Thursday, September 20, 2018
We desperately need a ministry that's directly responsible and accountable for the broad portfolio of disability policy
By Jennifer Zwicker
and Stephanie Dunn
Breaking Down Barriers is the galvanizing theme of a recent report from the Senate Standing Committee on Social Affairs, Science and Technology. It outlines urgently-needed recommendations to improve access to underused federal disability supports: the Disability Tax Credit (DTC) and Registered Disability Savings Plan (RDSP).
Some of our most vulnerable members of society face multiple hurdles trying to get access to DTC and RDSP. This includes eligibility criteria that don't reflect the realities of living with a disability and are more strict for people with impairments in mental function compared to those with physical disabilities. It also means a burdensome application processes that can include hidden costs, arbitrary eligibility decisions and opaque claims and appeals processes.
RDSP helps people with severe disabilities and their families to save for the future and the idea of the program was hailed as one of the most progressive savings plans in the world. Yet fewer than 15 per cent of Canadians with qualifying disabilities are accessing this program.
Bureaucracy is the greatest barrier that needs to be broken down. Accountability and measurable action by National Revenue Minister Diane Lebouthillier and Revenue Canada is long overdue.
Yet it doesn't make sense that we're tasking staff at Revenue Canada with determining complex eligibility for much-needed disability savings and income support programs in the first place. The minister of Families, Children and Social Development and the minister of Finance need to heed the Senate recommendations.
The lived experience of the extreme fragmentation of programs and supports is significant.
If you're a Canadian living in low income with a severe disability, you have to prove your disability status to your provincial government to claim disability supports, and then prove your status again to the federal government to gain eligibility to DTC to set up an RDSP.
Completing these applications is not without cost; people can pay hundreds of dollars to their physicians to complete an application form certifying their disability (in some cases every year). And the certification is out of touch with global standards of disability determination. As well, many bank branches simply don't support in-person setup of RDSP.
For this to happen, collaboration between ministries and across different levels of government is needed. Yet recommendations of this nature aren't new in Canada. In the 1998 In Unison: A Canadian Approach to Disability Issues report, ministers agreed that "More effective and co-ordinated programs would better serve Canadians with disabilities and the country as a whole."
That this statement is as true today - two decades later - demonstrates that effective action has failed to follow this intergovernmental vision.
How can we turn this dismal lack of action around? Can the current federal Liberal government make it happen?
Let's hope so.
In the short-term, the federal government needs to mandate that the ministry of Finance, the Canada Revenue Agency, and Employment and Social Development Canada enact the recommendations outlined in the Senate report, ensuring collaboration where required.
In the longer term, Canada desperately needs a strong and empowered ministry that's directly responsible and accountable for the broad portfolio of disability policy, including supports and rights-based legislation.
This ministry should engage with provinces to determine how to best streamline federal and provincial disability supports.
Finally, all parties need to realize that the current system is working against Canadians with disabilities. Denying this already disadvantaged group access to the supports that they need - and are entitled to - works against our vision of an inclusive Canada.Dr. Jennifer Zwicker is a director of Health Policy at the School of Public Policy and assistant professor in the Department of Kinesiology at the University of Calgary. Stephanie Dunn is a research associate in the Health Policy division at the School of Public Policy at the University of Calgary. They are both contributors with EvidenceNetwork.ca, which is based at the University of Winnipeg.
Monday, September 17, 2018
It's clear the status quo isn't meeting the needs of our aging population. So what can be done?
By Ruta Valaitis
and Maureen Markle-Reid
Despite having diabetes and arthritis, Verne was a thriving independent 72-year-old who lived at home with his wife when he had a stroke. He had excellent emergency care in the hospital and began his recovery there. But he didn't adjust well after arriving home. He started to show signs of depression and was at risk of re-hospitalization.
Verne feared he would have another stroke as he waited for follow-up appointments with neurology, physiotherapy and speech pathology. He had difficulty remembering to take his new medications and adapting to using a walker.
Add to this the challenge of managing complex health conditions and the risks for depression and recurring poor health and hospitalization are high.
Unfortunately, Verne's experience is not uncommon.
The 2016 State of Seniors Health Care in Canada report from the Canadian Medical Association (CMA), highlights a key problem: our medicare system was established to deal largely with acute, episodic care for a relatively young population.
Today, our system struggles to care properly for patients managing multiple ongoing health issues. We know older adults with chronic conditions need more health services and have a higher risk of hospitalization compared to those with a single chronic condition.
Adults 65 years and older are the fastest growing age group in the country. In Ontario, 16.7 per cent, in British Columbia and Quebec 18.3 per cent, and in Nova Scotia 19.9 per cent of the population is 65 years or older.
Like Verne, these patients face several challenges in managing their conditions. A lack of care co-ordination amongst health professionals combined with low health literacy gets in the way. Their care is piecemeal and fragmented, with little focus on the patient and family as a whole. Limited financial resources to cover the costs of supplies, additional care and transportation also create barriers to self-management.
These seniors often experience loneliness. Their family caregivers often lack support. Managing multiple, often interacting medications is also difficult.
So what can be done? We asked seniors to find the answers.
As researchers with the Aging, Community and Health Research Unit at McMaster University, we're working with older adults with multiple chronic conditions and their family caregivers to promote optimal aging at home.
Community Assets Supporting Transitions (CAST) is a new hospital-to-home transitional care program in Sudbury, Burlington and Hamilton that aims to reduce depressive symptoms, improve patients' quality of life and self-management ability, and support family caregivers. CAST is delivered by registered nurses who support patients transitioning from hospital to home over a six-month period through in-home visits, telephone follow-up and care co-ordination.
There's also a community-based diabetes self-management program in Ontario, Quebec and P.E.I. that was developed for older adults with diabetes and multiple chronic conditions. The program includes monthly wellness sessions, and a series of home visits with a registered nurse and a registered dietitian. They work as a team with staff and volunteers from seniors centres or YMCAs to deliver a health promotion program for participants.
We've also been creating a new way of providing outpatient stroke rehabilitation services for older adults with stroke and multiple chronic conditions living in the community. We provide regular in-home visits for the patient and monthly interprofessional care conferences for the providers. We also developed a new web-based app, MyST (My Stroke Team), to support communication and collaboration among the interprofessional stroke team.
Clearly, the status quo isn't meeting the needs of our aging population and fails to provide quality care for seniors. Creating innovative pilot projects to improve the transition from hospital to home will help us provide a better system that's both more efficient and cost-effective, and will improve the standard of care to seniors like Verne.Dr. Ruta Valaitis is a professor McMaster University School of Nursing, the Dorothy C. Hall Chair in Primary Health Care Nursing and co-scientific director of the Aging, Community and Health Research Unit and a contributor with EvidenceNetwork.ca, which is based at the University of Winnipeg. Dr. Maureen Markle-Reid, is a professor McMaster University School of Nursing the Canada Research Chair in Person-Centred Interventions for Older Adults with Multimorbidity and their Caregivers and co-scientific director of the Aging, Community and Health Research Unit.
Thursday, September 13, 2018
Chicken Pot Pie -this classic homemade chicken pot pie is the ultimate comfort food! Learn how to make this easy chicken pot pie recipe and you’ll never buy a chicken pot pie again!