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M E M O /
N O T E D E S E R V I C E
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To / Destinataire
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ToHealth, Recreation and Social
Services Committee
Comité de la
santé, des loisirs et des services sociaux
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File/N° de
fichier: File NumberACS2003-CCV-HSS-0001
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From / Expéditeur
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FromCommittee Coordinator
Coordonnatrice
du Comité
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Subject / Objet
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SubjectEquity in Health and Social
Services in Ottawa
Equité en
matière de services sociaux et de santé à Ottawa
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Date: Date2 September 2003
Le 2 septembre
2003
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BACKGROUND
The Health and Social Services Advisory Committee (HSSAC) met with
representatives from the Carlington Community Health Centre (CHC) on 25 Feb
2003 and with the Ottawa Coalition of Community Health and Resource Centres at
the Centertown CHC on 26 May 2003. The purpose of the meetings was to identify
which health and social services in the city were working well and which ones
needed strengthening.
Subsequently the HSSAC, at its meeting of 23 June 2003, considered a
report from Member L. Diem and approved the following recommendations:
1.
The Health
Recreation Social Services Committee and City Council support the funding requests from the Community Health
and Resource Centres.
2.
The Health Recreation
Social Services Committee and City Council advocate to the Ontario Ministry of
Health for more funding and to other ministries for coordination of services on
behalf of the Community Health and Resource Centres.
DEPARTMENTAL COMMENTS
“The (People Services) Department
acknowledges and values the important contributions that the 14 Community
Health and Resource Centres make in the community by providing a diverse range
of services to residents. These services reduce poverty, increase community
participation, improve health and the overall quality of life for children,
adults and families.
In 2003, the City increased the level of funding to the
14 Centres by $ 472,687. The 2003
combined funding to all Centres (project funding and sustained funding) is $
6,162,139. This represents an increase
of 8.3% between 2002-2003. The Department acknowledges that Centres respond to
increasing community needs in responsive ways by building effective
partnerships with community agencies and volunteers. This level of City funding
recognizes the important role of Centres in our service delivery system.
Domiciliary Hostels
The Department
subsidizes approximately 850 individuals in 25 privately owned domiciliary
hostels. These facilities are not nursing homes or retirement homes but the
operators do provide personal care services as well as supports for daily
living to adult men and women who are frail, elderly and/or have special needs
that may include mental health illnesses.
The operators attempt to establish working relationships with community
resources to support their residents.
However, the Department and the domiciliary hostel operators recognize
that the resources for both physical and mental healthcare are limited.
Although the
level of subsidy ($40.90 per diem) presents challenges for the hostel
operators, they are expected to comply with all the conditions of a contract
that outlines applicable municipal, provincial and federal legislation
regarding property, fire health and safety standards. There are also strict terms and conditions, which outline the
amount of personal space, ventilation, lighting, nutrition, management of
medication, and opportunities for recreational activities.
The
Department’s contract administrator conducts a formal site visit at least once
a year, notes any deficiencies, issues warnings in writing and follows up to
ensure compliance. There are also site
visits in response to complaints from any of the stakeholders or to review
concerns expressed by other city staff, which regularly visit these facilities
to monitor the continuing eligibility of the clients for subsidy and other
benefits”.
Appendix
1
EQUITY IN HEALTH AND SOCIAL
SERVICES IN OTTAWA
Report from the Health and Social Services Advisory
Committee
To Health
Recreation Social Services Standing Committee and
Date: July 17, 2003
Background
The Health
and Social Services Advisory Committee (HSSAC) met with the staff at Carlington
Community Health Centre on Feb. 25, 2003 and with representatives from the
Ottawa Coalition of Community Health and Resource Centres (CHC's and RC's) at
Centretown CHC on May 26, 2003. The purpose of the meetings was to identify which
health and social services in the city were working well and which ones needed
strengthening.
Findings
The HSSAC
was impressed with both the range of health and social services offered by the
CHC's and RC's and how they coordinate their services. For example Centretown
CHC has developed a diabetic program that is used throughout the city; Somerset
West has special programs for the Asian population of the city; and Sandy Hill
has specialized programs for the homeless. They willingly share their knowledge
with each other, and work closely with many of the City programs and volunteer
organizations in the City.
The CHC's
and RC's are struggling to provide needed programs. Most of the difficulties
stem from reduced funding. They are in a squeeze. They receive less money from
the Ontario Ministry of Health and the City at the same time as the people they
serve have less money. The people they serve cannot deal with a medical
condition or seek employment when they are worried about food and shelter.
A second
difficulty is the restrictions of some services, such as education and
employment programs that prevent people from gaining the knowledge and skills
to improve their lives. Lack of appropriate funds and programs restricts the
services available to the working poor, people living in poverty, homeless
people, people with mental illness, people who do not speak English or French,
people who have little education, people with a debilitating chronic illness,
and people trying to raise children without resources or supports. Under the
present conditions, the skills and talents of most of these people and their
children will be lost to the economy of the city and country.
The CHC's
and RC's provided the following examples from their everyday practice of the struggles
of some of the residents of Ottawa:
Example 1: Warehousing people
with chronic mental illness
One particular group of people suffering from chronic mental
illness are living in appalling conditions. The following is a description from
one of the mental health workers at Carlington:
"There is huge overcrowding in domicilary housing
units. In some cases, there are 60
residents living in 6 units with many units having 3-4 adults living in a
bedroom with no privacy. Stealing occurs often and smoking is a big problem as
there is not proper ventilation. These
people do not participate in recreational activities and/or daily chores such
as cooking and cleaning since they have no kitchen or laundry privileges. Out
of boredom, they spend too much time sleeping.
They do not have control of what they eat; it is often fattening which
results in sickness. Because of some medications, the clients get a dry mouth
and end up drinking soft drinks, as opposed to fruit juices or water, which are
not available. These conditions which
are basically warehousing the residents, increase the chances of a relapse. The
clients only get $112/month for personal expenditures. Staff, who are often underpaid ($8/hr), deal
with high levels of stress, which results in a high turn over of
staff."
Additional information: The domiciliary hostels provide
shelter to people suffering from chronic mental illness. If the hostels were
not available, the people would be on the street. Some hostel owners try to
provide a decent service and reduce overcrowding, but the monetary return is
simply too low. While a licence (for
bylaw regulations) is required from the City to operate these units, there do
not appear to be standards for space, staff qualifications, nor dispensing of
medication; or funding to support the implementation of standards.
Example 2: Quandaries of
families who do not speak English or French
Another health professional from Carlington deals with
multicultural families. She provided the following explanation of their situation.
"All of the issues and concerns that were raised
[poverty, housing, and nutrition] also apply to my clients. Also, they do not know how to reach the
services they need or get support because of language barriers and not knowing
who to ask. I am told that it is particularly difficult to obtain a job at the
City of Ottawa. A great many highly educated professionals are trapped in
minimum wage jobs paid by the hour. They do not have work schedules which allow
them to take English/French courses and if they leave their jobs to upgrade
their skills, they do not qualify for social assistance. Many refugees suffer
from post-traumatic stress disorder which is made worse by their living and
working conditions.
There are also school problems. Children who arrive in
Canada and are immediately put in schools are expected to act and behave like
the rest of the students. Some of these children have experienced tragic events
in their countries of origin (e.g., war) and I feel that an orientation session
to prepare students for the Canadian system and allow them to speak a little of
their experiences would benefit.
Mental health problems are another area of concern because
of the huge stigma attached to having a mentally ill family member and not
knowing where to seek help in Canada."
Example 3: People
and families who do not fit within present system.
Presenters from the CHC's and Resource Centres identified
that they cannot meet overlapping needs that would make a difference for many
residents. They suggest that better funding, planning and coordination could
address some of these needs:
"A high number of clients are single parents, in
abusive relationships and have mental health issues. A lot are unemployed and many families are from an ethnic
background.
Most clients have multiple issues i.e. not enough money to
buy food."
"More clients we deal with are depressed and in some
cases attempt suicide. The need is so
great that the Centre has to turn some clients down. We are looking for more
funding."
"There are lot of people with serious diseases and what
concerns me is these people should be thinking about getting well and not
having to think about how to put food on the table. Many clients have poor
diets. I also take care of replacing household items and clothing. There are a lot of large immigrant families
on waiting lists for affordable housing and the problem will only get worse as
there is not enough housing in Ottawa."
"Much more can be done for these people, but because of
lack of funding, housing, facilities, and services, staff’s hands are
tied. They would like to be more
proactive but lack of resources leaves no time for planning. The largest increase in clients is among the
working poor."
RECOMMENDATIONS
Since the CHC's and RC are ideally located in the community
and have the expertise and the commitment to provide timely and cost effective
services at a time when their services will prevent the health and social
problems from becoming more serious and long term, we therefore recommend:
1.
The Health
Recreation Social Services Committee and City Council support the funding requests from the Community Health
and Resource Centres.
2.
The Health Recreation
Social Services Committee and City Council advocate to the Ontario Ministry of
Health for more funding and to other ministries for coordination of services on
behalf of the Community Health and Resource Centres.
Appendix
2
Extract of Draft Minute
Health
and Social Services Advisory Committee
23 June
2003
UP-DATE ON SUB-COMMITTEES
MISE-À-JOUR
SUR LES SOUS-COMITÉS
That the Health and Social Services Advisory Committee receive an
update from representative of the following sub-committees:
Equity in Health and Social Services
in Ottawa
Member L. Diem has distributed by
e-mail a copy of the Sub-Committee’s Report “Equity in Health and Social
Services in Ottawa”. Members are asked
to review the report and provide comments as soon as possible.
Committee Members made the following
comments on the report:
·
That
the centres do not have sufficient funding to handle all the problems out
there;
·
That Committee should describe the good things about
health and resource centres and then describe their challenges and
frustrations, before going into how the overall "present system" is
failing selected groups of people.
·
The Committee should be extremely careful not to
provide ammunition to those who might argue that the best direction for future
health care delivery would lie in providing more funding to hospitals at the
expense of health centers;
·
For all the CHC's and Resource Centres, the poorly
served residents include the working poor, people living in poverty, homeless
people, people with mental illness, people who do not speak English or French,
people who have little education, people with more than one or a debilitating
chronic illness;
·
People are trying to raise children without resources
or supports;
·
People who are poorly served do not fit into the
present system because the system is not designed to handle people with
overlapping and overwhelming needs. Coordinated services could provide more
continuity and flexibility to match needs and services".
The Committee agreed that Member L
Diem would rewrite the recommendations and provide members with the Final
Report before the next meeting.