ARCH!TYPE

In
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Editorial: Balancing the Disability Agenda
Who Loses What? The Impact of
"MegaWeek" on People with Disabilities
- Social and Community Health Services
- Housing and Related Services
- Health & Long-Term Care
- Education
- Municipal and Regional Transportation
Ontarians with Disabilities Act:
An Update
Open Letter from Income Maintenance
Group to Community & Social Services
A Review of the Proposed Reform of the
Workers' Compensation Act
Disability and Work: Solutions for
Canadians
Winter
1997
ARCH!TYPE is published by ARCH,
Editorial
David
Baker,
A LegalBoard:
Resource
Centre
forHarry
Persons
Beatty,
Patti Bregman,
Lisa by
Weitz
with Disabilities.
It is read
disabled
and non-disabled readers alike,
Production/Subscriptions
including consumers/advocates,
Lisa
Weitz
government,
service providers,
community organizations, employers,
Cover
Illustration:
unions,
professionals, families and
Steve
Cartwright,
April Rigg,
Lisa Weitz
others
with an interest
in disability
issues.
Printing: Pressing Business Printing
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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Ontario Building Code Proposals Released
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Also available in large print, disk,
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Accessible Buses Prove Themselves
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Supreme Court of Canada Hears Eaton
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ARCH!TYPE
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How to File A Human Rights Complaint
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Death, Testimony and Inquest:
A Critique
5
An Open Letter from the Council of
Canadians with Disabilities [ Latimer]
5
Thumbs Up for Task Force on Disability Report
5
News in Brief
6
Bulletin Board
7
Advertising Rates
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ARCH Member Groups
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Winter 1997
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Winter
1997
1
E
d
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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 cutbacks 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.
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WHO LOSES WHAT?
The Impact of "MegaWeek" on
People with Disabilities in
Ontario
Winter
1997
3
4
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Winter 1997
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 amalgamating 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 Provincial
Government
has 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 housing
It 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
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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.
Winter
1997
5
 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,
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Winter 1997
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 governments 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?
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 costshared 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.
8] LEGISLATION AND PUBLIC DISWhether 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
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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
Winter
1997
7
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
Reserve
Social
Assistance
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.

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
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
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ARCH!TYPE
Winter 1997
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 provincewide 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 longterm care and social services to the municipal level
run the risk of fragmenting the system rather than
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unifying it, as many important components of the
health and social services system will remain at the
provincial level. The particular consequences in
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
Winter
1997
9
the area of health and long-term care will be
discussed below.
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?
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Winter 1997
5] Impact on Social Service Agencies
The government says that these new social
! 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?
services will be delivered by 50 new community
service agencies instead of the hundreds of existing
agencies.
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?
! 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
! 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 lowincome households including seniors and persons
with disabilities. The programs are either federally
or provincially funded or both funded.
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There are three types: Ontario Housing
Corporation, rent-supplement housing and nonprofit corporations. Many tenants pay rent-geared
to income with government subsidies for the full
Existing Program
Total subsidies now are $1.4 billion/year.
$886 is provincial, $564 federal.
Ontario Housing and rural, urban and native
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
Rent Supplement Housing:
13,000 units.
$81 million/year: $49 million provincial, $32
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 nonprofits, 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.
Winter
1997
11
cost. The government subsidizes the different
between market rent and the subsidized cost in
some housing. There are 275,000 units of social
housing.
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
housing:
market rent any change in the market rent will
increase the cost to the municipality.
! Will the government require all
portfolio through
54 local housing
authorities.
municipalities
to provide
social housing
and rent subsidies?
! Will
the
government
prohibit
million federal.
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?
Timeframe for Change
3] Hostel programs:
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.
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.
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
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ARCH!TYPE
Winter 1997
! 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
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:
news release from the Minister and
Community and Social Services suggests
that there will be no required service.
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?
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.
! Will the transfer of fiscal responsibility
occur before the establishment of the longterm care agency?
2] Home Care and Other Services:
! Who will decide what services will be
provided and the amount of co-payments,
if any?
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:
! 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?
ARCH!TYPE
! Will property tax revenue allocated for
long-term care be allocated on a provincewide basis? In other words, will
municipalities that do not have a longterm 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.
Winter
1997
13
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 LongTerm Care agency to be invested in new
services or sent to the province, municipal
government or service providers?
 QUESTIONS ABOUT CHANGES
TO EDUCATION
14
ARCH!TYPE
Winter 1997
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
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:
government announced that grants for 1997-98
would not be cut.
2] Special Education Funding:
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
ARCH!TYPE
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.
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.
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
1997
15
! 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
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.
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.
Winter
 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
16
ARCH!TYPE
Winter 1997
Accountability Office, established by 1996
legislation and headed by Bette
Stephenson will address the issue of
standardized testing and the accommodation of children with disabilities?
3] Provincial Schools:
! What will happen to the provincial
schools?
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.
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:
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
ARCH!TYPE
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
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.

the province should proceed with the
Community Transportation Action Program
to coordinate and integrate existing
transportation services (August 14, 1996)

make service delivery more efficient by
reducing costs, eliminating duplication and
clarifying accountability (November 4, 1996)

transfer the province's financial responsibility
for municipal transit operating ($193 million)
and capital - excepting subways ($165
million) 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 to
the taxpayer"
1997
17
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 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 intermunicipal service coordination and
integration

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 for
GO Trains (December 20, 1996)

a Greater Toronto Services Board to assume
the $110 million responsibility for GO Transit
(December 23, 1996).
5] Crombie Panel
The Transportation and Utilities Sub-Panel of
the Who Does What Panel made the following
recommendations:
Winter
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 the
Toronto 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 the
subway.

GO Transit is transferred to the municipalities

Milt Farrow was appointed to review "the
importance of cross-boundary GO service as
18
ARCH!TYPE
Winter 1997
part of his broader review of a possible
Greater 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 crossboundary services for special transit?

ARCH!TYPE
Winter
1997
19
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.
October 3, 1996
20
ARCH!TYPE
Winter 1997
While these public statements are desirable, they
your government have not yet made any substan
Hon. Marilyn Mushinski
develop and pass an Ontarians with Disabilities
Minister of Citizenship,
and Recreation
law is Culture
to be passed
which will achieve a barrier77 Bloor St. W., 7th
Floor
it must be in place and working well before the e
Toronto, Ontario the worse because we have waited through the s
M7A 2R9
for developing and implementing an Ontarians w
to present to us by mid-summer, according to yo
Dear Ms. Mushinski:
you.
I am writing on behalf of the Ontarians with
Disabilities Act Committee, of which I am coChair, 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.
ARCH!TYPE
8 Easy Steps to Help Secure a Strong
Ontarians with Disabilities Act
If 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 1
Join 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) 9795514.
Step 2
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 3
Get friends and associates to join the
Ontarians with Disabilities Act Committee. Tell
Winter
1997
21
that a meaningful Ontarians with Disabilities Act
We
May
Premier
look
we forward
respectfully
and the to
cooperation
hearing
requestfrom
that
of all
youoffollow
atthe
your
other
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M
proposals
ODA
have to
anbe
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set"meaningful"
out in
For
this
that
letter.
and
reason,
to "have
we respectfully
teeth", withp
you
together
the following
to seek athree
meeting
actions:
with the Premier. We
Yours sincerely,
1.
Could you please advise us of you
and with the broader community to develop an OD
which we tabled with you on June 14 of this year.
M.
September
David Lepofsky,
28, 1996 C.M.,
presentation,
LL.B., LL.M.
you indicated it
introduction of such legislation, even though you
cc:
proposed
Naomi
reforms
Alboin,
to theDeputy
OntarioMinister,
Human Rights
77 Bloor
Co
the Ontario
Karen
Human
Cohl,Rights
Assistant
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the same
Minister,
is feasi
Po
received5th
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Toronto
forON
an implementation pro
brief discussion
M7A 2R9
with you about the process in ord
possible. Any public consultations must, in our vi
options to be considered. For example, your limite
Opportunity Plan was conducted with the fatally-f
must be voluntary and non-legislative. Such pre-c
2.
We ask that you direct your Mini
and develop a wide range of policy options for me
Ontarians with Disabilities Act, to promote the go
through identification and removal of existing bar
research could, for example, look to different met
tried or considered in other jurisdictions, such as t
appreciate it if any research on these policy option
community who are interested in promoting a barr
then be able to benefit from the constructive feedb
3.
Finally, we ask that you assist us
soon as possible to discuss the implementation of
Disabilities Act. As you know, he has consistently
our June 14 meeting with you, we asked for your
in a meeting with the Premier. At that time and su
your public appearance at the ARCH Annual Gen
response to my repeating this request, you gave a
Even though you are the Minister Respon
a meaningful Ontarians with Disabilities A
the Premier and the cooperation of all of t
legislation would have an impact. For tha
interest and yours to join together to seek
your refusal to help in this regard.
We look forward to hearing from you at your earli
proposals set out in this letter.
Yours sincerely,
M. David Lepofsky, C.M., LL.B., LL.M.
cc:
Naomi Alboin, Deputy Minister, 77 Bloo
Karen Cohl, Assistant Deputy Minister, P
Floor, Toronto ON, M7A 2R9
22
ARCH!TYPE
Winter 1997
them what we are all about and encourage them to
make their voices heard too.
Phone 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 5
Contact 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 windowdressing.
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. Harris
Premier of Ontario
Step 4
Legislative Building, Queen's Park
Toronto, 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 Mushinski
Minister of Citizenship, Culture
and Recreation
77 Bloor St. W., 6th Floor
Toronto, Ontario
M7A 2R9
Or fax the letter to: (416) 325-6195.
Step 7
Help 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 8
If 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
ARCH!TYPE
information, contact the Committee c/o:
Steve Kean
Spina Bifida and Hydrocephalus Assn of Ontario,
310 - 35 McCaul St.
Toronto Ontario M5T 1V7
(416) 979-5514.
Winter
1997
23
24
ARCH!TYPE
Winter 1997
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.
It was also proposed that only disabilities expect
people with cyclical disabilities have difficulty in
with mental health problems or multiple sclerosi
make it extremely difficult for these individuals
October 23, 1996
The Honourable Janet Ecker
Minister of Community and Social Services
6th Floor, Hepburn Block
80 Grosvenor St.
Toronto, ON
M7A 1E9
Re: Income Program Proposals
Dear Ms. Ecker:
The Income Maintenance Group is a coalition
disabilities. It has met regularly since 1978 to
respect to social assistance and other program
disabilities.
The IMG is greatly concerned about the impli
disability which were presented on October 8t
are convinced that this proposed definition wi
allowance recipients ineligible for the new pro
Who is disabled?
According to the proposals, only people with
and/or employment will be eligible for the new
dependent on the perceptions of others. It doe
and barriers that prevent people with disabilit
community activities. Research done by the R
with "moderate" and "mild" disabilities canno
are not made to meet their needs.
ARCH!TYPE
Winter
1997
25
For more information or to get involved with the IMG, contact:
*
increased asset exemption for pe
*
of the rule
requiringof
lifethe
in
The proposals
dorepeal
not include
a recognition
Scott Seiler, Coordinator
disabilities. Factors such as age, lower education l
2121 Roche Court
* whether
payment
of 25%
of Assist
determining
a person
withofacost
disability
is a
Suite 425
overcome these obstacles are often not available e
Mississauga, Ontario
These
are improvements in the direction that the I
restrictive.
L5K 2C7
a system that would be based solely on income an
Tel: (905) 855-6940 Fax: (905) 823-1083
proposals,
butimplementing
they should this
not definition
be "paid for"
by
The result of
will be
forced into the Ontario Works program. They will
Also see information about an upcoming conference about Employment
which many will
beNew
able Program
to comply with. They
andnot
the
disability and social assistance on page 53.
the 21.6% welfare rate cut. Many will be unable to
As
stated by Ministry
staff and yourself
at the
medications.
Their disability-related
needs
willOct
no
organizations,
including
theCurrently
IMG, have
advocated
forced to live on
the street.
there
are an
as
an eligibility
It is important
to many
make more
the sya
homeless.
Thesetest.
proposals
will place
losing their right to assistance when needed. We d
unemployable",
test
beand
narrowed
an
It was also statedthe
at eligibility
the October
8th
9th consu
apply to General Welfare Assistance/Ontario Wor
We
aremunicipalities
concerned that
people
withRegion),
disabilities
many
(such
as Peel
thiswil
w
able
to findleaves
real work
either,
of their
disab
stripping"
people
withbecause
disabilities
destitute
employment
market. Discriminatory attitudes, lack
circumstances.
transportation and personal supports prevent many
working.
Your government
has repealed
Empl
In the "Common
Sense Revolution",
yourthe
Govern
plan
to address
systemic barriers.
170,000
people these
with disabilities
and seniors who r
people being disqualified by the new system. In fa
We
acknowledge
you and
your system.
officialsTo
have
disabilities
would that
be given
a better
quo
proposals for persons with disabilities and the IMG
are known.
Another important step in welfare reform
the disabled -- out of the "welfare syste
We appreciate
opportunity to consult with you
the firstthe
place.
consideration to our submissions, especially relate
We will establish a new and separate inco
Yours sincerely,
work. Funding for this program will be
disabled will not be cut.
Marilyn
Ferrell
The Income
Maintenance Group asks for your ass
Chair
Family Benefits be transferred onto the new system
eligibility.
Improvements in the New Program
The proposals presented on October 8th and 9th c
important are:
*
increased asset level for single rec
*
increased inheritance trust capital
*
increased asset exemption for per
*
repeal of rule requiring life insura
26
ARCH!TYPE
Winter 1997
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
ARCH!TYPE



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).
Winter
1997
27
Postal Service Customer Council
Canada 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 PSCC
600-1809 Barrington St., Halifax NS, B3J 3K8
Coordinator: Phyllis Turner
Phone: (902) 420-8643 (accepts collect calls)
Quebec PSCC
536-2 Place Quebec
Quebec City, Quebec, G1R 2B5
Coordinator: James Haberlin
Phone: 1-800-529-8995
(418) 529-8995
[cont'd on p.51]
28
ARCH!TYPE
Winter 1997
Bob White
[Based on a speech presented to the National Conference on Disability and Work, Oct. 7, 1996]
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
In response to these changes, the Canadian
Federation of Independent Business was quoted as
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.
saying that employers in the province of Manitoba
were happy about the rebate, but are worried about
ARCH!TYPE
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).
Winter
1997
29
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
They are getting ready Claims management does not really save injuries by offering prizes,
to hand over the Ontario
such as company jackets
money. It just displaces the costs from
workers'
compensation
and even vacations
one system to the next. When the
system to their friends, like workers' compensation system fails, other
private
insurance
abroad to the worker or
public systems are left to pick up the
companies. The proposals
work team that goes the
pieces. It is sort of a new twist on the
currently under considerlongest amount of time
federal/provincial devolution.
ation will allow for the
without filing a compenprivatization of the workers'
sation claim. Then, when
compensation sys-tem for the first six weeks of a
claims are filed, many employers have a standard
claim. The days of an independent system where
policy of appealing every case. Claims
workers are treated with some respect and dignity,
management is very straightforward - ten claims
have access to an appeals system and know the
filed - six denied - a net savings of big dollars for
rules of entitlement, will be gone.
the company, but an injustice to the six workers.
A company jacket worth $25 or even a vacation
Instead, injured workers will have to rely on
package at $3000 is still far less than the average
the good will and dominance of their employer and
claim costs of about $6000. An uninjured worker
insurance company to provide them with income
is a much greater saving, even in terms of dollar
support and rehabilitation. Workers compensation
value.
boards across this country paid out $5 billion in
benefits, or an average of $6,170 per claim to
Yet, claims management does not save
workers in 1994 (the most recent year that statistics
money. It just displaces the costs from one system
are available).
to another. When the workers' compensation
system fails, other public systems are left to pick
When you combine that figure with the
up the pieces. It is sort of a new twist on the
indirect costs - loss of productivity, training costs
federal/provincial devolution.
for replacement staff, damage to equipment and
materials, wages and time loss for the duration of
Right now, the federal social programs for
Minister of Human Resources Development
people with disabilities are being wound down.
Canada told people with disabilities not to bother
According to the Globe and Mail (Sept.14/96), the
him - that they are now a provincial responsibility.
30
ARCH!TYPE
Winter 1997
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 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% selfinsured). 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.
ARCH!TYPE
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
Winter
1997
31
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.
32
ARCH!TYPE
Winter 1997
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.
Vocational
Rehabilitation
Services Under
Review
David 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 Waxman
Opportunities for Persons with Disabilities
Branch
56 Wellesley Street W., 17th Floor
Toronto, Ontario
M5S 2S3
Fax: (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 redirected. Establishing eligibility would be
based on existing documentation and client
submissions for VRS plans, with assessments
done only in rare cases.
ARCH!TYPE
4]
5]
6]
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.
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.
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."
1997
33
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?
The Ministry is considering how to fund
programs to rehabilitate persons to perform
homemaking or to modify homes outside of
Vocational Rehabilitation Services.
7]
Winter
 CONCLUSION
 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)?
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.
34
ARCH!TYPE
Winter 1997
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 physiotherapist. The team's opinion
is that it is no longer safe for
Mrs. S. to live in her apartment.
Various options, including 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 placement decision. His wife is determined 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
ARCH!TYPE
to specific languages, religious
Since 1994, all applications for admission to
LTCFs are made to the
Placement
Coordination
Services (PCS) office located
in the area where the applicant
lives. Applications are reviewed 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 complete 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
However, she can remain
or ethnic backgrounds.
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) accommodation (usually 4 people
per room)
$1,225.62

semi-private (2 people per
room)
$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
on the waiting list and move
Winter
1997
35
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 preference.
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 discharged and no longer needs
an acute care bed, hospital
policy requires her to accept
the first bed offered from her
list.
when a bed in one of the
36
ARCH!TYPE
Winter 1997
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 reviewed (reports prepared by
the Ministry of Health contain
findings of facility inspections). 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 advised 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 applications 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 applying 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
ARCH!TYPE
Hospital staff may complete 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 assessment. 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
Some hospitals classify
patients as "social admits" to
cannot be met in those LTCFs
which you do not want to
include among your choices.
Requirement to Choose
Specific Facility or
Restrict Choice
The hospital cannot require 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
Winter
1997
37
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 agreeing to accept an offer of a bed
from all of the facilities on the
list. This is why you should
make enquiries before including 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 circumstances. 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 unforeseen 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
"First available bed"
policies require you to accept
have them admitted to the first
available bed in a LTCF.
Social admits are specific
situations where people do not
38
ARCH!TYPE
Winter 1997
need medical treatment, but are
admitted to hospital temporarily due to a crisis situation in
the community where admittance 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 immediately and indicate what
medical treatment you received
in hospital.
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.
Signing Agreements with
Hospital
Accepting Beds on
Patient's Behalf
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 hospital when treatment is no
longer required, the physician
also has a duty to ensure that
the person is discharged to a
safe environment. If appropriate 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 community. 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.
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.
Capable patients, however, cannot be prevented from
returning home if they wish,
even
against
caregivers'
wishes. Capable people have
the right to risk their health
deteriorating, necessitating readmission to hospital or
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
noncompliance 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.
Threatening Discharge
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 hospitalizations is not necessary. The
legality of such charges has not
yet been determined by the
courts, although it is questionable whether a hospital would
be successful in obtaining
judgement where the person or
their SDM has acted reasonably in the circumstances and
not contracted to make these
payments.
Applications to Care
Facilities
Hospitals may recommend 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 procedures 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
ARCH!TYPE
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.
Winter
1997
39
40
ARCH!TYPE
Winter 1997
Metro Consumers for Community-Based Long-Term Care, [reprinted from Network News, #4 November
1996]
table
ARCH!TYPE
table cont'd
Winter
1997
41