new eligibility requirements which have not yet been announced. The municipalities will be responsible for delivery of Ontario Works. Apparently the province will deliver the disability income program.

2] Municipal Social Assistance Reserve

The Government will establish a Municipal Social Assistance Reserve to provide additional funds to municipalities if there are unforseen changes in the economy that raise the cost of welfare. The initial contribution to the fund will be $700 million. The government has not announced how municipalities will qualify for that funding.

3] Child Care (day care)

This will be managed by the municipalities and funded on a 50/50 basis by the municipalities and province. At the present time municipalities that provide child care generally contribute 20% to the cost of day care programs. (The province funds 100% of the cost for children with special needs in integrated prorams).

The government said that all municipalities will now be required to provide child care programs and that the province will develop comprehensive provincial quality and safety standards.

4] Social Housing

Municipal governments will now be solely responsible for the previous provincial component of maintaining, creating and funding

social housing including rent subsidies. The federal government does contribute towards social housing but they are in the process of

renegotiating their contracts with the provincial governments to limit their involvement.

5] Public Health

Municipalities will assume full funding of public health programs, with the province retaining responsibility for those programs with a province-wide reach, such as disease control and immunization.

6] Land Ambulances

Municipalities will assume responsibility for the delivery and financing of land ambulance services, while the province will continue to set standards. The province will continue to be responsible for air ambulances.

7] Long-Term Care

The Community Access Centres (CACs) introduced by the government to provide long-term care throughout the province will remain. A new Long-term Care agency will be created through legislation. That agency will coordinate the system within province-wide standards. Municipalities will be responsible for 50% of long-term care funding including nursing homes and homes for the aged.

8] Health Care Spending Level

The province states that it remains committed to maintaining health care spending at $17.4 billion.

9] Children=s Aid

The province will assume responsibility for full funding of Children's Aid Societies.

10] Women=s Shelters

The province will assume responsibility for full funding of women's shelters.

QUESTIONS AND ANALYSIS

TRANSFER OF THE FUNDING OF SOCIAL AND COMMUNITY HEALTH SERVICES TO THE MUNICIPALITIES

One of the most controversial features of the plan announced by Minister Ecker is the major transfer of major responsibility for funding and delivering social assistance, social services, and community health services to Ontario's municipalities. This is contrary to how these services are funded and delivered in Canada's other provinces, and in most other jurisdictions. No one, including the government, has cited any study supporting this approach.

In fact, the "WHO DOES WHAT?" panel appointed by the Government itself strongly and unequivocally recommended against this approach. In its final reporting letter written on December 23rd, 1996 to the Honourable Al Leach, Minister of Municipal Affairs and Housing, the panel stated that it "strongly opposes such a move".

The Panel emphasized that "we are unanimous in the view that if there is a choice between placing education or health and welfare on the property tax, it is clearly preferable to continue to rely on the property tax for the funding of education". The Provincial Government has chosen to take the opposite approach to that recommended by the Panel.

In view of the significance of the changes, the potential implications for people with disabilities, and the complexity of the issues we believe it is important to review and raise questions about the proposals made to date.

To begin with, transfers of important long-term care and social services to the municipal level run the risk of fragmenting the system rather than unifying it, as many important components of the health and social services

system will remain at the provincial level. The particular consequences in the area of health and

long-term care will be discussed below.

Many municipalities, especially northern and rural ones, will have to acquire significant new areas of expertise and structures in order to deliver these programs and services adequately. Even where the municipality has played a key role in actually delivering the service, the new funding obligations will require new administrative obligations and the creation of new local bureaucracies.

Coming at the same time as major municipalities amalgamate across the province this has the potential, at least in the next several years, to create a chaotic system which will not be able to respond to pressing needs.

For the transferred programs, much of the acquired expertise in the provincial system will be lost. The full implications cannot be determined without additional information.

QUESTIONS ABOUT CHANGES TO SOCIAL ASSISTANCE PROGRAMS

Following are questions related to the proposed changes to social assistance programs:

1] Definition of Disability in New Disability Income Program:

In the Common Sense Revolution the current government promised to move 170,000 seniors and people with disabilities from welfare to a new income program. In subsequent statements and consultations. However, there were strong indications that the Provincial Government was considering a much narrower definition of "disability" for the new program which would leave thousands of current Family Benefits recipients on Ontario Works (workfare or, at best, a low level of benefits).

While no other reductions in the program have been discussed, the narrowing definition of "disability" would raise major concerns. No details of the new disability income program have been announced as yet. (see p.20 re an "Open Letter" from the Income Maintenance

Group to the Minister of Community and Social Services).

2] Responsibility for the Ontario Drug Benefit Plan and Dental Program:

! Will the municipalities be required to assume 50% of the cost of the Ontario Drug Benefit Plan and dental plan currently funded by the Provincial Government for people on social assistance and home care?

3] Special Needs Program:

Some municipalities, but not all, have provided funds for special needs such as transportation and the unpaid portion of the cost of assistive devices. These programs are now funded 80% by the provincial government and 20% by the municipality.

! Will the provincial government require all municipalities to introduce these programs or will they eliminate all cost sharing for these special need programs?

4] Social Assistance Review Board:

At the present time, there is a significant backlog of cases. The 1995/96 annual report of the Board shows that the largest component relate to people with disabilities.

! Will the municipalities be required to take over the funding of the Social Assistance Review Board? If so, at what level?

! Will the Board be restructured?

How will the government ensure consistency if each municipality runs its own review board?

5] Impact on Social Service

Agencies

The government says that these new social

services will be delivered by 50 new community service agencies instead of the hundreds of existing agencies.

! Does this mean that not every municipality will have a community service agency? How will it be decided which municipality will be responsible for running and funding the centres if they serve more than one municipality?

! Who will run these agencies?

! How will they relate to the Community Access Centres which are responsible for long-term care?

! When will they be set up?

! How will the government ensure that people with disabilities have access to these centres where there is no accessible transportation or funding for that transportation available?

QUESTIONS ABOUT CHANGES TO CHILD CARE

1] Child Care Funding:

Child care funding will be shared 50/50. Currently it is cost-shared 80/20.The province currently provides 100% funding for supports for children in integrated programs.

! Will the funding for special needs continue. If the subsidy is not provided it will increase the cost to the municipalities and jeopardize the protection for integrated child care.

QUESTIONS ABOUT CHANGES TO CHILDREN'S AID

1] Children=s Aid Societies:

The provincial government will assume 100% funding for Children's Aid Societies. They currently fund 80%.

! What are the implications with respect to untangling the system since most of

the services that the children and family will be needing will now be funded and delivered through the municipality?

! Will the continuing fragmentation mean that families who need assistance will still have to submit to the child protection system even where there is no issue of abuse or neglect since it is the only way for families to get necessary funds.

QUESTIONS ABOUT CHANGES TO SHELTERS FOR ABUSED WOMEN AND CHILDREN

1] Shelters for abused women and children:

The provincial government will assume 100% of the funding.

! Will the province increase its own budget by the amount currently paid for by municipalities.

! Will the government increase access to shelters for women with disabilities?

QUESTIONS ABOUT HOUSING AND RELATED ISSUES

1] Municipalities responsible for all social housing not paid for by the federal government:

Social housing is defined by the government as rental housing financed by government for low-income households including seniors and persons with disabilities. The programs are either federally or provincially funded or both funded.

There are three types: Ontario Housing Corporation, rent-supplement housing and non-profit corporations. Many tenants pay rent-geared to income with government subsidies for the full cost. The government subsidizes the

different between market rent and the subsidized cost in some housing. There are 275,000 units of

social housing.

Existing Program

Total subsidies now are $1.4 billion/year. $886 is provincial, $564 federal.

Ontario Housing and rural, urban and native housing:

89,000 units of the 275,000 units. $353 million: $142 of which is provincial, $211 federal. 84,000 owned by OHC which administers

the portfolio through 54 local housing authorities.

Rent Supplement Housing:13,000 units. $81 million/year: $49 million provincial,

$32 million federal.

Non-profit and Co-op:172,000 units Over $1 billion: $696 million provincial, $321 million federal. Owned and operated by community-based corporations divided into municipal non-profits, private non-profits, coops. All

provincial costs will be transferred to the municipalities. There are currently more than 100 municipalities with responsibility for social housing.

Changed Provincial Role

The province will set, maintain and enforce province-wide standards in the areas of eligibility and maintenance.

Timeframe for Change

The government estimates it will take 2-3 years to transfer the funding to the municipal governments because of the need to renegotiate agreements with the federal government.

2] Rent Subsidy:

What will happen to existing housing programs including rent subsidy? The provincial government eliminated the rent-geared-to-income program and has said they will replace it with a rental subsidy program. However, almost one year after ending the rent-

geared-to-income program the replacement program is not in place. Since the purpose of the rent subsidy program is to provide funding to low-income people to rent apartments at market rent any change in the market rent will increase the cost to the municipality.

! Will the government require all municipalities to provide social housing and rent subsidies?

! Will the government prohibit municipalities from decreasing the amount of social housing they fund?

! What will be the impact of the Tenant Protection Act which removes rent control each time an apartment changes hand allowing potentially increasing the cost of housing? The Act also allows landlords to pass on tax increases to tenants above the permitted rate of increase for apartments subject to rent control?

! If housing support programs decrease will people with disabilities be forced to return to institutions to obtain the services they need since many of the service programs, such as attendant care, are delivered in conjunction with social housing programs?

3] Hostel programs:

Currently the province pays 80% and sets standards and per diems. Municipalities will continue to operate the program at a rate of 50/50 for emergency hostels and 100% municipal for clients in domiciliary hostels and homes for special care. These are funded now through the General Welfare Assistance program. The Ministries of Health, Housing and Community and Social Services will design service models to be delivered and paid for by the municipalities.

! Will there provincial standards that municipalities provide these services at a level adequate to meet the need? Who will be responsible for establishing and enforcing safety and related rules. The

news release from the Minister and Community and Social Services suggests that there will be no required

service.

4] Homes for Special Care:

This is described by the government as a program for people with psychiatric disabilities. In the past it was an important form of housing for people with developmental disabilities. Municipalities will be required to fund this at 100%. The government states there will be no changes for either operators or residents, but it is not clear on what basis that promise is made. What protection will people have in municipalities which currently have little or no housing for people with disabilities and are facing an increased number of people in the community due to downsizing of psychiatric beds.

! Will there be safety standards, landlord and tenant protection for long-term housing?

QUESTIONS ABOUT HEALTH AND LONG-TERM CARE

1] Homes for the Aged:

The 99 Homes for the Aged, which are now run by municipalities and funded primarily by the province will no be cost-shared with municipalities on a 50/50 basis.

2] Home Care and Other Services:

Municipalities will also assume 50% of the cost for community access centres, which are replacing home care and placement coordination services, nursing homes, and other community long-term services. Up until now these were funded 100% by the provincial government although municipalities could provide additional programs with funding from their own budget.

3] Funding Level:

The Minister announced that funding for Long-term care would not be cut but the provincial allocation for long-term care will be cut by 50%, the amount to be picked up by the

municipalities.

4] New Agency: There will also be a new long-term care

agency created in the future. The announcement says that there will be consultation prior to the introduction of legislation to create the agency. The agency will be responsible for maintaining provincial standards to ensure consistency across the province. The Community Access Centres will remain although there is no indication what the relationship will be between the CACs, the new agency, the provincial and municipal governments, as well as the new social and health agencies to be created as a result of to the changes to the welfare system.

! What will be the timing of the introduction of the new agency? Since they will apparently play a lead role in allocating resources and services what guidelines will the Community Access Centres use until this agency is established?

! Will the transfer of fiscal responsibility occur before the establishment of the long-term care agency?

! Who will decide what services will be provided and the amount of co-payments, if any?

! Will the provincial government increase the funding to meet the increased levels of home care and other long-term care required as recommended by the Health Services Restructuring Commission?

! Will the government ensure that hospital closures do not occur until new long-term care services are in place at the level necessary to meet the demand?

! Will property tax revenue allocated for long-term care be allocated on a province-wide basis? In other words, will municipalities that do not have a long-term care facility be responsible for subsidizing a facility in another municipality? Who will determine what proportion of its property tax revenue a municipality will receive from the new Agency if funding from several municipalities is pooled. Who will decide which municipalities will deliver which services?

5] Land Ambulance:

Municipalities will take on 100% responsibility for land ambulances. At the present time Metropolitan Toronto does contribute towards the funding but it is inconsistent across the province. Ambulances are currently operated by the province, hospitals, municipalities, volunteer groups and private operators. The Provincial government will regulate provincial standards and operate air ambulances. The provincial government will also license ambulance operators and maintain standards for service levels, equipment and quality of services.

! What are the implications for ambulance services as hospitals are shut down and regionalized, particularly if there is no uniform access to accessible transit.

! Will those municipalities with no hospitals be required to bear the full cost of transporting people to facilities in other municipalities?

6] Public Health:

There are currently 42 Boards of health, 27 of which are autonomous and encompass more than one municipality. They provide a range of services dealing with health promotion, tobacco use, food safety and water quality control. In nine regions public health is a department of regional government. Municipalities now pay 25% of mandatory programs.

The province also funds 100% of priority programs such as AIDS. In Metro the provide pays 40% of public health. The province sets

and monitors standards, does disease surveillance at the provincial level and provides expertise to the local boards. Public health programs will now be fully funded by the municipalities. The Ministry of Health will set and enforce minimum standards, manage disease control and fund some provincial programs such as immunization. Under the new system municipalities will be required to fund 50% of the cost.

! What programs will be mandatory? Who will decide which programs are provincial?

7] Health Care Funding:

The government has stated that it will continue to maintain spending on health care at $17.4 billion.

! Will this amount include funds spent by municipalities on long-term care, public health, etc? If so, how will the government ensure that funding levels are maintained?

8] Co-payments:

Co-payments already exist for some long-term care services, additional co-payments may be required.

! Who will decide whether municipalities will be able to charge co-payments for long-term care services and, if they are, how much the co-payments will be?

! Will co-payments be sent to the Long-Term Care agency to be invested in new services or sent to the province, municipal government or service providers?

QUESTIONS ABOUT CHANGES TO EDUCATION

1] General Education Funding:

Provincial grants for the general education component of the education budget, an set

amount allocated per person, have been cut by $400 million already. In November, 1996, the government announced that grants for 1997-98 would not be cut.

2] Special Education Funding:

The special education component to provide services for children with special needs was actually increased for 1996-97. The specialized special education grants (e.g., grants in lieu, transportation, s.27 for hospital, correctional facilities, etc.) have not been cut.

In March 1996, after announcing the $400 million cuts, the Minister of Education outlined a "Tool Box" outlining how the Ministry felt cuts should be applied. Special education was not mentioned.

3] School Board Cuts to Services for Children with Disabilities:

School boards and trustees have responded with widespread cuts to educational services for children with disabilities, such as teachers' aides (permitting supported integration), self-contained classes, social workers and psychological services. Many of these cuts have violated the legal requirement (see s.170(8) of the Education Act and O.Reg.306 s.6) that special education services will be provided in compliance with a plan which is reviewed by the board's Special Education Advisory Committee, and submitted to the Minister of Education for approval. Many boards are unilaterally cutting services without regard to this process.

When plans containing special education cuts are submitted to the Minister, he has not been using his authority under s.2(5) of the Regulation to require that they be amended to fulfil his obligation under s.8(2) of the Act to ensure "...all exceptional children in Ontario have available to them...appropriate special education programs and special education services without payment of fees...". The Minister has not approved the plans which cut services (notwithstanding increases in special education funding). He has simply not responded.

4] Outside Classroom Spending:

The Minister recently released a study conducted for the Ministry by the consulting firm, Ernst and Young which purports to

identify wastage on services to children outside the classroom. The services listed by the report as being non-classroom spending, and therefore potentially wasteful, including psychologists, guidance counsellors and other services benefitting children with disabilities. This report reinforces the view of school boards that special education is a luxury, thereby justifying cuts to the necessary supports.

5] "Who Does What Panel?"

David Crombie's "Who Does What?" Panel reported on education on November 13th. It recommended:

the province assume an increased role in funding the school system and in providing leadership for curriculum and standards

there be fewer school boards

the province establish a new funding formula which is sensitive to the varying needs of students and school boards

establish a provincial business tax rate which should be provincially pooled and distributed based on enrollment, with residential property taxes limited to enrichment of educational programs.

When the Panel learned of the province's intention to transfer health and social services funding to the municipalities in exchange for assuming additional responsibility for the costs of education, it revised its advice on December 23, 1996, stating:

"We are unanimous in the view that if there is a choice between placing education on health and welfare on the property tax, it is clearly preferable to continue to rely on the property tax for the funding of education."

As an alternative, it proposed the establishment of a provincial pool of property tax funds from which to equitably distribute education funding.

! How will it be decided which municipality will be responsible for running and funding the centres if they

serve more than one municipality?

6] Bill 104

On January 13, 1997, the Minister introduced Bill 104, the Fewer School Boards Act. Basically, it:

reduces 129 major school boards to 66 (29 English public, 26 English separate, 4 French public and 7 French separate)

37 boards in remote areas will continue as "school authorities"

reduces the number of school trustees from 1900 to 700

limits trustee compensation to $5000

establishes a Commission to oversee budgets of boards during the transitional period.

7] Future Directions

On the same day the Minister introduced Bill 104, he announced that $5.4 billion in education costs would be removed from the residential property tax base (total elementary and secondary education costs $13 billion). Business property taxes will continue to be allocated to education. However, the province will assume 100% responsibility for establishing funding levels for the new boards.

Currently, per student spending ranges from board to board, from a high of $9000 to a low of $4000. The level of funding established by the province will have an immediate impact on the ability of the new boards to deliver special education services, however it chooses to designate special education funds. If, for example, the province fixed general funding at $4000 per pupil, the trustees of the new boards have to make very deep cuts and would likely view special education as being a low priority because it would affect a relatively small group of students.

In his speech, the Minister states the new funding model will:

fund all students according to their needs

recognize the cost of educating students, including special circumstances, such as students learning English for the first time in the classroom; students with special needs; and students in remote areas

put education dollars on students and teachers in the classroom.

In addition, he promised:

legislation in the spring requiring that every school have an advisory council

to develop a standard curriculum with a new curriculum for Grades 1-9 in language, math, science and technology, to be released in the coming months.

UNANSWERED QUESTIONS

Apart from the issue of the per student funding level, the following questions remain unanswered:

1] Funding Formula:

! What is the formula for funding special education services?

2] Standardized Testing:

! How will the Education Quality and Accountability Office, established by 1996 legislation and headed by Bette Stephenson will address the issue of standardized testing and the accom-modation of children with disabilities?

3] Provincial Schools:  

! What will happen to the provincial schools?

4] Ministry Role:

! What is the role of Ministry staff in

holding Ministry regional offices (if they continue) and school boards accountable for the special education

program and services they provide?

5] Minister's Role: When will the Minister fulfill his

responsibility to ensure appropriate education for exceptional students under s. 8(2) of the Education Act?

QUESTIONS ABOUT CHANGES TO MUNICIPAL AND REGIONAL TRANSPORTATION

1] Background - Prior to 1995

Leadership on accessible municipal and regional transportation has consistently come from the province. The province also established a provincial parking permit system and program to subsidize the purchase of accessible taxis.

Using its control over funding, the province imposed a requirement that all new municipal conventional buses would be low floor and wheelchair accessible. It established minimum criteria for establishing eligibility to use municipal special transit services, which were based on the ability of a person to use the conventional transit service.

Special transportation services (both capital and operating) were cost-shared on a 50-50 basis with local municipalities. The province monitored fares, refusal rates, hours of service and used its funding authority to encourage equity between conventional and special services.

GO Transit is provincially subsidized on the operating side at a rate of $110 million. The province paid for substantial modifications to make GO train stations wheelchair accessible.

2] Common Sense Revolution

The Progressive Conservative Party made the following promises to disabled voters during the 1995 election campaign in response to questions posed by Transportation Action Now and printed in the May/June 1995 issue of ARCH!TYPE:

1. Specialized Transit

"A Mike Harris government would remain committed to funding fully accessible conventional public transportation, community buses, accessible taxis and specialized transit services."

2. Private Inter-city Bus

"A Harris government would work to ensure that all new inter-city buses purchased in Ontario are fully accessible."

3. Municipal Conventional Buses

"A Harris government would continue this policy ["that all conventional buses be low floor and wheelchair accessible"] within the current fiscal reality."

3] Provincial Role Shift

During his first year in office the new Minister of Transportation announced he had capped the provincial funding, limiting it to its previously open-ended share of municipal transportation operating expenses. Moreover, its contribution towards the operating cost of both conventional and special services would decrease by 6.2%.

Following protests by the disability community, the Minister authorized municipal transit operators to reallocate the cuts from the special to the conventional budgets and expressed the hope they would do so. He declined to use his authority to confine the cuts to the conventional side, and now says the province is not responsible for how the municipalities cut special services.

The province allowed the Toronto Transit Commission to purchase lift-equipped rather than low-floor conventional buses over the objections of persons with disabilities, but states the general requirement remains in place.

The province has offered to contribute $225 million towards the cost of new subway construction in Metropolitan Toronto. It is not

clear whether the province accepts any responsibility for ensuring the subway meets basic accessibility standards.

4] Federal Role Divestment

The federal government divested much of its responsibility for operating and regulating the modes of transportation under its jurisdiction (i.e., air, rail, ocean ferries, inter-provincial bus) in 1987 and 1993.

Over this period of time, the public role was increasingly restricted to safety standards and accessibility for persons with disabilities. These two areas were felt to require public regulation because of the public interests involved and the proven failure of the private sector to address those interests.

5] Crombie Panel

The Transportation and Utilities Sub-Panel of the Who Does What Panel made the following recommendations:

the province should proceed with the Community Transportation Action Program to coordinate and integrate existingtransportation services (August 14, 1996)

make service delivery more efficient by reducing costs, eliminating duplication andclarifying accountability (November 4,

1996)

transfer the province's financial responsibility for municipal transit operating ($193 million) and capital - excepting subways ($165million) to municipalities

this shift was intended to "spur innovation in service delivery, encourage private sector interest, enable municipalities to design services tailored to local circumstances and improve efficiency and reduce overall cost tothe taxpayer"

the residual provincial role would "lie principally in establishing safety standards for transit systems, coordination of broader transportation planning and playing a mediation role in resolving problems of inter-municipal service coordination andintegration

divest the province's financial and policy

role with GO Transit ($110 million) by privatizing or contracting out the bus service while maintaining the provincial responsibility forGO Trains (December 20, 1996)

a Greater Toronto Services Board to assume the $110 million responsibility for GO Transit (December 23, 1996).

JANUARY 15 ANNOUNCEMENT:

The Minister of Transportation announced the following:

municipalities to assume full financial and operational responsibility for municipal transit with the provincial contribution estimated at $217 million operating and $391 capital in 1996-97 with the exception of theToronto subway

the province will continue to set safety standards, coordinate area-wide policy and play a role in inter-municipal dispute resolution and "one-time" capital commitments to municipalities purchasing Ontario Bus Industries purchases and for thesubway.

GO Transit is transferred to the

municipalities

Milt Farrow was appointed to review "the importance of cross-boundary GO service as part of his broader review of a possibleGreater Toronto Services Board.

UNANSWERED QUESTIONS: WILL PROMISES BE KEPT?

1] Transportation

! Will the province keep any of the promises made to Transportation Action Now re municipal transit?

2] Ontarians with Disabilities Act:

! How does this announcement relate to

the government's commitment to implement an Ontarians with Disabilities Act during its first term?

3] Access Standards:

! Will the provincial role in coordinating area-wide policy for municipal transit include access standards and cross-boundary services for special transit?

David Lepofsky

I am writing to update you about recent developments in the Ontarians with Disabilities Act Committee's efforts to secure passage of a strong and effective Ontarians with Disabilities Act. During the fall, there were successful public forums in London and Thunder Bay to supplement the successful public forums we had last winter and spring in Hamilton, Ottawa and Toronto. Interest in an Ontarians with Disabilities Act is quickly spreading across the province. For an update on the status of the provincial government's action or inaction on their election promise for an ODA, please see the letter below that I wrote to the Honourable Marilyn Mushinski, Minister of Citizenship.

Following this letter is a recently-prepared pamphlet, entitled "8 Easy Steps to Help Secure Passage of a Strong Ontarians with Disabilities Act". Please share this information with your friends and associates, and that you encourage them to join the Ontarians with Disabilities Act Committee. If your organization is already a member of the ODA Committee, please share this information with your Board members, staff and client population. It is important that as many people as possible learn about what we are doing, and of the specific advocacy suggestions that are set out in the "8 Easy Steps" pamphlet.

Finally, if you have any specific suggestions regarding policy issues which you would like to see included in an Ontarians with Disabilities Act, please write or contact our legal counsel, David Baker, at ARCH, 40 Orchard View Blvd., Suite 255, Toronto ON, M4R 1B9. We urge that any policy recommendations take

into account the fact that the aim and scope of an ODA would be the achievement of a barrier-free society for persons with disabilities in Ontario, through the removal of existing barriers and the prevention of new barriers in the future. We will especially benefit from any ideas that you have on ways to ensure that such a law is effectively enforced.

8 Easy Steps to Help Secure a Strong

Ontarians with Disabilities ActIf you want the Ontario Government to prepare and pass a strong and effective Ontarians with Disabilities Act, there are 8 easy steps which you or an organization with which you are affiliated can take to help reach this goal. People often feel that there is nothing that they can do to influence the huge, detached and distant governmen. This is just not true. Here are the steps you can take. Any one of them is very important. Taking more than one of these steps is even better.

Step 1Join the Ontarians with Disabilities Act

Committee. Membership is free to any

individual and any non-profit organization which subscribes to the basic goals and principles that the Ontarians with Disabilities Act Committee has approved, and which are set out in its Brief, dated September 1995 ("Towards a Barrier-Free Society for Persons with Disabilities by the Year 2000"). Get an application form, fill it out and send it in. Join your voice with ours! Application forms can be obtained from Steve Kean, Spina Bifida and Hydrocephalus Association of Ontario, 35 McCaul St, Suite 310, Toronto ON, M5T 1V7 or call him at (416) 979-5514.

Step 2

October 3, 1996Hon. Marilyn MushinskiMinister of Citizenship, Culture and Recreation77 Bloor St. W., 7th FloorToronto, OntarioM7A 2R9

Dear Ms. Mushinski:

I am writing on behalf of the Ontarians with Disabilities Act Committee, of which I am co-Chair, as a follow-up to your public presentation to the ARCH Annual General Meeting in Toronto on September 28, 1996. This is also a follow-up to my letter to you dated July 25, 1996 to which you have not replied. We acknowledge your public commitment on September 28, 1996 to fulfill your Party's election promise to pass an Ontarians with Disabilities Act during this Government term, and to work together with the Ontarians with Disabilities Act Committee to address this promise. We also specifically acknowledge your public commitment on September 28, 1996, as accurately reported in The Toronto Star of Sunday, September 29, 1996 that the government should not pass an Act that has "no teeth" and that this legislation must "be meaningful". We also noted with interest your announcement that as of about a month prior to the September 28 public presentation, your Ministry assigned a staff person with responsibility to explore the gaps which the ODA Committee has identified.

that a meaningful Ontarians with Disabilities Act with teeth can be developed without the leadership of the Premier and the cooperation of all of the other Ministries of the Crown on which such legislation would have an impact. For that reason, we respectfully propose that it is in both our interest and yours to join together to seek a meeting with the Premier. We ask that you reconsider your refusal to help in this regard.

We look forward to hearing from you at your earliest convenience with regard to the three specific proposals set out in this letter.

Yours sincerely,

M. David Lepofsky, C.M., LL.B., LL.M.

cc: Naomi Alboin, Deputy Minister, 77 Bloor St. W., 6th Floor, Toronto ON, M7A 2R9Karen Cohl, Assistant Deputy Minister, Policy and Planning Division, 77 Bloor St. W. 5th Floor, Toronto ONM7A 2R9

If you are a member or client of a non-profit organization which is interested in the welfare and rights of persons with disabilities, get this organization to join. The Ontarians with Disabilities Act Committee welcomes non-profit organizations and individuals as members. The more community organizations that join us, the stronger is our potential.

Step 3Get friends and associates to join the

Ontarians with Disabilities Act Committee. Tell them what we are all about and encourage them to make their voices heard too.

Step 4Phone your local member of the Provincial

Parliament either at their local constituency office in your community, or at his/her office at Queen's Park. Make an appointment to see and tell him/her that you want the Government to pass a strong and effective Ontarians with Disabilities Act as soon as possible, and to keep their election promises concerning this. Ask your MPP to contact the Premier's office and the Ministry of Citizenship to demand immediate action on this election promise, and to contact you to let you know what answer they received.

This is especially important if your MPP is on the Government side, since both Opposition Parties have already thrown their active support behind our cause. If you cannot get to see the Member of the Legislature, then meet with his/her staff assistant. If you do not have the time or opportunity to go and meet with either your MPP or an assistant in person, then call and express your strong support for the Ontarians with Disabilities Act. You can also write a letter stating that you strongly support the proposal for an Ontarians with Disabilities Act, and ask them to report to you on what steps they are prepared to take to move this promise forward to a reality.

Step 5Contact the office of Premier Mike Harris

to express your strong support for the immediate passage of a strong and effective ODA, and ask him to agree to meet with representatives of the ODA Committee, which he has refused to do to date. Ask him to contact you to let you know what he personally is prepared to do to help ensure that the Government keeps its election promise on the Ontarians with Disabilities Act. Emphasize that the law must be a strong and effective one. We will not settle for a weak law which is only window-dressing.

You can phone the Premier's office at (416) 325-1941. You will obviously not get through to him personally, but you can ask for one of his

assistants so that you can explain your position. You can also write to him at:

The Honourable Michael D. HarrisPremier of OntarioLegislative Building, Queen's ParkToronto, ON M7A 1A1

Or fax the letter to: (416) 325-7578.Step 6

Contact the office of the Minister of Citizenship, the Honourable Marilyn Mushinski, who has been assigned responsibility for the Ontarians with Disabilities Act. You can express to her your strong support for the immediate passage of a strong and effective ODA, and ask her to help arrange a meeting with representatives of the ODA Committee and the Premier. Ask her to contact you to let you know what she personally is prepared to do to help ensure that the Government keeps its election promise for an ODA. Emphasize that the law must be a strong and effective one.

You can contact Minister Mushinski's office at (416) 325-6200. Since she will likely not speak to you personally, you can ask for one of her assistants. You can also write to her at:

The Honourable Marilyn MushinskiMinister of Citizenship, Culture and Recreation77 Bloor St. W., 6th FloorToronto, OntarioM7A 2R9

Or fax the letter to: (416) 325-6195.

Step 7Help get the word out to the media about

the need for a strong and effective ODA. The best way to do this is by calling your local radio station's phone-in radio programs and raising the subject. This will help get the word out to the public. You can explain that persons with disabilities face many barriers in Ontario, and

that during the election campaign, the Conservative Party promised a new law to be called an Ontarians with Disabilities Act to address these barriers. To date, we have not seen any such law.

Step 8If you have ideas about what an Ontarians

with Disabilities Act should contain, within the terms of the general principles of the ODA Committee (see our Brief), or would like more information, contact the Committee c/o:Steve KeanSpina Bifida and Hydrocephalus Assn of Ontario, 310 - 35 McCaul St.Toronto Ontario M5T 1V7 (416) 979-5514.

This is an open letter which the Income Maintenance Group wrote to the Ontario Minister of Community and Social Services, the Honourable Janet Ecker. It was sent on October 23. The Minister has not yet responded.

For more information or to get involved with the IMG, contact:

Scott Seiler, Coordinator2121 Roche CourtSuite 425Mississauga, Ontario

* increased asset exemption for personal injury awards to $100,000* repeal of the rule requiring life insurance policies to be cashed in

* payment of 25% of cost of Assistive Devices (not covered by ADP).

These are improvements in the direction that the IMG has advocated for the past number of years towards a system that would be based solely on income and not on assets. We welcome their inclusion in the new proposals, but they should not be "paid for" by restricting eligibility.

Employment and the New Program

As stated by Ministry staff and yourself at the October 8th and 9th consultations, many individuals and organizations, including the IMG, have advocated ending the use of the label "permanently unemployable" as an eligibility test. It is important to make the system more flexible so that people can work without losing their right to assistance when needed. We did not advocate that by removing the term "permanently unemployable", the eligibility test be narrowed and people removed from the system.

We are concerned that people with disabilities will be found ineligible for the new program but will not be able to find real work either, because of their disabilities. People with disabilities face many barriers in the employment market. Discriminatory attitudes, lack of accommodation, workplace inflexibility, lack of transportation and personal supports prevent many people who have "less severe" disabilities from working. Your government has repealed the Employment Equity Act but has not presented an alternative plan to address these systemic barriers.

We acknowledge that you and your officials have made a commitment to present employment-related proposals for persons with disabilities and the IMG will make a further submission when these proposals are known.

We appreciate the opportunity to consult with you on these issues. We hope you will give careful consideration to our submissions, especially related to the definition of disability.

Yours sincerely,

Marilyn FerrellChair

L5K 2C7Tel: (905) 855-6940 Fax: (905) 823-1083

Also see information about an upcoming conference about disability and social assistance on page 53.

A Review of the Proposed Reform of the Workers' Compensation Act

Valerie Varah, Industrial Accident Victims' Group of Ontario

On November 26, 1996, the Tory government tabled Bill 99, a Bill to replace the Workers' Compensation Act with the Workplace Safety and Insurance Act. The Bill is supposed to come into force on July 1, 1997. The government has now promised that the Standing Committee on Resources Development will conduct hearings: when, where and how the hearings will be convened is still not clear. As you can see from the change in the name of the proposed Act, the emphasis has shifted from compensation for injured workers to workplace safety and accident prevention. The irony is that the Act is both vague and misleading on the issue of workplace safety.

The Board of Directors of the Workplace Safety and Insurance Board (the Board) is mandated in Part II of the proposed Act to "promote health and safety in workplaces and to prevent and to reduce the occurrence of workplace injuries and occupational diseases". The legislation lists eleven separate functions of the Board to achieve their mandate. The problem is that the Board no longer has any worker representation. It will be left to a Board hand-picked by the Tory government and heavily represented by employers to develop a process for achieving its mandate. It isn't hard to imagine how the process will evolve.

While the government purports to be promoting health and safety in the workplace, what it is really doing is significantly reducing the level of payments and making them more difficult to obtain in the first place. In this way, the Board can discourage workers from making claims and take credit for the reduction of

"accidents" in the workplace. Some of the more odious changes which will affect workers injured after July 1, 1997 are as follows:

Full benefits will be based on 85% of net average earnings, reduced from 90%

Occupational stress is no longer compensable. Traumatic stress will be compensable but only if it results from a sudden and unexpected traumatic event

Entitlement to chronic pain compensation will be severely restricted and subject to limits that will be prescribed in Regulations

The wording for the notice provision has changed. Although a six-month limitation for reporting an accident has always been in the Act, the Board has rarely enforced it. It would appear that this will change and the Board will reject claims on the basis of late filing. The onus will be on the injured worker to demonstrate that consent to file should be granted because "it is just to do so".

At the time of reporting the accident, the injured worker will be required to provide consent to disclose all medical documents to the employer which the Board considers necessary.

The injured worker may be obligated to undergo such "health care measures" as the Board deems appropriate or risk a reduction or suspension of benefits.

The return to work provisions are particularly onerous. It is left to the employer and the worker to develop a return-to-work plan. The Board only gets involved if there is a dispute between the

worker and employer. The worker and employer must be in regular contact with each other from the time of the accident and the goal is to get the worker back to work as quickly as possible.

If the worker is unlikely to return to the workplace where the accident occurred, a labour market re-entry plan will be prepared. The Board will prepare the plan, and while the legislation says that the Board shall consult the worker and may consult the worker's doctor, it is the final decision of the Board that will prevail, and the worker is required to cooperate or risk termination of benefits. The Board may also arrange for "another entity to prepare the plan". The beginning of privatization?

The distinction between temporary and permanent benefits is gone. Deeming is still present and benefits are calculated on the basis of wage loss from the day of the accident. This could mean the end of total benefits being paid to injured workers if the Board deems them partially disabled from the day of the accident. In fact, this office has already had experience with this type of decision. How will this translate into benefit payments to workers is anyone's guess.

Finally, the Tory government has further eroded inflation protection to injured workers and, with few exceptions, the indexing formula will be 50% of CPI less 1% to a maximum of 4% and a minimum of 0%.

The proposed legislation does not bode well for disabled persons in Ontario, whatever the cause of their disabilities. In the name of deficit cutting, tax decreases, "productivity" and competitiveness, this government is ignoring at its peril the plight of its most vulnerable citizens. In particular, with workplace injuries, much of the cost will be transferred from an employer-funded system to injured workers, their families and other tax supported services, like welfare and OHIP. But with cuts in those areas already implemented or still in the planning stages, the future looks grim.

If you would like more information, or to become involved in injured workers' rights, contact IAVGO at 489 College St., Suite 203, Tor. ON, M6G 1A5, (416) 924-6477, 924-2472 (fax).

Bob White[Based on a speech presented to the National Conference on Disability and Work, Oct. 7,

1996]

Postal Service Customer CouncilCanada Post Corporation established the Postal Service Customer Council (PSCC) in 1989, in each of its postal divisions across Canada. These Councils are independent advisory bodies comprised of volunteer members who represent a cross-section of postal users. These include:

Interest groups in the community- local and municipal authorities- volunteer and community associations- consumer, trade, industry, commerce and professional organizations- disabled community

Regions of the Division- rural community- major city- each major area of the division

Mail Users- large volume mail users- individual/residential users

The Council primarily deals with postal service policy issues and makes recommendations to Canada Post. For example, the Huron/Rideau PSCC meets 4 times a year to discuss postal policy inquiries and policy recommendations as raised by members of the public. Accessibility, Community Mail Boxes (CMB) and Group Mail Boxes (GMB) are issues raised by members of the disabled community and have been discussed at the Huron/Rideau PSCC meetings.

There are customer councils in eight regions across Canada:

Atlantic PSCC600-1809 Barrington St., Halifax NS, B3J 3K8Coordinator: Phyllis Turner Phone: (902) 420-8643 (accepts collect calls)

Quebec PSCC536-2 Place QuebecQuebec City, Quebec, G1R 2B5Coordinator: James HaberlinPhone: 1-800-529-8995

(418) 529-8995

[cont'd on p.51]

As the President of the Canadian Labour Congress, I can assure you that the labour movement supports the goals of reducing the human, financial and social impact of disability. The Canadian Labour Congress is made up of about 2.3 million members from affiliated unions. The CLC Health and Safety Committee includes full participation by injured workers' groups. A number of CLC affiliates have been in the forefront of demanding workplace change around the whole issue of disabilities. Some have worked with enlightened employers to reduce workplace dangers and accidents, to rehabilitate injured workers and to open up opportunities for people with disabilities.

However, we have witnessed in the past few years the dismantling of programs, provincially and federally, designed to assist workers with disabilities. The best example of disability program erosion is the current attack on workers' compensation systems in Canada. The workers' compensation so-called reforms that have been sweeping the country have mainly targeted workers - their benefit levels and entitlement provisions.

In Newfoundland and Labrador, benefits have been reduced to as low as 75% of the net wage, being raised to only 80% after 39 weeks. Prince Edward Island and Nova Scotia have the lowest benefit levels. Benefits for even highly skilled and trained workers are capped at $35,000 and $38,000 respectively. In Nova Scotia and Newfoundland, the topping up of benefits by employers has been made illegal -

wiping out collective agreement provisions. In fact, Nova Scotia's most recent amendments to their Workers' Compensation Act does not require an employer to pay workers for the day on which they are injured!

New Brunswick has imposed a three-day waiting period before an injured worker can apply for benefits. In our opinion, this is a short-sighted ploy to restrict injured workers' entitlement. It has resulted in an enormous increase in the use of sick leave provisions in that province.

British Columbia is starting its Royal Commission on Workers' Compensation. Saskatchewan is undertaking a regulatory review. We expect that both of these provinces will be intensively pressured to adopt some of the regressive changes that have swept across other parts of the country.

Manitoba announced on September 24, 1996 that after retiring its deficit this year, it will be providing a rebate of 5% each year for three years to employers - worth $40 million. The Workers' Compensation Board will be increasing their rainy day fund to $50 million to cushion employers from further rate shocks. Unfortunately, the Manitoba Workers' Compensation Board assigned only $5.4 million over three years to improve services to workers such as health and safety education, prevention and training programs.

In response to these changes, the Canadian Federation of Independent Business was quoted as saying that employers in the province of Manitoba were happy about the rebate, but are worried about the Board's plan to improve services to workers. It doesn't seem to matter that the deficit was created in the first place by employers who were not paying high enough assessment rates. And it doesn't seem to matter that the Manitoba Workers' Compensation Board's deficit was eliminated by cutting injured workers' benefit levels, pensions and entitlement.

Alberta has taken the lead in slashing its compensation system through their program of "claims management". It has resulted in denying claims which would have been accepted

prior to 1993 in the name of deficit reduction. The Ontario non-Common Sense Revolution is getting ready to dismantle workers' compensation as we know it - with their bill on workers' compensation reform scheduled to be introduced later this month (Editors' note: please see p.13 for an analysis of these proposed reforms).

They are getting ready to hand over the Ontario workers' compensation system to their friends, like private insurance companies. The proposals currently under consider-ation will allow for the privatization of the workers' compensation sys-tem for the first six weeks of a claim. The days of an independent system where workers are treated with some respect and dignity, have access to an appeals system and know the rules of entitlement, will be gone.

Instead, injured workers will have to rely on the good will and dominance of their employer and insurance company to provide them with income support and rehabilitation. Workers compensation boards across this country paid out $5 billion in benefits, or an average of $6,170 per claim to workers in 1994 (the most recent year that statistics are available).

When you combine that figure with the indirect costs - loss of productivity, training costs for replacement staff, damage to equipment and materials, wages and time loss for the duration of an accident - the annual total cost to the economy is about $10.1 billion. 10.1 billion dollars is a horrendous figure, and there is no doubt that we need to reduce it. However, rather than cutting benefit levels and entitlement to workers' compensation, why not concentrate on the real source of the costs - the high level of injuries, deaths and diseases that are caused in the workplace.

Instead, many employers faced with escalating costs turn their energies to claims

management, because it provides a short-term return on their investment.

It is very simple. With a claims management approach, a company concentrates on reducing the number of claims filed and the number of claims accepted by workers' compensation boards. Many employers run programs designed to reduce the reporting of workplace injuries by offering prizes, such as company jackets and even vacations

abroad to the worker or work team that goes the longest amount of time without filing a compen-sation claim. Then, when claims are filed, many employers have a standard policy of appealing every case. Claims management is very straightforward - ten claims filed - six denied - a net savings of big dollars for the company, but an injustice to the six workers. A company jacket worth $25 or even a vacation package at $3000 is still far less than the average claim costs of about $6000. An uninjured worker is a much greater saving, even in terms of dollar value.

Yet, claims management does not save money. It just displaces the costs from one system to another. When the workers' compensation system fails, other public systems are left to pick up the pieces. It is sort of a new twist on the federal/provincial devolution.

Right now, the federal social programs for people with disabilities are being wound down. According to the Globe and Mail (Sept.14/96), the Minister of Human Resources Development Canada told people with disabilities not to bother him - that they are now a provincial responsibility. The federal government is intent on tabling cuts to the Canada Pension Plan Disability Benefit Program this fall, and will replace it with some form of tax-based benefit - family income-tested of course.

Earlier this year, the federal government ended its five-year National Strategy for the Integration of Persons with Disabilities - a program that gave about $160 million a year to ten federal departments and agencies to accomplish such goals as making buses and passenger rail cars wheelchair accessible. Ottawa has also put its major vocational program for disabled people under the microscope, trimming its funding by $20 million to $168 million this year, and refusing to guarantee the program's survival beyond next

Claims management does not really save money. It just displaces the costs from

one system to the next. When the workers' compensation system fails,

other public systems are left to pick up the pieces. It is sort of a new twist on the

federal/provincial devolution.

year. In that time, the federal government hopes to pass the responsibility to the provinces, many of which will not take up this responsibility, but instead divert the money to programs with less social benefits.

Injured workers, having lost entitlement to provincial workers' compensation, turn to the federal government's programs for people with disabilities only to find that there are none. Canadians have been in an unemployment crisis for almost six years. Within this time period, relentless corporate and government downsizing has resulted in massive layoffs. With very little job growth within the past year and a half, injured workers attempting to reintegrate into the workforce face an even tougher battle.

Canadian society must recognize the need to help the disadvantaged. We have a collective responsibility to meet their needs. Meeting their needs must be guaranteed by law and by good government policy. If social programs are to be reviewed, then we must enhance benefit levels, increase the fairness of the administration system and ensure that all programs treat people with respect and dignity. I do not believe that Canadians want people with disabilities to live in poverty, to be effectively discriminated against because of their disability, to be shut out of the labour market and to feel that they are the target of government deficit reduction mania.

With competitiveness and globalization, the corporate mantras of today, why would employers hire a person with a disability when ten times the number of people without disabilities are applying for the same job?

The reality is that many will not hire people with disabilities in any significant numbers until they are forced. All employers should provide employment for people with disabilities. Many European countries compel the hiring of people

with disabilities in a much more forceful way than Canadian equity law. In Germany for example, employers with more than 16 workers must ensure that at least 6% of their workforce are employees with disabilities. And if they do not, substantial financial levies are imposed on the employer for each employee not hired under the requirement. The money that is collected is given in turn to a comprehensive rehabilitation system, as well as subsidies for employers who exceed the quota.

A similar law exists in Japan, which also has one of the strongest economies in the world. In contrast, the United States has the most miserly social programs of any country in the industrialized world. This is true as well in their workers' compensation system.

At the Canadian Labour Congress' recent national conference on workers' compensation, a United States expert agreed that, in general, U.S. workers' compensation benefits are roughly half the level of benefits in Canada, but at twice the cost.Why? Because there is no single provider of coverage. More than half of U.S. workers' compensation systems are run mainly by large private sector insurance companies (Note: 52.4% private insurers, 23.9% state insurance, 23% self-insured). Liberty Mutual, the parent company of Liberty Canada, is the largest U.S. carrier of workers' compensation.

There is one fundamental difference between a public workers' compensation plan and a privatized system. Private insurance must make a profit. Competitors must compete for business through marketing and sales efforts, all of which cost money. Each company must provide identical administration systems causing expensive overlap. It is one of the most lucrative businesses in the world today.

How do insurance companies make a profit? By denying claims, and paying out the lowest possible benefit while taking in the highest amount of premiums. In other words, they make money when they don't pay out. And when they do pay out, there are administration costs which are built into the benefit levels. The average ratio of benefits to costs in the United States was $0.73 in 1993 (down from $0.79 in 1992). That is, for every dollar than an injured

worker is entitled to, s/he receives only $0.73. $41.6 billion in benefits were paid out in the United States in 1993. Wage replacement rates in the United States are generally in the line of 60% of pre-injury earnings.

With the Ontario government bringing forward their amendments to the workers' compensation, the prospect of having the first six weeks of coverage for workers provided by

the employer seems imminent. Most employers will provide this coverage through private insurance. Providing only the first six weeks of coverage is the most lucrative part of the business. Insurance companies stand to make huge profits. The Ontario government has proposed to keep the longer-term disabilities which are more costly.

If the Ontario government pushes ahead with their proposals, it will not be long before employers will see a disparity between the premiums paid to their private insurer and their workers' compensation assessment rates. The workers' compensation board assessment rates will rise because without the short term revenue, the long term claims will make the remaining system financially unviable. There will be another intense lobby - this time to privatize the entire system. And workers in Ontario will take up the fight to bring their employers to court seeking remedies for workplace accidents and diseases. We will then see a complete Americanization of the workers' compensation system in Ontario.

Private insurance writes its own rules. These private plans are between employer and the insurance carrier. The beneficiaries (the workers, and their representatives, the unions) do not have access to the plan itself, but receive a short brochure describing only some of the rules.

By contrast, the rules of workers' compensation are public - not secret. Anyone can access workers' compensation policies and procedures and know the rules of coverage and entitlement. Since the private plan is between the employer and the insurance company, an injured worker who has been disentitled often has no right file a grievance or arbitrate disentitlement. In the United States, workers who protest disentitlement to workers' compensation must appeal to the courts. There is no right to a free, impartial appeals tribunal as

there is in most Canadian jurisdictions. It is quite likely that much more money is spent on lawyers rather than on providing benefits to those who need it.

Currently, there are various provincial and federal government programs as well as other private plans which provide varying degrees of income support to people with disabilities, based on stringent definitions of entitlement. Some organizations of people with disabilities and organizations within the labour movement have supported the replacement of the workers' compensation system and the various competing and overlapping disability schemes with one system - a universal disability system that would compensate people with disabilities regardless of the cause of disability. But all of these groups support the provision of the universal disability system by a single public plan. The CLC's national health and safety committee is currently in the process of examining the issue of a universal disability system.

There is an effective and socially responsible way that the costs of workers' compensation can be reduced and that is by preventing injuries and occupational diseases from occurring in the first place. The prevention of accident and occupational diseases will only occur when we have strong laws enforced by independent government regulators.

Governments need to allocate more resources to enforcement initiatives including increasing the training and staffing levels of their inspectorate. Health and safety inspectors can only do their job when the political will exists. We need only to look to Nova Scotia for an example of the costs of poor enforcement of health and safety laws where, in our opinion, lax enforcement policies by provincial inspectors were a significant contributing factor in the Westray tragedy.

Employers and unions must work together to find more ways to fulfill their obligations under the duty to accommodate which reintegrates injured workers back into the workplace. It is important that jobs be modified to accommodate people with disabilities through the use of sound, ergonomic principles.

We must move forward with legislation that will compel employers to hire people with disabilities - even to the point of developing tax rebates and subsidy programs like those which exist in Europe. Human Resources Development Canada and the enforcement arms of the various provincial governments must play a much stronger role in compelling employers to

provide safe and healthy workplaces. Passing the proposed changes to Part II of the Canada Labour Code (developed jointly by business, labour and government) before the end of this year will also go a long way in achieving this goal for federally regulated workers.

VocationalRehabilitationServices UnderReviewDavid Baker

The Ministry of Community and Social Services is conducting consultation on possible changes to the way Vocational Rehabilitation services are delivered. Groups or individuals who wish to have input in the consultation are advised to respond quickly to:

Ellen WaxmanOpportunities for Persons with

Disabilities Branch56 Wellesley Street W., 17th FloorToronto, Ontario M5S 2S3Fax: (416) 326-1735

Consultations were held during the week of November 24th with representatives of voluntary agencies, employers and persons with disabilities. Written material was not shared because of fears that it would be assumed to reflect government policy. At this stage, the

proposals reflect current Branch thinking.

OUTLINE OF PROPOSAL

Ms. Waxman stated that:

1] It was assumed there would not be any cut to VRS funding as a consequence of restructuring. Presently, those services are cost shared 50-50 with the federal government. The VRDP cost sharing agreement is scheduled to expire March 31, 1997. Discussions between the federal government and the provinces about its future are ongoing. It was not clear how cuts in federal funding would affect funding for the program.

2] Currently, people receiving Family Benefits Allowance (FBA) are eligible for VRS. The government apparently decided that substituting the Guaranteed Support Plan (GSP) for FBA should not result in people being disentitled.

3] She indicated that a $35 million budget was allocated for VRS (excluding workshops): $10 million to OPS vocational rehabilitation counsellors, $5 million to vocational rehabilitation counsellors in voluntary agencies, and $20 million towards direct services. She indicated that 50% of the OPS counsellors' time goes into counselling and assessment, and that $5 million of the direct services budget goes into assessment. She stated that this $10 million would likely be re-directed. Establishing eligibility would be based on existing documentation and client submissions for VRS plans, with assessments done only in rare cases.

4] The program would focus on job placement/creation. Results would be evaluated and successful programs expanded. She was aware of the dangers of "creaming" but didn't specifically indicate how to control this.

5] Post-secondary education programs are to be transferred to the Ministry of Education,

Colleges and Universities. This includes American universities with programs for the deaf and disability related supports such as reader, notetakers, interpreters, etc. Income support for students over and above OSAP will remain with the Ministry of Community and Social Services. It is not clear whether students will have a "right" to these services as they do to Vocational

Rehabilitation services.

6] The Ministry is considering how to fund programs to rehabilitate persons to perform homemaking or to modify homes outside of Vocational Rehabilitation Services.

7] Those with disabilities related to drug or alcohol addiction, said to currently represent 17 per cent of cases, will be transferred to the Ministry of Health.

8] The intention is to plan so budgets are not expended mid-year, but no details were provided. Likewise, waiting lists were recognized as hurting rehabilitation.

9] Eligibility was to be changed from people who are "incapable (because of a disability) of pursuing regularly and substantially gainful occupation...." to "persons with a verifiable long-standing disability which represents a barrier to seeking accepting or maintaining employment."

ISSUES RAISED FOR DISCUSSION

1. Should special training programs be funded (e.g., Discovery) or should all disabled people be in mainstream training?

2. How should self-employment programs be funded (e.g., for consumer-survivors)?

3. Should resources be allocated based on an individual or family income test as opposed to the current universal program?

4. Would the program be discretionary or would it remain "as of right" with an appeal of a refusal to the Social Assistance Review Board?

5. How can others responsible for vocational rehabilitation (e.g., auto insurance, WCB, LTD insurance, etc.) be prevented from "dumping" on the public program?

6. Should the program fund accommodations and pursue employers for reimbursement on behalf of individuals? Some felt this would make human rights protections more

effective and increase funding for rehabilitation. Others felt it would make employers more resistant to hiring persons with disabilities.

7. Direct funding (comparable to that available under auto insurance) was discussed as an option. Disabled people would receive funding with which to purchase services from private, non-profit or public sources. What should be the mix between direct funding and funding programs?

8. How would demand be managed? Would waiting lists continue to be the primary means or should a priority system be established?

9. What about people for whom competitive employment was not a realistic goal? Should there be ongoing self-employment support or employment subsidies?

CONCLUSION

Change at any time can be very stressful. With federal support for VRDP cost-sharing in doubt, and the provincial government cutting funding in many other areas, this is particularly true today of vocational rehabilitation. Groups and individuals are encouraged to make their views known as soon as possible.

Jane E. Meadus

Seniors in hospital with serious health problems sometimes find themselves in a difficult situation. The hospital is anxious to discharge the senior as soon as possible if hospital care is no longer required.

However, the senior may not be able to return home if adequate care is not available. A nursing home or home for the aged may be the only practical alternative.

The senior may resist the suggestion to go to a long term care facility, or an appropriate facility may not be immediately available. The hospital may exert pressure to take the first available bed even if the senior views this as inappropriate.

This article explores the process involved in going from hospital to a long-term care facility in two somewhat different situations. In Part 1, I write about what should happen. In Part 2, the ways in which the process can go wrong are explored.

Part 1

Mrs. S., a seventy-four year-old woman, is admitted to

hospital after falling and breaking her hip. She also has diabetes and has been going blind. Mr. A. is a 68 year-old man admitted to hospital for pneumonia. He also has Alzheimer's Disease which has deteriorated, and his wife can no longer care for him at home.

In both cases, the hospital medical team has determined that placement in a long term care facility (LTCF) is appropriate. Once Mrs. S.'s hip has been treated and she is well enough, a meeting is scheduled with the entire medical team, including a doctor, primary care nurse, social worker and physio-therapist. The team's opinion is that it is no longer safe for Mrs. S. to live in her apart-ment.

Various options, includ-ing community supports, are discussed, but it is strongly recommended that Mrs. S. meet with the social worker, who also has duties in discharge planning, to discuss making an application to LTCFs. Mrs. S. is very upset, but agrees, and a meeting is set up. Mrs. S., a widow, asks that her daughter attend the meeting and assist her. This is agreeable, but it is

emphasized that all decisions must be made solely by Mrs. S.

As for Mr. A., the medical team feels that he is not capable of making a place-ment decision. His wife is de-termined to be the appropriate substitute decision maker pursuant to the Health Care Consent Act (HCCA).

A meeting between Mr. and Mrs. A. and the medical team is scheduled. Mrs. A. states that she can no longer care for Mr. A. at home and an application to LTCFs should be pursued.

A meeting is set up with the hospital discharge planner, whose sole responsibility is to assist patients in planning for their hospital discharge.

The first question asked is "What is a long term care facility and how do we apply?".

In Ontario, LTCFs are defined as municipal homes for the aged, charitable homes for the aged, and nursing homes. Certain facilities cater to specific languages, religious or ethnic backgrounds.

Since 1994, all appli-cations for admission to LTCFs are made to the Placement Coordination Services (PCS) office located in the area where the applicant lives. Applications are re-viewed by PCS to determine eligibility. Once eligibility is confirmed, the application is sent to the chosen LTCFs for approval. Approval can be denied only if the person's needs cannot be met at a particular facility. Applicants are then placed on waiting lists for the chosen LTCFs until a bed becomes available.

The application package contains the following:

consent form application form medical form functional assessment social assessment facility choice sheet evaluator's questionnaire

The applicant will com-plete and sign the consent form, application form and facility choice sheet, while the rest will be completed by professionals. A two-page document specifically prepared by PCS for persons applying for admission to LTCFs from hospital is also to be completed and signed (in Metro only). Other documents prepared by PCS describing the application process and other helpful information is given to assist the applicant with the process (documents vary between PCS offices).

The health care portion of the services is paid by the Ministry of Health. The resident co-payment rates (as of July 1, 1996) for the monthly accommodation portion for long stays are as follows:

basic (ward) accommo-dation (usually 4 people per room)$1,225.62

semi-private (2 people perroom)$1,468.95

private (one person per room)$1,773.12

Mrs. A. states that their income allows them to afford semi-private accommodation.

Mrs. S. becomes upset when her government pensions amount to less than $1,000 per month. She is advised that once admitted to a LTCF, facility staff will assist her in applying for a rate reduction (or an extraordinary rate reduction if necessary). The rate reduction will be granted where the person meets eligibility requirements and supplies the appropriate income documentation. The rate reduction will reduce the accommodation rate, leaving her with $112.00/month spending money.

All of the daily needs requirements, such as food, personal care items, and laundry services are included in the charges, with only

optional personal items such as telephones, cable television and hairdressing services, requiring extra payments.

A list of LTCFs in the area is provided to assist in choosing LTCFs. Mrs. S., who lives in Scarborough, asks if she can also apply in Durham region, because her daughter lives in Whitby. She is advised that she can choose LTCFs from any area and that her application will be forwarded to the appropriate PCS. The social worker provides Mrs. S. with a hospital-prepared sheet and advises that she must choose six facilities, two of which must be identified as having short waiting lists. Her other choices can be any other facilities in the province.

The importance of making an informed decision when choosing LTCFs is emphasized since she must be sure that the choices she makes are LTCFs that she is willing to live in. She must consent to all the facilities included on her choice list, ranking them according to prefer-ence.

It is highly recommended that she or a representative tour each LTCF prior to including it on the choice list. Mrs. S. is advised that once she is medically able to be dis-charged and no longer needs an acute care bed, hospital policy requires her to accept the first bed offered from her list.

However, she can remain on the waiting list

and move when a bed in one of the higher ranked facilities

is offered. If a bed offer is refused without good reason,

the hospital could charge her the daily rate for the bed, which would be very expensive. Mrs. S. feels that she is not well enough to tour the LTCFs and asks her daughter to do this for her, reporting back so that Mrs. S. can make an informed choice. A reasonable timetable is set up for the facility visits and application submission.

At their meeting, Mrs. A. is given most of the same information as Mrs. S. The hospital policy here dictates that five facilities, including two on short lists, be included. Because Mr. A. has been deemed incapable, Mrs. A. will be doing the research and making the facility choices.

The facilities are toured. The most recent facility compliance reports are re-viewed (reports prepared by the Ministry of Health contain findings of facility inspec-tions). Once the choice is made, the carefully reviewed application, consent form and facility choice sheet are completed and sent to PCS.

Since an evaluator (under the HCCA) has found Mr. A. to be incapable of making placement decisions, he is ad-vised of his rights to a hearing before the Consent and Capacity Board, which he declines. (If he had applied for a hearing, it must be held within seven days. He has the right to be represented by counsel and have the opportunity to present his case to the Board. Placement cannot take place

until after the hearing, and only if the Board upholds the finding of incapacity).

After making the application, Mrs. A. wishes to change her mind about one of her choices. She contacts her PCS coordinator directly and the change is made. Mrs. S. asks the social worker to add another facility to the list, because she has spoken with a cousin who lives there and is very happy.

Bed offers are made shortly thereafter. Mrs. S. accepts the bed in her third choice facility immediately and plans are made to transfer her the following day. She decides to remain on the list for her higher facility choices. Mrs. A. is offered the first choice facility, but wishes to discuss the matter with her husband and family. She accepts on her husband's behalf the following morning, but due to a small medical problem, admission is delayed for the maximum of three days, during which time payment must be made to hold the bed.

Part 2

In Part 1, the appropriate application process for long term care (LTC) was outlined. Part 2 attempts to point out some common difficulties and how to avoid or deal with them.

Applying for Long Term Care Facilities

The hospital may want you to make the decision to apply and complete appli-

cations for LTC immediately. These decisions will affect the rest of your life and should not be made too quickly. Problems encountered in the application process should be discussed with the appropriate hospital personnel, and if they cannot be resolved, they should be brought to the attention of your Placement Coordinator from PCS.

However, you must be reasonable in your decisions and with your choices. When acute care in hospital is no longer required, you must act reasonably in assisting with your discharge.

This may include apply-ing to a LTCF that is not your first choice, since it may have a long waiting list. It is unreasonable to expect to remain in hospital for a long time because of waiting lists where other LTCFs, although less desirable, can meet your needs and have short lists.

Application and consent forms must be signed by the person wanting to enter a LTCF, unless they have been found incapable of making decisions regarding admission by an evaluator pursuant to the HCCA. If the applicant is incapable, their substitute decision maker (SDM) then makes decisions on his/her behalf. All information must be provided to the capable person so that they can make an informed decision about admission.

Application Process

Hospital staff may com-plete the PCS application with no input from the person or their SDM, which may result in incomplete or incorrect information. The applicant must have as much input as possible in the process to ensure that the information is correct. Family and friends should be consulted when completing the social assess-ment. The applicant or their SDM should ask to review the application prior to it being sent to PCS.

If refused, ask the Placement Coordinator for a copy. Correct and up-to-date information must be provided to ensure placement in a LTCF which can meet your needs. Any new information should be submitted to PCS as necessary.

Short List Requirements

Most hospitals have a policy requiring that a specific number of LTCFs, including a number with short waiting lists (as defined by the hospital), be included in the facility choice list. No law requires this, but a reasonable number of LTCFs must be chosen, including some with short waiting lists. People entering LTCFs from hospital often must accept a lower ranked LTCF and wait for a transfer to a higher ranked facility.

However, the hospital cannot require you to choose LTCFs which cannot meet your needs. You must advise the hospital of why your

needs cannot be met in those LTCFs which you do not want to include among your choices.

Requirement to Choose Specific Facility or

Restrict ChoiceThe hospital cannot re-

quire you to choose specific LTCFs, nor restrict the location of the LTCFs. You may apply to any LTCF in Ontario. When choosing LTCFs from other areas, it may be helpful if you can advise the hospital if they are considering long or short list facilities.

Requiring You to Choose Facilities Before

Visiting Them

Many hospitals may tell you that it is not necessary to visit LTCFs, or that you can visit them after including them in your application.

You should never include any LTCF on your list until you or your representative (SDM, family, friend) has visited it.

If the LTCF is visited after inclusion on your list, you may be pressured to keep it on the list, especially if a bed offer has been made. Facilities may be added to or deleted from the list at any time.

"First Available Bed" vs. "First Bed Offer" Policy

"First available bed" policies require you to accept

the first bed available in your area, whether or not it has been included in your facility choice list.

"First bed offer" policies require you to accept the first bed offered from your list of LTCF choices.Most hospitals will require you to accept the first bed offer from your list of choices. If you include a LTCF on your list, essentially you are agree-ing to accept an offer of a bed from all of the facilities on the list. This is why you should make enquiries before includ-ing a LTCF on your list.

However, you are not required to accept the first available bed in any facility when you are in hospital, except in limited circum-stances. The following are examples of these exceptions:

where admission to a LTCF is required due to a traumatizing experience - e.g., if you were assaulted by a staff person

where there has been a disaster - e.g., a fire

where there is an unfore-seen closure of the hospital.

The hospital wanting you to accept the bed is not a situation where you could be forced to accept the first available bed in your area.

Social Admits

Some hospitals classify patients as "social admits" to

have them admitted to the first available bed in a LTCF.

Social admits are specific situations where people do

not need medical treatment, but are admitted to hospital tempor-arily due to a crisis situation in the community where admit-tance to a LTCF at that specific point in time cannot be arranged (e.g., because it is the middle of the night). If you are labelled a "social admit" and do not agree, advise your Placement Coordinator immed-iately and indicate what medical treatment you received in hospital.

Signing Agreements with Hospital

Hospitals may ask the patient or their family to sign documents pertaining to discharge planning. Such documents may include agreeing to accept the first bed available in your area when you are ready to be discharged, or accepting responsibility for bed charges for non-compliance with hospital policies.

It is not recommended that such documents be signed. Treatment cannot be refused or withheld because you will not sign such documents. The only discharge planning documents one should sign are the standard PCS application and consents.

Accepting Beds on Patient's Behalf

Some hospitals have policies that they will accept bed offers on behalf of patients. The hospital can never legally do so. The only people who can accept bed offers are the capable person or the incapable

person's SDM. Bed offers do not have to be accepted immediately. PCS generally allows 24 hours for this decision. You should not be pressured into accepting immediately, since there may be changes in circumstances that warrant you changing your mind. If you refuse the bed offer, however, be prepared to provide an appropriate reason for that decision.

Threatening Discharge

Hospitals may threaten to discharge you home when the discharge planning process is not going the way they want. Although the Public Hospitals Act requires physicians to discharge patients from hos-pital when treatment is no longer required, the physician also has a duty to ensure that the person is discharged to a safe environment. If appro-priate care cannot be provided with the help of community services, discharge should not take place. The person should indicate that they will be at risk if discharged into the com-munity. If the person lives with a caregiver who cannot provide the required care, the physician should be advised that the person will not be accepted at home if discharged from hospital. For example, safety is a concern if the caregiver refuses entry of ambulance attendants into the home.

Capable patients, how-ever, cannot be prevented from returning home if they wish, even against caregivers' wishes. Capable people have the right to risk their health

deteriorating, necessitating re-admission to hospital or emergency admission to a LTCF.

Threatening to Charge the Daily Rate

Hospitals may threaten to charge the "daily rate" e.g., if a bed offer is refused or the application is not completed on deadline. A per diem (daily) rate will be billed directly to the person (perhaps $450/day) once acute care hospitali-zations is not necessary. The legality of such charges has not yet been determined by the courts, although it is question-able whether a hospital would be successful in obtaining judgement where the person or their SDM has acted reason-ably in the circumstances and not contracted to make these payments.

Applications to Care Facilities

Hospitals may recom-mend that people apply to retirement homes since some retirement homes offer nursing care and other services. If nursing care is required, one should be cautious and make inquiries since retirement homes are not covered by the same laws as LTCFs.

Legislation sets standards for care and complaints pro-cedures in LTCFs. There are no similar legislative standards for care in retirement homes. While retirement homes are covered by the Landlord and Tenant Act and general public health

rules, these rights can be difficult to enforce.

ACE is a legal clinic which provides advice, representation, public legal education and law reform activities on legal issues relating to seniors. Jane Meadus is a lawyer and institutional advocate there.Part 1 (Vol.2 No.1),Part 2 (Vol.2 No.2) 1996.Reprinted from ACE newsletter.

Metro Consumers for Community-Based Long-Term Care, [reprinted from Network News, #4 November 1996]

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