The Ford government looks to be trying to avoid any type of democratic debate when it comes to eligibility of health services particularly for the disabled. It’s been long known that the Ford Government is looking at redefining eligibility to the Ontario Disability Support Program (ODSP). Before we get into the details here I need to explain the difference between legislation and regulations. Legislation requires democratic debate, while regulations allow the government to make changes without debate, and/or public oversight.
Bill 175 – Connecting People to Home and Community Care Act – is allowing the Ford government autonomy over a broad swath of services that the disabled rely on, and not just those on ODSP will be impacted. It’s everyone relying on any type of support from government in the disability community.
Arch Disability handed a written submission to the committee studying this bill. All of their recommendations were rejected by the Ford Government and come with chilling warnings for the disabled and their caregivers. Arch Disability had the following concerns regarding introducing the power of the government to regulate rather than legislate (emphasis added):
ARCH is very concerned with the new legislative framework proposed in Bill 175 as it is silent on many fundamental aspects of service delivery currently enshrined in HCCSA. Rather, Bill 175 shifts important matters wholly to regulations to be developed at a future time.
Moving key aspects of the law into regulations is problematic for at least three reasons. First, regulations are intended to be a vehicle used to fill in details of a statute. They are not meant to address entire and critical aspects of that statute, as is the case with Bill 175.
Second, the content of regulations can be altered without the oversight of the Legislature. This significantly contributes to a lack of oversight and transparency.
Third, this shift creates the risk of shifting the landscape on issues that are of utmost concern to consumers without consumers being provided notice or an opportunity to provide input.
I interviewed the Canadian Civil Liberties Association about a year ago, on a similar move by the government to make itself immune to legal action. The CCLA stated in respects to government’s use of regulations in the crown liability protection act, which was one of their main concerns with crown liabiity legislation:
“Basically without making an amendment to the legislation, the government can just pass a regulation that calls something a policy matter or a regulatory decision and give itself immunity.”
Combine both the changes made to the crown liability protection act, and Bill 177 a stark picture emerges. The Ford Government with Bill 177 can protect itself from public scrutiny and make itself immune legally to changing things like the definition of a disability, and/or who is eligible for support. Arch Disability on the concerns regarding eligibility of services for the disabled (emphasis added):
Bill 175 proposes regulations under the Connecting Care Act that state that care coordination functions are going to be the responsibility of “Health Service Providers”. They will have the discretion to assign care coordination functions to contracted providers or partner organizations. Under this proposed regulation, detailed expectations of care coordination functions are left to be outlined in policy, and what this policy “could” include is listed in general and vague terms.
This is an alarming change from HCCSA as care coordination functions are central to the delivery of services. Care coordination functions are the basis of many barriers and difficulties that consumers experience in this sector. Care coordination functions include:
– determinations of eligibility;
– assessing a consumer’s needs;
– reassessments of need;
– developing a services plan;
– updating services plans; and
– managing issues with service delivery.
Shifting these sizeable responsibilities to an unidentified and unaccountable health service provider raises red flags. Such health services providers may be for-profit or non-profit and vary in capacity, size, and resources. Moving such important aspects of home and community services in this way expands the scope of private companies that may sacrifice quality of services for fiscal efficiency. We have seen the impact of how private companies may sacrifice quality of services for fiscal efficiency as demonstrated by the COVID-19 pandemic.
Leaving details of care coordination to policy contributes to a serious lack of public governance, accountability, and transparency. The proposed regulations, as drafted, provide minimal detail on this shift in responsibility. There is a need for uniformity in issues like reassessment requirements, and guidance to ensure equity across the province, but the draft regulations provide no detail as to how this will be carried out.
Arch Disability is also concerned that abuse protections with those in care and are enshrined in law have now been significantly eroded. All of Arch’s recommendations were rejected in committee:
1. Amend the Connecting Care Act to include a provision specifying that individuals’ preferences are protected, as stated in section 1(d) of HCCSA.
2. Amend the Connecting Care Act to include the following provisions which are based on those currently in HCCSA:
– A Health Service Provider must operate in compliance with the Bill of Rights. Home and Community services shall be provided with competence, honesty, integrity and concern for the health, safety and well-being of the persons receiving the services.
– The Minister can only approve a Health Service Provider if they are satisfied that the premises are suitable for the provision of home and community services.
– A Health Service provider shall develop and implement a plan for preventing, recognizing and addressing physical, mental and financial abuse of persons who receive home and community services.
– A health service provider shall ensure that a quality management system is developed and implemented for monitoring, evaluating, and improving the quality of the services provided or arranged by the health service provide.
– The health service provider shall upon request provide a copy of a consumer’s plan of service. If the consumer also asks that their plan of service be explained to them, the health service provide shall provide the consumer with an explanation of their plan of service in a format that is accessible to the consumer.
People concerned about this need to get in touch with their MPP’s and voice your concerns over this bill and demand transparency, and democratic oversight over changes to disability supports. You can find out who your representative is here: https://www.ola.org/en/members