7TH REPORT OF THE

ACCESSIBILITY ADVISORY COMMllTEE

Meeting held on August 28,2008, commencing at 3:03 p.m.

PRESENT: R. Khouri (Chair), S. Balcom, K. Higgins, K. Husain, B. Quesnel, A. Rinn, A. Robertson, P. Stewart and A. Tankus and H. Lysynski (Acting Secretary).

ALSO PRESENT: R. Armistead, J. Knight and D. Wilson-McLeod.

REGRETS: P. Schuck.

I YOUR COMMllTEE REPORTS:

Delegation - 1, That the Accessibility Advisory Committee (ACCAC) heard the attached presentation from J. Fisher, Executive J. Fisher,

Cheshire Homes of Director, Cheshire Homes of London, with respect to the London mandate of Cheshire Homes.

Chair's 2. (C.R.) That the Accessibility Advisory Committee (ACCAC) Remarks was advised by R. Khouri of the following:

(a) he met with the Nominating Committee and two new ACCAC members have been appointed,which completes the ACCAC composition; and

(b) he attended the public participation meetings relating to drive-throughs at the Planning Committee and accessible taxicabs at the Environment and Transportation Committee; it being noted that he was approached by representatives of the Ontario Restaurant Hotel and Motel Association and Tim Hortons with respect to the City of London's Facility Accessibility Design Standards (FADS).

Policy 3. (A) That the Accessibility Advisory Committee (ACCAC) heard verbal updates from K. Higgins and K. Husain with

Committee respect to the Policy Development Sub-Committee, noting that J. Kirkham, Chief Strategic Planning Officer, will be presenting the Accessibility Policy to the next Policy Development Sub- committee meeting. K. Higgins also asked the Chairs of the Sub-Committees to provide feedback on the Accessibility Quotient Plan.

Education and 4. (B) That the Accessibility Advisory committee (ACCAC) heard the following verbal updates from R. Khouri and K. Awareness

Committee Husain:

(a) R. Khouri, A. Rinn and A. Robertson met with P. Crawley, Communications Specialist, with respect to updates to the ACCAC website; it being noted that the ACCAC will be

Sub-

Sub-

ACCAC - 2

Facilities Sub- Committee

2009 Mayor’s New Year’s Honour List

Age-Friendly Cities

2009 Budget Request

Audible Pedestrian Signals

provided with the amendments prior to them going online; and

(b) K. Husain advised that all of the speakers, except for the Honourable D. C. Onley, have been confirmed for the 14th Annual Empowerment & Action Day and requested that ACCAC members assist with the advance preparation and on the day of the event itself. (See attached added communication from K. Husain with respect to the 14th Annual Empowerment &Action Day.)

5. (D) That the Accessibility Advisory Committee (ACCAC) was advised by A. Robertson of the following:

(a) the assessment form has been completed and is ready to be posted to the ACCAC website;

(b) the Ministry of Transportation will be implementing accessible rest stops along Highway 401, which will include adult change tables;

(c) swimming pools will be placing lifts in the change rooms; and

(d) Extendicare is making accessible changes to its facility, including front door access and ramps.

6. (2) That the Accessibility Advisory Committee (ACCAC) received a communication dated July 3, 2008 from the City Clerk with respect to the 2009 Mayor’s New Year’s Honour List. The ACCAC referred the matter to an Ad-hoc Working Group to be co-ordinated by B. Quesnel.

7. (9) That the Accessibility Advisory Committee (ACCAC) received a communication dated August 7, 2008 from the Creative City Committee with respect to age-friendly cities. The ACCAC referred this matter to J. Knight for consideration and to report back at a future meeting of the ACCAC.

8. (Add)That the Accessibility Advisory Committee (ACCAC) received a communication dated June 18, 2008 from the City Clerk with respect to its 2009 budget request. The ACCAC asked that its 2009 budget remain at its current allocation of $7,500.00, to continue to allow the ACCAC to support the implementation of audible pedestrian signals, and for costs associated with ACCAC’s Annual Empowerment and Action Day.

9. (Add)That the Accessibility Advisory Committee (ACCAC) was advised by R. Khouri that the City is installing audible pedestrian signals at the intersection of William Street and Princess Avenue and approximately 500 metres west of the

ACCAC - 3 intersection of Gainsborough Road and Wonderland Road, on Gainsborough Road.

Annual 10. (Add)That the Accessibility Advisory Committee (ACCAC) was advised by S. Balcom that the Independent Living Centre General

Meeting - Independent Will be holding its Annual General Meeting on September 11, Livingcentre 2008 from 2:OO p.m. to 4:OO p.m. at the Cherryhill Library; it

being noted that J. Schlemmer, Executive Director, Neighbourhood Legal Services, will be the guest speaker.

11. That the Accessibility Advisory Committee (ACCAC) received and noted the following:

6thRePofiof (a) (1) the 6th Report of the ACCAC from its meeting held the on June 26,2008;

Taxicab (b) (3) a Municipal Council resolution adopted at its LicensingBy- meeting held on June 23, 2008 with respect to proposed law

amendments to the Taxicab Licensing By-law;

Accessible (c) (4) a Municipal Council resolution adopted at its meeting held on July 21, 2008 with respect to an Accessible Taxicab

Survey Taxicab Survey;

Taxicab (d) (5) a Municipal Council resolution adopted at its Licensing By- meeting held on July 21, 2008 with respect to the Taxicab law L.-126- 256 Licensing By-law;

Invitation to (e) (6) a Municipal Council resolution adopted at its meeting held on July 21, 2008 with respect to the invitation the

Honourable D. C. Onley extended to the Honourable D. C. Onley, Lieutenant Governor

of Ontario, to the October 4, 2008 Empowerment and Action Day Conference being held by the ACCAC;

Drive-Through (f) (7) a Municipal Council resolution adopted at its meeting held on July 21, 2008 with respect to drive-through facilities;

Appointments (9) (8) a Municipal Council resolution adopted at its tothe meeting held on July 21, 2008 with respect to the appointment

of P. Schuck and A. Tankus to the ACCAC;

Webtrends, (h) (1 0) a communication from the Committee Secretary with June and July* respect to the Webtrends report for June and July, 2008;

FADS (i) (11) a communication dated June 24, 2008 from the Division Manager, Facilities Design and Construction, with City of

Vaughan respect to the adoption of the Facility Accessibility Design Standards (FADS) document by the City of Vaughan; it being also noted that the ACCAC asked for an updated list of the municipalities and organizations that have adopted the FADS document; and

Facilities

2008

ACCAC - 4

“ArchAler (j) (12) the August 2008 edition of the “Arch Alert” newsletter.

Next Meeting 12. That the next regular meeting of the Accessibility Advisory Committee will be held on Thursday, September 25, 2008 at 3:OO p.m.

The meeting adjourned at 4:48 p.m.

Newsletter

OCSA Ontario Community .,

Support Association

Attendant Services Advisory Committee Ontario Community Support Association July2008

-. .-

2

TABLE OF CONTENTS

Don, who has a spinal cord injury that resulted in quadriplegia, has been ready to leave

hospital for 3 years, but is on a wait list for Self-Managed Attendant Service - Direct

Funding. This has cost $l,200/day to the tax payers, instead of the $200/day it would

have cost if he had attendant services at home. Twelve other consumers/year could have

received Attendant Services with the over $1.3 million in hospital spending over the 3 years,

and a bed/day would have been freed up at the hospital to move a patient from ER or

reduce wait lists for surgeries.

EXECUTIVE SUMMARY 3

A. Introduction 6

7 B. The Current Service Delivery System

The Independent Living (IL) Model of Service Provision for Persons with Disabilities

The Preferred Option over More Costly and Institutional Care

E. Chronic Diseases &Aging Among Persons with Disabilities

C. The Roots of the Current Attendant Services Delivery System: 8

D. Providing Attendant Services: 0

10

10

12

H. Next Steps 13

E Wait Lists for Attendant Services in Ontario

G. The OCSA Attendant Services Advisory Committee's Recommendations for Action

APPENDIX A OCSA's Attendant Services Advisory Committee: Mandateand Membership . 14

APPENDIX B The History of the Independent Living Model and Legislative Changes 14

16

17

APPENDIX C A Day in theLife of aconsumerwith Attendant Outreach Services

APPENDIX D Listina of Attendant Service Providers across Ontario

Acknowiedgemsnt: Thanks to Jamie and Alison for permission to use their photograph. See their story on page 9.

The Ontario Community Support Association, a provincialassociation, is thevoiceand representative body of homeand cornrnunitysupport in Ontario, working to ensure Ontarians of all ages andconditions have access to an integrated rangeof healthcare solutions outside of hospitals and long-term care facilities.

EXECUTIVE SUMMARY

The United Nation’s Convention on the Rights of Persons with Disabilities’ Article 19 b) states:“ Persons with disabilities have access to a range of in-home, residential and other community support services, including personal assistance necessary to support living and inclusion in the community, and to prevent isolation or segregation from the community”. The Convention was ratified on April 3,2008 and became legally binding May3,2008. Canada’s House of Commons has unanimously endorsed Canada ratifying the convention.

Currently in Ontario, there is unmet need, extensive wait lists and long wait times for Attendant Services for persons with physical disabilities [mobility impairment]. The number of people with disabilities is growing, and this population is aging, as are their family supports whose health status is declining. This is putting pressure on other parts of the health care system as people needing attendant services remain inappropriately in long-term care homes, acute care beds, chronic continuing care hospitals, and rehabilitation facilities at much higher costs to

the system. Attendant Services should be a right for persons with physical disabilities, but instead the majority of consumers are either not getting the services or not getting the right services in the right place.

Ontario has an opportunity to play a leadership role by rectifying the situation and showcasing a provincial strategy to help Canada meet its obligations under the UN Charter.

Who the Consumers of Attendant Services Are: Those who use Attendant Services are adults, ranging in age from 16-13 years of age, with physical disabilities. Conditions include Cerebral Palv Arthritis, Stroke, Multiple Sclerosis, Muscular Dystrophy, Spi id Cord Injury (SCI), Spina Bitida or Huntington’s Disease. Many people have two or more disabilities. Consumers direct their attendants to perform the services they need to perform the activities of daily living. Attendant Services are an “Independent Living model of service - as directed by the consumer (a model chat grew out of the civil rights and hutwan rights movements in the 1960s in the U.S.).

This report is intended to bring to the attention of the general public, politicians, the Ministry of Health 81 Long-Term Care (MOHLTC) and the 14 Local Health Integration Networks (LHINs) the current Attendant Services siruation across the province and rn make recommendations about how to move forward wirh an effective m a t e 3 for the health care system and persons wirh physical disabilities who require Artendat Services.

The current Attendant Services funded by MOHLTC and the LHlNsserve 6,000 consumers across Ontario:

Self-Managed Attendant Service - Direct Funding (DF): ...

enables adults with a physical disability to take full responsibility for managing a budget and hiring and supervising their own attendants. Current provincial funding is $221M.

Attendant Outreach Services: service is provided in the consumer‘s home between the hours of G a m . and midnight on a pre-scheduled basis. Services may also be provided ar the workplace, college or university. Current provincial funding is $48.8M.

Assisted living Services in Supportive Housing: Supportive Housing providers typically offer several accessible, affordable apartments integrated throughout a larger apartment building. Most Supportive Housing providers offer Attendant Services to their tenants on a pre-scheduled and on-call 24-hour basis. Also includcd in this category are dusrer models that provide service to consumers within a set radius of the office location, and congregate living and group homes which offer a communal home setting with attendant services for people who may have limired capacity to self-direct or who have multiple service needs. Current provincial funding is $80.2M.

Agenda Item #

4

Who the Service Providers are:

Self Managed Attendant Service-Direct Funding flows directly to the provider agency, for instalice rhe Centre for Independenr Living Toronto (CILT), From rhe Provincial PC Priorities Programs Branch, MOHLTC. For both Attendant Outreach Services and Assisted Living Services in Supportive Housing, funding is provided to registered non-profit comrnuniry support services organizations directly by Local Healrh Integrarion Networks (LHINs). Currenrly there are 47 local agencies or provincial organizations across the province providing Atrendanr Services to persons with disabilities.

The OCSA Attendant Services Advisory Committee has four key recommendation sfor action by MOHLTCand theLHINs:

Recommendation #I: that MOHLTC and the LHINs host a special forum with a broad reprcsentation of attendanr services consumers, service providers and relevant provincial associations to ensure the Onrario Government and the LHINs integrate the needs of persons with disabilities into any policy and program healrh system strategies being developed. This would include iniriatives such as the ,k ing at Home Strategy, the Diabetes Straregy, rhe Chronic Diseases Prevention and tvlanagement Strategy the Provincial Poverty initiative, the Accessibility for Ontarians with Disabilities Act and any provincial supportive housing enhancemenr plans. Recommendations from rhe forum could be referred to future Joint Work Groups to explore and develop implementation strategies.

Recommendatlon #2: Add the lengthy wait times for Attendant Servkes and Supportive Houslng to tho MOHLTC Provincial Wait L id Strategy and ask the

Ontario Health Quality Council to report on progress. To address the wait lists for all Attendant Service programs would rake $73 million - d IO million in each of the next rhree years and $21.5 million in years 4 and 5 ro allow time for the development of affordable housing srock. Supporting persons with disabilities ar home will help reduce wait lisrs for acute care, complex continuing care and rehabilitation facilities and enhance the healrh status of aging family supports.

Recommendation #3: Institute individually-based funding for a11 persons requiring Attendant Services. Funding should be determined based on an assessmeiit of the individualized services needed, with funding adjustmenis as condirions change. A secure level of ongoing services to maincain independence and base stabilization funding for service providers would ensure the ongoing infrasrructure and capacity to meet growing servicc needs.

provlde an increase in funding of $12 milllonlyear in each of the next three years to the Attendant Services sector to allow providers ro be able to continue ro deliver the same level of service tn current consumers, to deal with existing consumer< increasing needs as rhey age andlor as their disability progresses. The funding would also be used to build on the current successes and innovative ways of providing quality, cost effective services. Community support services have lost 23% of their spending power in the last 10 years because funding has nor kept pace with inflation. Efficiencies and con-saving partnerships continue but are nor enough to keep up with increasing costs like employee compensation and Fuel prices.

Recommendation #4: MOHLTC should immediately

Why it is imperative that action be taken to enhance Attendant Services in Ontario:

I People who nced Artendant Services use services for The costs to the system when Attendant Services are not available and people are forced into other inappropriate healthcaresettings:

the entirety of their lives, are living longer with medical technology, have changing needs as rhey age, and acquire age-relared diseases earlier than the general population. ar 50 years of age. They also have much higher incidents of chronic diseases like diabetes and arrhritis.'

2 The numbers of people requiring Artendant Services is growing and Funding is not keeping pace with the demographics.> For instance, the wait lisc for Assisted Living in Supportive Wousing and Attendant Outreach services inToronto alone is 900 people, with 10% of these people inappropriarely living in hospital Alternate Level of Care beds, chronic care hospitals or long-term care homes.

. .:, . ,... . ,, ' $1,200

$900 LongkrinCareHome bsd(ubto2 hlursoicarelday) ~. $135 CoinmunityCanAcce..C~"Lre(3 hb;u&fs&/d;y) _:j. .....A 8 . ' . . ' $150 Al.lliedUvinginSuppdrfivs Ho&in&averageol

Self-M&&.dAttendant Sekice- Direct FUndi~g. (a maximum of 6 hourrlday -with an average of 5 hourrlday):

... .... ? .. . : Hospital Ked .. ,

., ' : . . bntinuing C& H&pital b i d ..

Attendant Outreach (average of 2.5 hdurdday) $80

3 People with physical disabilities cannot continue to rely on aged Family supporrs that are physically unable ro rransfcr rhan or are in inaccessible honies without proper equipment. The aging Family supports cannot cope with rhc caregiving burdens and rheir health is declining as a r e d , addiiig more costs ro the health care system. In the end, they will no longer be there ro provide ongoing support. Of those on rhe Toronro wait list for artendant services, 15% are currenrly living with their parents, many of whom are ~ e n i o r s . ~

Evidence in other Jurisdictions:

In Brirish Columbia, Vancouver Coastal Hcalrh targeted the highesr need groups (adults with disabilities and seniors requiring complex cnrc) and linked community care funding to system outcomes (e.g. Alternate Level of Care bed reductions5) and shifted the focus from residenrial care beds to assisted living in supportive housing (with 4,000 assisted living units crated). Residential care beds have decreased by 25-30%; ALC beds were reduced from 12% to 6% and 17 in-patient hospital beds were freed up.

5

4 Recruitment and rerenrion ofscaRis a serious concern and will force people to more costly acurc c w e serrings if workers are not nv;iilnhle to deliver the services ar home or i n the communirv. The wJge s ~ p is widening between workers in atrendmr setring versus long-rerm care homes and hospitals. A srraregy ro keep workers in rhe comrnuniry is needed imm&xely.

5 Thc poverty rare for adults with disabilities is 25%. which is 15% higher than the general population.”This means rhat affordable housing stock is inregral ro any strategy ro address this popularion’s needs.

The OCSA Attendant Services Advisory Committee is confident that the above recommendation sfor consideration: * Are in keeping with the Ontario Government’s

commirmenr ro promote citizens’ auronomy and self- derermination

Supports the LHINs’ new integrated, cominiuiity-Focused direction

Empowers consumer involvement and control of their own lives and health

Helps the Governmcnr with its Wait List Strategy for hedrh services

Provides services ro people in the right place, by the right provider, at rhe righr rime, and at the appropriare price for the taxpayers

Can be an integral part of &e Aging at Home Srraregy, and

Achicves healrh equity

UNLEASHING ATTENDANT SERVICES: Enhancing People's Potential, Reducing Wait Times

For Acute Care And Long-Term Care

A. Introduction

In March 2008, rhe Ontario Community Support ,Association (OCSA) crearsd an Atrendanr Services Advisory Commitree5 made up of consumers and Arrendanr Service provider organizarions ro give the Associarion advice on whar steps should be taken to ensure persons wirh physical disabilities [mobility impairments] get services ro maintain their auronomy and be conrrihuting members ro Ontarian society.

There is unmer need, long wair lisrs and long wair times for Attendanr Services for persons with physical disabiliries. The number of people with disabilities is growing, and consumers are aging, as are their family supporrs.

This report is intended ro bring to rhe artention of the general public, polidciais, rhe Ministry of Healrh & Long-Term Care (MOHLTC) and the 14 Local Healrh lnregrarion Networks (LHINs) rhe existing Artendant Services siruarion across rhe province and to make recommendations about how to move forward with an effective srrategy for persons wirh physical mobility disabiliries who require Atrendanr Services.'

Who are the Consumers of Attendant Services Those who use Artendant Services are people with physical disabiliries with conditions such as Cerebral Palsy, Arthritis, Srroke, Mulriple Sclerosis, Muscular Dysrrophy, Spinal Cord Injury (SCI), Spina Bifida or Huntington's Diseaw. Many people have two or more disabilities. Consumers direct their attendants to perform the activities of daily living (ADL) rhey require ro get on with rheir day-to-day lives. Attendanr services include: bathing and washing, transferring, roileting, dressing, skin care, essenrial communications, and meal ptepararion. The consumer is responsible for rhe decisions and rraining involved in hidher own services.

Canada has signed thc Unired Nation's Convention on the Righrs of Persons with Disabiliries. Article 19 b. of rhe Convention states:

"Persons with disabilities have access to a range of in-home, residential and other community support services, including personal assistance necessary Io support living and inclusion in the community, and to prevent isolation or segregation from the community'!

Onratio has an opporruniry to play a leadership role in the world by ensuring rhar the convention is insriruted in rhe province. An expansion and enhancemenr of Arrendant Services would demonstrare rhe Onrario Governmenrj commitrnenr to rhe United Nation's Righa of Persons wirh Disabilities Convention and the Government could showcase its srraregy with its FedenllProvincial/rrirorial parrners in Canada.

Among the issues that need to be addressed are: * People using Artendant Services use services for the rcsr

of their lives, are living longer with medical rechnology and rehabilitation, have changing nee& as they age, and acquire age-related diseases a t an earlier age than the general population?

' Consumers are also more likely ro be poor than the general population. From 1993 to 1998 an average oF25% oFadulrs wirh disabilities were living in households below the Low Income Cur Off (LICO), compared to an average of 10% of those wirhour disabilities and LICO did not factor in the addirional costs associated with a disability." As a result, affordable housing srock is one of the-issues rhar needs ro be addressed.

* The numbers of people requiring Atrendant Services is growing and funding is not kceping pace wirh the demographics of a growing number OF people needing services and growing wait lists." In fact, funding increases have not kept pace with inflarion and there are significant increases for operaring toss and collecrive agreements. Providers have losr 23% OF their spending power in the last 10 years. There will be fewer people receiving services rhan are currently being served if funding issues are not addressed immediarely T h i s , in an environmenr wherc rhe rare of increase in rhe wAir lists is growing and will be expected ro grow dramatically as rhe population ages. The number of seniors is expected to double in the next 16 years.l2

* Not taking action 011 rhis issue will force people to rely on more cosrly acure care serritigs like hospitals, resulting in increasing wait lisrs for orher peoples' desperately needed surgeries or padencs nor being able ro leave ER for amre care because hospital beds are inapptopriarely being used.

'See AppndixA lor thalirtoi Advirary Cornminee mernben. 'Thirreportaddrciierallendaotrwicero~l~Therearemanylrnporian~,~latedrerviwlorpeiianr~ithphv.icalmobi~~l~diiabilillltilunded bvMOHLTCandotherlunderrlhiltarsnat addressed In his report, i.s tranrportation, youth lraniitlon programs. BThe Unlted Nation's Convenlian an L e Rlyhlr 01 Perrons with Dirabililier, ralllied on April 3,2008 and lesaliy bindins M a y 9 2008. The Canadian Homed Commons has unanimously endorred Canada rslilying the mllvention 'There is re=arch.Mdence that perranr with phy4caldirabilitier aye prematurely. 1 Kailer, Aging with Oirability~, Rehabililalion Research and Training Cenln on Aeingwil Spinal Cord Injury, Caiilarnia, 1998. l ~A~~anhglhah~ i~ur ;~no~Perroo lv i lhDi rab; l ;H~r , 2002 Human RemurceraSociJ Development Canada. Figure, 20 p.47. *StatirttcrCaneda'r2007'PariitioationandActivt~Llm%ation S u ~ ~ ~ r e l a t e ~ t h a t o v e r a i ~ ~ ~ ~ l e a r ~ e r i o d i r o m 2 0 0 1 - 2 w 6 . ?he jevei$3ijiiabililierforaduhi aged!5 ar.dalder,ncreared 1 n 3 dteoped Crhion~,wilhaniicnareJ16,4%nportingavwyrewredtrability[p3~ VS!ate-e-t b y b m e . l?inii:e. si %akh S -ong.T<- C3ra George Smitberwn. in an .nier;.ew4th :he To~onio Star ioti l2A. 2003.

7

* Recruitineiit and retention of staffis a serious concern, particularly given the much higher salaries and benefiry in hospirals. long-term care homes and for the Developmental Support Workers in the Ministry of Communiry and Social Services who recently received a large increase i n hourly wages. A shortage of Attendant Service workers will Force people to use more costly acute care and long-term care settings if Artendant Service workers are not available to

deliver the services i n people's homes. A health system human resources strategy is required.

Traditional Fdinily roles are under stress, both health wise and financidly13 and family supports will decline over time as the population ages. The lack of Attendant Services funding will mean that dependent adults remain with family well beyond the family's ability to humanly, physically and financially cope - unable to transfer, inaccessible environments with inappropriate assistive deviccs, and then the family support dies.

The time is right for the Minisrry of Health & Long-Term Care (MOHLTC) and the Local Health Integration Networks (LHINs) to hold a forum and work with consumers aiid providers to develop provincial policies and fund local programs to enhance Attendant Services to ensure people with physical disabilities get the services they need in the community.

Many people are inappropriately forced to turn to the more costly acute care hospitals or long term care homes for seniors because the more appropriate and cost-effective services in the communicy are not available. As well, the Communiry Care Access Centres are having to try to cobble together home care services because here are insufficient or non-existent Attendant Services in certain areas. Home care services are not the righr services For this consumer group and are more costly than attendant services to the health care system.

"People with disabilities should have the same kind of opportunities as everyone else. They should be able to do the things that most of us take for granted -going to work or school, shopping, taking in a movie or eating out.* (The Ontario Ministry of Community 8. Social Services Website).

What happens when Attendant Services are not available In 2004, 'Don' entered hospital with complications arising from his earlier spinal cord injury that resulted in quadriplegia.

s been ready for discharge since March 2005, ng in a hospital for over 3 years because he is o n a y wait list for Selt-Managed Altendant Service-Direct

in his home. The.cost/day for Don to be in the is 81,200lday or $438,00O/year.

remely frustrated because he knows he could be home with the right services he needs at a cost of

vailable overnight. The hospital bed could have Up to reduce the wait lists for s u r g e k and

$ZOO/day'- 6 hours of service during the day and an.

d have been independent in his own home. ionalcost to t&payen to date as aresult of Don

ble to access the right service in the ..: ri.ght place time has beenover.$l3 million aver 3 y'ears. nal inapproGiate hospital costs could have

Attendant Services to 12 piople perycarJ4

B. The Current Service Deliverv Svstem

Currently in Ontario, 8150.4 millionlyear in Funding is provided for Atrendant Services to about 6,000 people by MOHLTC. Following are the Attendant Service categories'5 ,, For persons with physical disabilities that are funded by the Ministry OF Healrh & Long-Term Care (MOHLTC) and in need of enhancement and expansion:

Attendant Outreach Services: service is provided in the consumer's home between the hours of 6 a.m. and midnight on a pre-scheduled basis. Services may also be provided at the workplace, college or universiry. There is currently 3 ceiling of 90 hours OF service per month. The policy for attendanr outreach requires that persons who need more than 90 hours per month to receive Ministry approval. Consumers are advised to have back-up support available, as Outreach cannot be provided on an on-call basis. Current provincial funding is $48.8M. (See Appendix C for a day-in-the-life of an Atrendant Outreach Services consumer on page IG.)

Self-Managed Attendant Servlce - Direct Funding (DF): enables adults with a physical disabiliry to take full responsibility for managing %budget and hiring and supervising their own attendants. Current provincial funding is $22.1M.

Assisted Living Services in Supportive Housing: Supportive Housing providers typically okTer several accessible apartments integrated throu$iout a larger apartment building. Most Supportive Housing providers o t k Attendant Services to their tenants on a pre-scheduled and on-call 24-hour basis. ius0 included i n this category is funding for congregate living and group homes which offers a communal home setting with attendant services for people who or who have multiple service needs. Current provincial funding la 580.2M.

have limited capacity to self-direct

Eligibility Criteria To be eligible for attendant services, people with physical disabilities must:

Be insured under the health Insurance Act of Ontario (i.e. possess a valid Ontario Health Card)

Be at least 16 years of age or older - Have a perniancnt phys id disability and rcquite physicd assistance with activities of daily living such as bathing, dressing, transferring and toileting

* Have the abiliv to direct their own services - communicating with the attendants about what they want done, when they want it done and how, and

Be able to have any medicallprofessional needs met by the existing community health network on a visitation basis

Who the Service Providers are For both Attendant Outrcdch and Assisted Services in Supportive Housing, funding is provided to registered non- profit community support seivice organizations by the Local Health Integration Networks. Currently there are 47 local agencies or provincial organizations across the province providing Attendant Services to persons with physical disabilities, other than Self-Managed Attendant Service-

Direct Funding. This pmgnini is coordinated through CILT (the Centre For independent Living Toronto) in partnership with the Indepmdent Living Resource Centtes of Onrario across Onrario as Direct Funding follows the client regardless of which LHIN they live in. Funding for this program Rows directly from the Provincial Programs Branch of MOHLTC.

Attendanr Service workers have a broader scope ofscrvicer than Personal Support Workers, including some functions that must be delivered by nurses or doctors in health care settings. i.e. ventilation, bowel & bladder, tracheal suctioning, tube feeding, assisting with medications under the direction of the consumer (exemption under the Regulated Health Professions Act) and assisting consumers with communication, including the use ofAugmenntive & Alternative Communications ( M C ) equipment. Note: Artendant Services do N O T include: professional services such as nursing care, physiotherapy, occupational therapy, respite care, physician services, “care” or taking responsibility for the person with a disability.

Other than the funding received from MOHLTC for Attendant Services. many agencies also receive targeted funding from MOHLTC and other sources to provide a variety of other services, i.e. youth services, transportation programs, transitional & life skills programs, and escort services for sociallrecreational activities. Agencies work collaboratively within rheir communities to integrate services and provide 3 continuum of supports for people.t6They also work with each other to ensure &dent usc of limited resources, i.e. ahaiing back office resources, shared wait lists.

The Attendant Outreach Service Providers and Assisted Living Services in Supportive Housing Providers across Ontario ate listcd by LHIN in Appendix D. There are gaps in service in certain parts of each LHIN and in some paru of the province there are no attendant services whatsoever - an issue that needs to be addressed.

C. The Roots of the Current Attendant Services Delivery System: The Independent Living (IL) Model of Service Provision for Persons with Di~abilities’~

Attendant Service provision for persons with physical disabilities developed in rhc 1960s and is based on the Independent Living model ofservice rather than the medicall rehabilitation or ‘charity’ models of service. The movement began at the Berkeley campus of the University of California by a group ofsrudents with disabilities and quickly spread throughout the United States and Canada and is uow a world-wide movement,

Attendant Services evolved out of the desire and the need of persons with disabilities to lead independent lives. It is 3 unique model which enables people with disabilities to direct their own services in the community. Before the advent of attendant services. most people with physical mobility disabilirics would have remained in chronic care hospitals, lived in institutions, or been cared for by Family members long after the age when most non-disabled people would choose to live independenrlv.

The Independent Living model embraces rhe norion char rights and responsibilities arc shared between cirizens and the srate. Focusing on building a sociery based on rhe principles of inclusion, eqitirF affo‘fordabiliry and justice. It is Founded on rhe righr of people wirh disabilities ro:

“For me, the roots of independent living lie in one place. Getting out of the Institution ... When I was not quite 11 years old in 1965, I left my home in Ottawa and came to Toronto to live in a “crippled (sic) children’s institution. That is the word they used then ... crippled. Worse actually. I still remember the day my father carried me in and sat me in a big chair in the lobby and I looked up at a plaque with names of donors headed up with the phrase “Home for Incurable Children: So that’s what I was,

- Live with digniry in their chosen community

* participate in dl aspects of their life, and

* control and make decisions about their own lives,

I thought, an “incurable child,’a child that couldn’t be fixed. None of us had a future, therefore no social value.

Even then it seemed that people who worked with us were little better, and had little more social value than we had. They were simply viewed as the “caretakers of the children with no social value”!8

Sandra Carpenter, Executive Director, Centre for Independent Living Toronto (CILT)

D . Providing Attendant Services: v

The Preferred Option over More Costly and Institutional Care

The evidence: - In British Columbia, Vancouver Coastal Healrh targeted rhe highest need groups (ndulrs wirh disabilities and seniors requiring complex care) and linked community care Funding to system outcomes (e.g. ALC bed reductionsn) and shifred the focus From residential care beds to assisred living in supporrive housing, (wirh a roral popularion of 1 million people, the Health Authority is creating 4,000 affordable, assisted living apartments For seniors and persons wirh disabilities wirh a budget of $380M For shelter and affordable housing in 2O08JM Residential care beds decreased !TY 25-30%; ALC beds were reduced from 12% to 8% and 17 in-patient hospital beds were Freed up?’

consrr~~crion o f new long-term care faciliries. Denmark’s health and soci:il services are now provided according to need wherever people reside. As a result of chis policy, the number o f nursing home beds decreased by 30% from 1987 to 1997. In thar same period the number ofsupportive housing unirs increased by 250%.”This strategy also supports the philosophy of people wirh disabiliries over time being able to age in place - at home.

In 1988. Deninark passed legislation limiting the

Utilizing respire unirs in supportive housing alleviates ALC bed pressures and decreases wair rimes in

Heal& services like acute care which rcflecr a medical niodel of health care, where people are assisredwirh an acute illness or people are rreared to recover from diseases are nor the kinds

ofservices rhat persons with disabiliries need on an ongoing basis. Persons with physical disabilities need Atrendant Services for their liferime, and need supporrs in order ro be engaged in employment, education and volunteer work so they can be productive and contriburing citizens. Affordable housing, physical accessibility, hedrh & wellness programs and income supports need ro be in place.

$8;1 E ff VfKj F i L,& Jamieand Alison Assisted Living in Supportive Housing, Cheshire- London

Jamie and Alison both have Cerebral Palsy with Jamie using a wheelchair. Before they married, Alison lived with her parents. Jamie had lived with his parents until finding a new way of independence, moving out on his own into one of Cheshire‘s supportive housing units in London. “I was getting older and Mom and Dad were getting older too,’ Jamie says. “My needs were changing yet I still wanted to maintain my independence. Alison and I have many friends here and heard great things about the building. That, with the excellent, friendly, helpful staff made the decision to move here on my own very easy. It feels very complete having Alison with me now.”

*Sandra Carpenter: In the Stream, Summer 2003, Feahm ‘ D ~ ~ . l ; ~ ~ a p ~ r h y A t d ~ ~ ~ Mhdds’

them home w gel the ierYi~e they need there n; il mq*d, in dhw ielhgr like lang-lwmcare hnmer.

21 Nancy Rho. Executive Director. Communily Care Network Vancower Coartal Health, Prerentatbn at the Suppartive Housing Symposium, October 15,2007, Richmond Hill. ca-iponrored by the Canadian Resex& Network lm Care inthe Commvnny a d the Onbrlo Community Support Arroclatbn. * Eigtl Boli Haoren. Pmlfemrot Economic., lnrtivtcof LocalGovsrnment Studies, DenrnaA Presentation at the Supportive Housing Sympaibrn Oc~oberlS. 2007.cn-sp0nsored by the Canadian Pereach Network I d a : * inlhe Cornmuob and t i e OntarroCornmrinity Support Arrociaiion. “Suppotiie Hmsinp orondm tnOnianowho hhiebemlcndallor re~pneunllr hsrebeenabletodtv~mmumwrwhoww~ wedhemreededuo io tk krpazlwcao ex~edile Aircharge !:om:he hoir:!al a9er I r-ort-term Ilnerr.

ALC (Alternate Lwel d Care) i i ddned 21 hospital beds being occupied by P~ROOI who are not or no longer in need of acute care but remain in hospital because there are no iupports to get

Pres Releara. Vancower Coartal Health webrle, May23.2007

10

E. Chronic Diseases & Aging Among Persons with Disabilities

The Can:idian Council for Social Development in 2004 released a Facr Sheet # I 4 eiirirled Prrronr i u i h DiilrbiLirier & Hmlt/7. I r highlights rhar rhe greatest ditFerence berween persons with or without disabiliries is rhe rates of arthritis/ rheumitism. It shows that about two-rhirds (66%) of women with disabiliries aged 65 and older reported arthriris/ rheumatism, compared wirh 39% of rheir non-disabled counterparts. Close to one-half of senior men with disabilities (48%) reported arthritis/ rheumatism, compared with less than one-quarter (23%) of rheir non-disabled countcrparts.

Diabetes is also an issue for persons with disabilities, especially as they age:

"Persons with disabilities are more likely than those without disabilities to have diabetes, and this is particularly pronounced among seniors. Among senior men with disabilities, nearly one in five (l9%) reported having diabetes, compared with 12% of their non-disabled counterparts,

Among senior women wi:h disabilities, 14% had diabetes, compared with 9% of !heir non-disabled counterparts: [CCSD2004, p, 71

Other conditions and diseases in addition to rhose above, which are more likely to haw an impact on seniors are high blood pressure. with a 10% higher rate for persons with disabiliries, and hearr disease, with a 15% higher race in persons with disabilities rhat are 65 years of age and over. It is also known that bersons with physical disabilities acquire age-rehced diseases ar a much earlier age -approximately 50 years of age.

Ir will be imporranr that healrh and wellness programs for persons with disabiliries are promoted as part of any strategy to address the needs of persons with disabilities in the interests of managing the provincial healrh care costs and obraining the best population healrh outcomes i n Ontario.

E Wait Lists for Attendant Services in Ontario

Wait Lists are mounring, as are the length of time people have ro wait. As a result, people are inappropilarely living i n long-term cue homes (which are inappropriate locations For a non-seniors population), and are also in hospitals and complex continuing care hospitals ar much higher costs to the governmenr.

For 12 years until 2003 there were virtually no funding increases to base budgets for communicy support services in Ontario which not only has affected the level of service, it in fact has eroded the infrastructure of agencies -ending up with a net loss after cosr of living adjustments of 23%. This year the increase is 2.25% which is equal to the Consumer Price Index. There are agency worker salary increases, mounting transporratinn and insurance costs, and increaed sraf f training cosrs because of the high turnover due to the low wages i n comparison to other healrh care sectors and the service industry. (For instance rhe Communiry Care Access Centres have received a 4% increase to their base budgers and the hospitals have received 4.9%, with the promise of more to come later in this fiscal year).

The Ontario March of Dimesir a provincial organization that provider Attendant Services across the provincewithofficer inall buttwoLHINs.lthasacentral- ized wait list with: * 398 people waiting for Attendant Outreach Services, and . 369 people wairing for Assisted Living in Supportive

Housing

The 'known' wait lists for Artendant Services across the province can range from 4 to 10 years.The 'rurnovei for atrendant services is very low because people need these services For the rest of their lives. Many people do not bother to fill out application forms with such long wait times, so it is difficult to dctcrminc the crue needs across the province.

..?. ,

John's'Story:Yeardng to he in the Community' *.,.

At 29 years oi age, John, who has Multiple Sclerosis (MS), has lived for 3 years in a chronic care facility because there is no age-appropriate housing .options for persons with physical disabilities in his community He is desperateto leave and live in the community with attendant services, SaysJohn: 'At the age of 29 I need to be out in the cornmu& being productive and socializing, rather than sitting'eveiyday on a chronic care f l ~ ~ r . . . " ~ ~

ClLT (Centre for Independent Living inToronto), which manages the Project Information Centre (PIC) wait l i s t for Attendant Outreach Services and Assisted Living in SupportiveHousingin theToronto areaz, has900 peopleon thelist. Of this total:

10% ofthe people are wditing in LTC homes, chronic care hospitals and in ALC" beds in hospitals which are needed For seniors and acute care patiencr.

Another 14% are living wirh rheir aging parents, and

* 18-20%1 are over 65 years of age. 2 of whom are living with their elderly parents.

* There are also over453 people with physical disabilities on CILT's wait list for Self-Managed Attendant Services-Direct Funding across the province. Only 29 spots become available each year?

* Since 1989 when the Common Waitlist for Attendant Services was created in the greater Ottawa area, the wait list hasgrownl0fold.Within thisgroupare peoplewhoare unable to workor participate in social and recreational activities until they have the attendant services they need in place.28

* In London, Cheshire, which provides bothsupportive housing and outreach services to 212 people, has a wait list of 137 people who have been waitingforyears.

* TheSouth East Community Care AccessCentre(CCAC) inSmith Falls has tried to"patchwork" home &personal support to get services to persons with physical mobility disabilities, but the acute care model i s insufficient and not the appropriate services.

There is currentlylimited Attendant Services in places like the far north and the Renfrew County area. Ottawa providers are asked to go to communities like Almonteto try to help out, Demand exceeds current capacity?

Hospitals and long-term care homes do not have staffwith the expertise to serve persons with disabilities in the Independent Living model of service. Attendant Service providers are often asked by nurses For mining in bowel routines and ask for attendants to support their clients with personal care and activities of daily living while in the hospital. In the case of long-term care homes, persons with disabilities are oken placed in the Alzheimerldementia care wings, because other parts of the institution do not have a high enough level of service For the unique nee& of persons with disabilities.

I1

h 2006 studv by rhe Candian Institute for Health InFormation (CIHI) found tha t 20% of resident Onrario hospital-based continuing care facilities were younger than 65, and the Canadian Healthcare Association found that 40% of complex continuing care facilitier' residents were under G5 ycirs ofage and the number is increising?O

The Ontario Human Rights Codestates:"Respect for the dignity of persons withdisabilities i s the key to preventing and removing barriers.This includes respect for self- worth, individuality, privacy, confidentiality, comfort and autonomy of persons with di~abilities."~'

:qJQ>M 5 k' &j ER 1 ;

'Sam' PACE-Independent Living, Toronto

Sam is a tenant in a supportive housing unit for persons with physical disabilities in Toronto. He is 35-years- old with cerebral palsy and uses a wheelchair and an augmentative communication device. He directs the Attendant Services provided by PACE to meet his daily needs. Sam has been living in his own apartment which he shares with another person, since1997. Staff is available 24 hours a day, but only go to his apartment at times agreed upon in advance. Sam uses about 6 hours of service/day.

Until the age of 21, Sam had lived at Bloorview Children's Hospital at which time he was discharged as his age disqualified him from eligibility for service there. Before he moved to PACE, he lived for 2 years at the Toronto Grace Hospital, a chronic care hospital - spending his days with seniors over 75 years of age or just sitting in the hallway.

Sam recently competed on a hockey team in the Canadian Electric Wheelchair national finals. "His passion is sports, he regularly attends baseball games, is active in his church, and enjoys concerts and other entertainment venues in the community.

12

The Costs of Service by Provider: should then follow that individual, regardless of wherher it is

Hospital bed

CompiexContinuing Care Hospital bed

Long-TermCareHomebed(upto2howrolcarelday)

Community Care Access Centre (3 hours ofcarefday)

ATTENDANT SERVICESs2 Assisted Living in Supportive Housing (averageof4hoursfday):

Self-Managed Attendant Service - Direot Funding: (anaverageof 5 hoursfday):

Attendant Outreach (averageof 25 hounlday)

.. $1,200 $900 $135 $150

Housing. As well, base stabilization fiinding for service providers will also be needed to enstire the ongoing infrastructure and capacity to provide the Attendant Services needed.

c C)bJ 5 1.) tvj 5 F? PR [JFj is E; Darlene Self-Managed Attendant Service-Direct Funding

$80

Integrating serviies for persons with disabilities should be factored in to any strategy the Governmenr or LHINs are planning or implernencing, i.e. poverry reduction, the Aging at Home Strategy, the Diabetes Strategy, the Chronic Disease Preveiition and Management Strategy, and provincial supportive housing ventures.

People with a permanent physical disabiliry should receive individually-based funding for the Atrendant Services that they will require for their lifetime. Funding should be determined based on an assessment of the individual Attendant Services need and regular re-assessment for the level of ongoing services required to maintain independence - the right preventative services to keep them out of the acute and long-term care systems. I t would also ensure that people can contribure their mmimum to their workplaces and communities. The funding

Darlene is in her mid-forties and lives alone in a rental accessible unit. She receives funding for 144 hours of Attendant Services/month. This translates into about 4.5 hourslday.

Darlene is self-employed and her work takes her away from home on some occasions. When she requires Attendant Services while traveling, she hires locally by getting in touch with other self-managers within the area where she is travelling, through the Direct Funding Ontario Network of Self-Managers - a peer support network facilitated by ClLT (Centre for Independent Living Toronto).

I

G. The OCSA Attendant Services Advisory Committee has four key recommendations for action bv MOHLTC and the Local Health Integration Networks (LHINs).

Recommendation #1: that MOHLTC and the LHINs host a special forum with a broad representation of attendant services consumers, service providers and relevant provincial associations to ensure the Ontario Government and the LHINs inregrare the needs of persons with disabilities into any policy and program health system strategies being developed. This would include initiatives such as the Aging at Home Stratep, the Diabetes Strategy, the Chronic Diseases Prevention and Management Strareegy, the Provincial Poverty initiative, the Accessibility for Ontarians with Disabilities Act and any provincial supportive housing enhancement plans. Recommendations from the forum could be reFerred to future Joint Work Groups to explore.

This Forum could address the unique demographic of Ontarians with physical dfiabilities with their need for a life-span strategy by exploring wellness models and innovative wxys of delivering service. For example, the "CLustering Model" of service provides service to groups OF consumers in the same geographic area in close proximity to

a supporrive housing or Attendant Outreach service agency. The model is a cost effective way to expand services on a 24/7 basis without having to build bricb and mortar and provides a more stable income For Attendant Service workers who can serve a larger number of people because of their proximity ro each orher."

Recommendation #2: add the lengthy wait times for Attendant Services and Supportlve Housing to the MOHLTC Provincial Wait Llst Strategy and ask the Ontario Health Quality Council to report on progress. To address the wait lists For all Attendant Service programs would take $73 million - $10 million in each ofthe next three years and $21.5 million in years 4 and 5 to allow time for the development of affordable housing stock. Supporting persons with disabilities at home will help reduce wait lists for acute care, complex continuing care and rehabiliration Facilities and enhance the health status of aging Family supports.

Recommendation #3: Institute individually-based Funding for all persons requiring ,Attendant Services. Funding should be determined based on an assessmenr of [lie individualized services needed, wirh re-assessments and funding aditiscments as conditions change. A secure level of ongoing services to maintain independence and base srabilization funding For service providers would ensure the ongoing infrastructure and capaciry to provide the services needed.

When the Ministry OF Community & Social Services (MCSS) embarked on the deinsritiitionalizarion OF persons with developmental disabilities in the 1990% the dollars followed the individual. Persons with Acquired Brain Injury (ABI) also have individualized funding for the services they need.

Recommendation #4: MOHLTC should immediately provide an increase in funding of $12 millionfyear in each of the next three years to the Attendant Services sector to allow providers to be able to continue LO deliver rhe same level of service to cutrenr consumers, to deal with existing consumers' increasing needs as thcy age andlor as their disability progresses. The funding would also be used ro build on the currenr successes and innovative ways of providing quality, cosr effective services. Community support services have lost 23% of their spending power in the last 10 years because funding has nor kept pace with inflation. EhEciendes and cost-saving partnershipr continue

H. Next Steps

The OCSA Attendant Services Advisory Committee will:

- Meet with MOHLTC to recommend that Lt host, with the LHINs, a one-day forum to discuss a Strategy to address the needs of persons with physical disabilities

Working with local service providers and their board Chairs, meet with representatives from each LHIN to raise awareness about attendant service issues and work in partnership to address current consumer needs and begin to address the growing wait lists for service

The OCSA Attendant Services Advisory Committeewill commit to releasing an Ontario progress report on May 3,2009- theoneyearanniversaryofthe UnitedNations Convention on the Rights of Personswith Disabilities becoming legally binding.

The OCSA Attendant Services Advisory Committee believes that the recommendations made to establish a MOHLTC/ LHIN Task Force to review the current and future prwision of Attendant Services for persons with physical disabilities, enhance funding to address current consumer needs, deal with Attendant Service wait lists, and clunge the Attendant Services funding formula:

bur are iiot enough to ksep tip with cosrs like ndary adjustments and climbing fuel prices.

The current provincial rota1 funding for Atrendant Services is $150 million. MOHLTC Funding increases to agencies over the years have been less than cost of living increases, (funding increased by 2% i i i 2002103, 1.5% in each of the past 4 years, and will increise by2.25% in 2008/09). Insufficienr funding is eroding agencies' abilities to maintain their current infrastructure or continue to provide current service levels, let alone address lengthy and growing wait lists.

People with physical disabiliries need to know that there is a foundation ofsupport available to them. Conditions and structures need to be created that honour their choices. These building blocks would include:

Independent planning and Faciliration

* Porcabdiry offunds and supports

Person-directed approaches and client-focused Funding

shared responsibility m d accountability and

economic conditions that enable &I1 participation

"Equity for people with disabilitiesis based on the principles of choice, flexibility, control, portability, mobilityandlullcommuniiy participation.""

* Are in keeping with the Ontario Government's commitment to promote citizens' autonomy and self-determination

Supports the LHINs new inregrated community-Focused direction

Helps the Gwerninenr reduce wait lints for health services

own health

Promotes services ro people in the right place, by the righr provider, at the righr rime, and at rhe appropriate price to taxpayers

* Could be 'an integral part of the Aging at Home Stratew, and

Empowers consumer involvement and control OF their

- Would achieve health equity

We look forward to provincial support from che Ontario Government and strong attention by the LHINs to [he needs of persons with disabilities in their communities. Addressing Attendant Services issues for persons with disabilities is the right thing to do and will also help to reduce wait rimes for acute and long-term care for other Onrarians who need those services.

Agenda Item #

_I__-...._

14

APPENDIX A: The Ontar io Communi ty Support Association's (OCSA) Attendant Services Advisory Commi t tee

The goai of rhe Arcendanr Services Advisory Commirtee was to provide direction and advice to the Ontario Commtiniry Support Association relared to the needs in rhe community

Committee Membership: 1 2 Judi Fisher, Execurive Director, Cheshire London 3 Lee Uarding, Director. Ontario March of Dimes - provincial organizarion 4 Ian Parker, I\.lanager, Direct Funding, CILT, Toronto & consumer represenrarive 5 Terry Richmond, Execurive Director, Cheshire Homes (Hasting &Prince Edward) Inc. 6 Valerie Scarfone, Executive Director, ICHN-Independenr Centre and Nenvork, Sudbury 7 Joanne Wilson, Executivc Director, PACE-Independent Living, Toronto (and VP, Board of Directors, OCSA)

Ontario Community Support Association: Lori Payne, Manager, Communications & Development Cheryl Gorman, Consultant

relared ro services for persons with physical disabiliries, the primary focus being the need for enhanced and expanded Attendanr Services across Ontario.

Sandra Carpenter, Executive Direcror, Centre for Independent Living Toronto (CILT) &consumer represenrative

In the production of this paper, consulrations were held wirh a number of organizations, consumers, and key informants.

APPENDIX B The History of the Independent Living (IL) Model of Service for Persons with Physical Mobility Disabilities in Ontario

Before the advent of the Independent Living movement and the inrroduction ofhttendant Services, most people with physical mobility disabilities would have remained in chronic

Catherine Fraree, Professor School of Disability Studies & Co-director Ryerson RBC Institute for Disability Studies inTorontoandapenonwitha physical mobility disability?

"Twenty-five years ago, the average Canadian thought it too expensive or impractical to make urban environments; buildings'and services accessible to disabled people or to desegregate public' schools. Significant numbers of disabled workers, outside the protections'of legislated employment standards, laboured in sheltered workshops foiconsiderably

care hospirals, lived in instir~itions, or been cared for by hmily members long after the age when most non-disabled people would choose to live independently.

. . less Yhan minimum wage. And by,and large,,the average Canadian was not troubled by this reality.

A quarter century'later, according to a 2004 Environics believe that disabled people should, be supported by publichnds to h e in the community ratherthan in institutional settings ... Canadians believe . . that our governments have a major role to play in.supporting persons .with disabilities with quality health care, accessible transportation, adaptive technology and appropriate education,'

morethan 8 in 19 Canadians

-

15

MILESTONES3' . The Independent Living Movement was born at the University

of California Berkeley campus in the late 1960s by a group of students with disabilities and quickly spread throughout the United States, Canada and the world. It was a unique model which enables people with disabilities to direct their own services in the community.

. In the1970s in Ontario, the Ministry of Community & Social Services began funding Independent Living services for persons with disabilities and established the first Support Service Living units (SSLU) in Ontario, Funding and program management for community support services, including Attendant Services, was transferred to the Ministry of Health 8. Long-Term Care in 1993.

. In 1981, the United Nations General Assembly declared the International Year of Disabled Persons, "heralding a global commitment to ensure people with disabilities share in the full benefits of ~itizenship.'"~

* That same year a Parliamentary Committee on the Disabled and the Handicapped, released Obstacles "providing a roadmap for improvements in legislation, programming, public recognition, research and the physical accessibilityto public buildings, including federal buildings, including federal offices, Parliament and the Government of Canada facilities abroad:

3 In 1983 the Ministry of Community & Social Services initiated Attendant Outreach Services for persons with disabilities to live independently in their own homes.

. In 1994, the Ministry of Health 8. Long-Term Care, with the Centre for Independent Living Toronto (CILT), launched the Direct Funding Pilot Project, Self-Managed Attendant Service - Direct Funding enables persons with physical disabilities to hire, train, pay and manage attendants directly.

* Twenty- five years ago, a young man by the name of Justin Clark had to take on his parents in court to get permission to leave the institution he had lived in since age 2. Justin Clark used a wheelchair and did not communicate verbally, When he won the right to make his own decisions and moved into a house in Ottawa with three other people at age 20, he made history?'

* In 1997 the Canadian Government released another reporl with the intent to "make disability issues a collective priority in the pursuit of social policy renewalY In Unison: A Canadian Approach to Disabi/ify/ssoes was prepared by the Federal/ ProvindallTerritoriaI Ministers Responsible for Social Services. John Lord. Judith Snow and Charlotte Dingwall in an article entitled Bui/dnqa Newstory: Transforming Disabikty Supporfs andPolicies note that:

'"In Unison has created an important value base for moving disability issues ahead in Canada. The orinciple of rights and responsibilities, empowerment and particioation, and equality and inclusion create a sound lramewcrk lor hinking abnut transforming existing polic:ies and programs."

. The Accessibility for Ontarians with Disabilities Act is passed by the Ontario legislature on June 13,2005.

. In March 2007, Canada signed the United Nation's Convention on the Rights of Persons with Disabilities. The Convention was ratified by the requisite number of UN countries on April 3, 2008 and was legally binding effective May3,2008. All parties in the House of Commons have unanimously committed to Canada ratifying the convention.

United Nation's Convention on the Rights of Penonswith Disabiliiles

Article 19 1 Living independently and being included in the community

Parties to this Conveniion recognizelhe equal right d all persons with disabilities to live in the community, with dwices,equalto others, and shall take effective and appropriate measures to +acili& full enjoyment by persobs with disabilities of this right and their full indiision and

tion in the community, including by ensuring that , , ,... , .

a.Perso?s with disabilities have the opportunity to choose their pface of residence and where and with whom they live onaA equal basis wfih others and a; not obliged to live in a particular living arrangement;

$,with disabilities have access to a ranye of in,home, residentialand other community support services, including personal assistance necessary to support living and inclusion in the community, and to prevent isolation or segregation from the community;

c. Community services and facilities for the general population are available on an equal basis to persons with disabilities and are responsive to their needs.

. In 2007, the Honourable David Onley, Ontario's Lieutenant- Governor, became the first person with a physical mobility disabilw to be appointed to the position. Renovations are underway to make the Lieutenant-Governor's quarters at the Ontario Legislature accessible far persons with disabilities.

. .

>

. In a March 15,2008 article in the Toronto Star, Helen Henderson tells the story of Justin Hines, a young man with a physical mobility disability. Justin Hines has had two songs on the charts from his debut album.

"Twentyfive years ago, a young musician in a wheelchair mighi have been little more khan a curiosily, a performer barred from many venues by a shortage of ramps and an oversupply of closed minds. Today, Hines has toured from London to Dubai with no problem."*'

~ ~ __j ~ .... .. ..

16

APPENDIX C A Day in the Life of an Attendant Outreach Services Consumer in Sudbury

The type of support provided by ICAN -Independence Centre and Nenvork Outreach Attendant Services program is unique in both the amount and the flexibility ofservicc.

The profile described below captures the range of support provided and the locations that services are provided in.

'Jill' is a young woman 35 years old who was born with Cerebnl Palsy. h a result of her disabiliry she requires assisrance with all aspects of daily living including communication. She lives at home with her mother in a completely acccssible home.

Jill attends Cambrian College working towards a General Science diploma and actively participates in the technically assisted leatninp centre at the local campus. While at school Jill is able to access the pre-arranged attendant services provided by ICAN - Independence Centre and Network. All personal care needs arc met while enrolled in courses at the post secondary institution.

It is important For Jill to be able to have regular, reliable staff to meet all of her personal care needs as that is what allows her to pursue his goals and live her life. Jill requires support to get up in the morning, SO by 6:OO a.m. the tndependent Living Assistant is there to complete the routine of getting up which takes an hour and forty-five niinutes to complete. Rising for

the day involves transfers using appropriate equipment to ensure comfort and safery. The early service makes it possible for Jill to take the Handi Transit to school or to pursue other recreational opportunities when school is finished or on break.

At the end of the day the Independent Living Assistant provides attendant support so Jill can retire for the evening complete wirh personal care needs met. As Jill uses augmentative communication device, service can take longer as there is the need to communicate and direct the care that is provided in her home.

Ovenll, Jill receives three to four hours ofsupport per day from the Outreach Attendant Care program of ICAN - Independence Centre and Network. It must be noted that there are more extensive carc needs that Jill has and those are provided by members of Jill's family.

There have been occsions where Jill has accessed the Supportive Housing respite unit in order to provide the family with the opportunity to travel out oftown on family business. The respite unit offered a completely accessible environment while at the same time allowed Jill to have an experience living away from her parents. Unfortunately, two years ago the respire beds were closed due to lack of funding and the Family had that support removed from their choice of service.

17

APPENDIX D Attendant Service Providers Across Ontario Funded by MOHLTC (other than Self-Managed Attendant Service-Direct Funding)* - July 2008 * Note: Self Managed Artendant Service-Direct Funding whereby consumers are directly funded ro manage their own ttteiidanrs is adminiitered by CILT (the Ceutre for Independent Living Toronto) for a11 o f Ontario in partnership with the Independent Living Resource Centres of Ontario

Codes: OAS: Outreach Attendant Services ALSH: Assisted Living in Supportive Housing CSH: Cluster Supportive Housing

Service Provider Types of Services Provided Cities

LHlN #I - Erie St. Clair

Association for Persons with Physical Disabilities (APPD) Shared Living (ALSH) Supportive Housing (ALSH) Attendant Outreach (OAS)

Windsor

Ontario March of Dimes (OMOD) Supportive Housing (ALSH) Chatham, Sarnia Attendant Outreach (OAS)

LHlN #2 - South West

Cheshire Homes of London Inc. Shared Living (ALSH) Supportive Housing (ALSH) Stratford, Woodstock Attendant Outreach (OAS)

Clinton, London, St. Thomas,

Participation House - London Attendant Outreach (OAS) London

Participation Lodge Grey Bruce Shared Living (ALSH) Supportive Housing (ALSH) Holland Centre Attendant Outreach (OAS)

Owen Sound, Hacover,

VON Canada - Middlesex-Elgin Supportive Housing (ALSH) London

LHlN #3 - Waterloo Wellington

Guelph Independent Living Supportive Housing (ALSH) Gudph . Attendant Outreach (OAS)

Independent ljving Centre Waterloo Region Shared Living (ALSH) Cambridge, Waterloo, Supportive Housing (ALSH) Kitchener Attendant Outreach (OAS) University Attendant Service

~~~~~ ~~

Ontario March of Dimes (OMOD) Supportive Housing (ALSH) Drayion

Participation House - Waterloo Wellington Supportive Housing (ALSH) Waterloo, Wellington

LHlN #4 - Hamilton Niagara Haldirnand Brant

Conway Opportunity Homes - Cheshire Homes Shared Living (ALSH) Hamilton

Halton Cheshire Homes Shared Living (ALSH) Burlington

Helen Zurbrigg Non Profit Horns Inc. Shared Living (ALSH)) Hamilton

Agenda Item B

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Niagara District Homes Committee for the Physically Disabled Inc. Shared Living (ALSH) Welland

Ontario March of Dimes (OMOD) Supportive Housing (ALSH) Attendant Outreach (OAS) University Attendant Services Simcoe

Hamilton, Niagara Falls, Thorold, St. Catharines,

~~

Participation House Brantford Shared Living (ALSH) Brantford Supportive Housing (ALSH) Attendant Outreach (OAS)

Participation House - Hamilton 8, District Shared Living (ALSH) Supportive Housing (ALSH) Binbrook, Burlington, Attendant Outreach (OAS) Mississauga

Hamilton, Stoney Creek,

LHlN #5 - CENTRAL WEST Ontario March of Dimes (OMOD) Supportive Housing (ALSH) Brampton, Fergus, Milton,

Attendant Outreach (QAS) Shelburne

Peel Cheshire Homes (Brampton) Inc. Shared Living (ALSH) Bramptm

LHlN #6 - MlSSlSSAUGA HALTON Joyce Scott Non-Profit Homes Inc. Shared Living (ALSH) Milton

Attendant Outreach (OAS)

Nucleus Independent Living Supportive Housing (ALSH) Mississauga, Toronto Attendant Outreach (OAS)

Ontario March of Dimes (OMOD) Supportive Housing (ALSH) Mississauga, Oakville Attendant Outreach (OAS)

Peel Cheshire Homes (Streetsville) Inc. Shared Living (ALSH) Mississauga

LHlN #7 - TORONTO CENTRAL Bellwoods Centres for Community Living Inc. Shared Living (ALSH) Toronto

Supportive Housing (ALSH) Attendant Outreach (OAS) Transitional Living Program (ALSH)

Canadian Paraplegic Association-Ontario (CPA) Attendant Outreach (OAS) Toronto

Clarendon Foundation (Cheshire Homes) Inc. Supportive Housing (ALSH) Toronto

Community Health Services - Canadian Red Cross Attendant Outreach (OAS) Toronto

Gage Transition to Independent Living Transitional Living Program Toronto

Nabors Sup@ive Housing (ALSH) Toronto

Ontario March of Dimes (OMOD) Supportive Housing (ALSH) Toronto University Support (ALSH)

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Three Trilliums Community Place Supportive Housing (ALSH) Toronto Attendant Outreach (OAS) Work Place Outreach

Tobias House Attendant Care Inc. Supportive Housing (ALSH) Toronto

LHlN #8 - CENTRAL Access Apartments for Physically Disabled Adults in Toronto Supportive Housing (ALSH) Toronto

Attendant Outreach (OAS)

Arts Carousel Attendant Outreach (OAS) Toronto

North Yorkers for Disabled Persons Inc. Shared Living (ALSH) Toronto

Ontario March of Dimes (OMOD) Shared Living (ALSH) Toronto, Newmarket, Supportive Housing (ALSH) Attendant Outreach (OAS) Markham University Attendant Services (ALSH)

Richmond Hill, Thornhill.

PACE Independent Living Supportive Housing (ALSH) Toronto Attendant Outreach (OAS)

Participation House Markham Shared Living (ALSH) Markham, Toronto, Thornhill Supportive Housing (ALSH)

LHlN #9 - CENTRAL EAST Kawartha Participation Projeds (KPP) Shared Living (ALSH) Lindsay, Peterborough

Supportive Housing (ALSH) Attendant Outreach (OAS)

Ontario March of Dimes (OMOD) Supportiye Housing (ALSH) Oshawa, Whitby

Participation House Proied (Durham Region) Shared Living (ALSH) Oshawa

LHlN #IO - SOUTH EAST Cheshire Homes (Hastings-Prince Edward) Shared Living (ALSH) Belleville, Hastings 8,

Supportive Housing (ALSH) Attendant Outreach (OAS)

Prince Edward, Pidon

Ontario March of Dimes (OMOD) Supportive Housing (ALSH) Attendant Outreach (OAS)

Erockville, Leeds, Grenville

Providence Continuing Care Centre Supportive Housing (ALSH) Kingston, Lennox, Attendant Outreach (OAS) Addington, Fmntenac

LHlN #I1 - CHAMPLAIN Algonquin College Attendant Services Supportive Housing (ALSH) Ottawa Carleton University Residence Attendants

Community Health Services - Canadian Red Cross

University Support

Supportive Housing (ALSH) Cornwall Attendant Outreach (OAS)

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Disabled Persons’ Community Resources (DPCR) Supportive Housing (ALSH) Ottawa

Ontario March of Dimes (OMOD) Supportive Housing (ALSH) Nepean Attendant Outreach (OAS)

Personal Choice Independent Living (PCIL) Supportive Housing (ALSH) Ottawa Transitional Living (ALSH)

VHA Health 8, Homesupport Attendant Outreach (OAS) Ottawa

LHIN #I2 - NORTH SIMCOE MUSKOKA Sirncoe County Association for the Physically Disabled (SCAPD) Shared Living (ALSH)

Supportive Housing (ALSH) Midland, Orillia Attendant Outreach (OAS) Cluster Living Support (CSH)

Barrie, Collingwood,

The Friends Shared Liviog (ALSH) Supportive Housing (ALSH) Attendant Outreach (OAS)

Bracebridge, Parry Sound

LHIN #I3 - NORTH EAST Access Better Living Inc. Supportive Housing (ALSH) Timrnins

Attendant Outreach (OAS)

Shared Living (ALSH) Supportive Housing (ALSH) Manitoulin Attendant Outreach (OAS)

ICAN - Independence Centre and Network Sudbury, Sudbury West,

Ontario March of Dimes (OMOD) Shared Living (ALSH) Supportive Housing (ALSH) Attendant Outreach (OAS)

Elliot Lake, Sault Ste. Marie

Physically Handicapped Adults’ Rehabilitation Association Supportive Housing (ALSH) North Bay (PHARA) Attendant Outreach (OAS)

LHlN #I4 - NORTH WEST HAG1 Community Sekices for Independence Supportive Housing (ALSH)

Attendant Outreach (OAS) Geraldton, Thunder Bay

~~~ ~ ~~

Northwestern Independent Living Services Inc. Supportive Housing (ALSH) Attendant Outreach (OAS)

Kenora/Rainy River Districts

For Immediate Release

OCSA Ontario Community Support Association -I__--.. Unled in our commitment to care

104 - 970 Lawrence Avenue West Toronto, ON M6A 386 (416) 256-3010 1-800-267-OCSA Fax: (416) 256-3021 www.ocsa.on.ca

CRISIS FOR PERSONS WITH PHYSICAL DISABILITIES

GROWXNG DEMAND AND LONG WAIT TIMES: REPORT

August 23,2006 -- Wait times in Ontario for Attendant Services (services that make it possible for persons with physical mobility disabilities to perform fundamental activities of daily living (ADL) like mobility transfers, bathing and dressing) have reached unprecedented crisis levels, a new report released today reveals.

Due to unmet need, the wait lists for people with physical disabilities range from 4 to 10 years. This crisis will only worsen, since the number of people with disabilities is growing, and this population is aging, the report "Unleashing AUendantServices" shows.

"Wlthout Attendant Services, people with physical disabilities are denied the basic ability to go to school, get to a job or contribute to their communities in other ways", said Susan Thorning, CEO of the Ontario Community Support Association.

Ontarians who need Attendant Services: Require services their entire lives Are living longer with medical technology Have changing needs as they age Acquire age-related diseases earlier than the general population, a t about 50 years of age Have much higher incidents of chronic diseases like diabetes and arthritis.

"People on Attendant Services wait lists put pressure on the health care system because they remain inappropriately stuck waiting in long-term care homes, acute care beds, chronic care hospitals, and rehabilitation facilities - all at much higher costs to taxpayers. For aging parents of adult children with physical disabilities still at home, the stress on their health is increasing and they are frankly not able to physically or mentally provide the care anymore." stressed Sandra Carpenter, Executive Director, Centre for Independent Living, (CILT), a consumer of Attendant Services, and a member of OCSA's Attendant Services Advisory Committee that is recommending changes.

The OCSA Attendant Services Advisory Committee is recommending rhat: 1) The Ministry of Health and Long Term Care and the Local Health Integration

Networks (LHINs) begin to immediately address this growing crisis by hosting a special Attendant Services forum with consumers, providers and relevant provincial associations

2) Attendant Services wait times be added as a priority to the Provincial Wait Times Strategy and have the Ontario Health Quality Council report annually on progress

3) The Ministry institute individually-based funding for all persons requiring Attendant Services to ensure a secure level of ongoing services to maintain independence, and secure base stabilization fundlng for service providers to ensure the ongoing infrastructure and capacity to provide the services needed, and

4) There be an immediate infusion of additional funding for existing services and clients as there has been a loss of 23% in Attendant Services providers' spending power over the past 10 years with funding not keeping pace with inflation in an environment of surging demand for services.

It's the right thing to do; it's right for Ontario's taxpayers

*Please note: The full text of the report is available online at www.ocsa.on.ca.

For more information OR TO ARRANGE INTERVIEWS WITH AN AlTENDENT SERVICES CLIENT, please contact: Lori Payne, Manager, Communications, OCSA Iori.uavne@ocsa.on.ca

website: www.ocsa.on.ca 416-256-3010 Ext 242

star.com

Tracy Odell, shown with her 15-month-old granddaughter Sabrina, has muscular dystrophy and requires care from support workers to live in her own home. She receives $40,000 a year in funding to cover attendant services. Report highlights 'crisis' in number of people lacking help from attendants, supportive housing August 13,2008 Tanya Talaga SOCIAL JUSTICE REPORTER

Nearly 1,450 people in Ontario with spinal cord injuries, cerebral palsy and other physical disabilities are languishing on waiting lists for in-home care and supportive housing - some as long as 10 years, a report has found.

Of those, 900 people are living in Toronto.

Without help at home, they are warehoused in group homes, long-term-care facilities and hospitals at a high cost to taxpayers.

One day in the hospital costs roughly $1,200, but if that person were to receive care at home from attendants, the cost would be $200 a day, according to the Ontario Community Support Association, which has written the report. Placing people with disabilities back in their homes is not only cheaper, it frees up hospital beds.

The report highlights what the association calls an "unprecedented crisis situation" in the number of people lacking in-home care from attendants and places to live in supportive housing.

The association is holding a news conference today at Queen's Park.

This is a human rights issue, as those who are physically disabled should have the right to choose the type of care they receive, says Susan Thorning, CEO of the association, which represents 700 provincial community support providers.

"We need to see more than just talk," she said.

It will take about $73 million from the provincial Ministry of Health to address the wait lists for attendant services over the next five years, the report says. The association wants wait times for attendant services and supportive housing added to the Ontario Wait Times Strategy. The strategy monitors waits in areas such as cancer surgery and joint replacements.

Health Minister David Caplan was unavailable for comment yesterday.

Attendants help people with physical disabilities perform daily tasks, such as going to the washroom, dressing, bathing and eating.

For four years, Theresa MacNeil, 46, has waited for direct funding so she can live in her own home and hire her own attendants. She has arthrogryposis, a rare disorder that contorts and stiffens her joints and muscles.

MacNeil is unable to walk. She lies flat out on her belly on an electric stretcher. Her physical limitations have not limited her life - she is married, has a 12-year-old daughter and travels downtown to her job.

Currently, the MacNeil family lives in supportive housing in Scarborough, where attendants are available 24 hours a day for people with chronic conditions.

"Being married is one thing, but putting the total responsibility to look after me is another," said MacNeil. "I don't believe in that. I want to give (my daughter) a home, I want to give her a house."

MacNeil recently discovered it could be another two to four years before she gets fimding from the province. "It's not that they don't want to give it to me, ifs that they can't."

About 6,000 people across Ontario receive attendant services in three ways. Self- managed direct funding allows adults with a physical disability to be in charge of their care - from managing a budget to hiring and supervising their own attendants. Outreach attendant services are provided at home between 6 a.m. and midnight and can be

provided at the workplace or post-secondary school. Supportive housing offers 24-hour care in a larger apartment building.

Tracy Odell, 50, has used attendant services for six years. "She helps me cook, all my personal care, getting up, going to bed and showering," says Odell, who has muscular dystrophy. She shares a Scarborough bungalow with her husband David. At age 7 she was sent to live at Bloorview Kids Rehab and stayed until she was 18. She lived in supportive housing for years.

"I wouldn't have survived without help," she said.

Odell, a grandmother, manages $40,000 a year in direct funding to support six hours of service a day, seven days a week. "I can work, I can contribute to my family," she says. "You never leave the program - these are permanent disabilities, it's not like a broken leg."

f a c t

Diversity: Disability Issues in Home and Community Care

The CRNCC 1s supported by iunding from the Social Sciences and Humanities Research Council of Canada (SSHRC) and Ryeaon University. s h e e t

Diversity has many dimensions. A broad and comprehensive understanding includes religious beliefs, cultural traditions, mental and physical ability, sexual orientation, class as well as differences in race, language and ethnicity. This In Focus, the third of our Diversify Series, looks at the challenges which people with disabilities and their providers face in home and community care.

What do we mean by disabilities?

We adopt the definition of disability used by The Participation and Activity Limitation Survey (PALS) which is a national survey designed by Statistics Canada to collect information on adults and children who have a disability. Disability is defined as a limitation of everyday activities because of a condition or health problem. The detinition includes disabilities that are both visible (e.g., problems with mobility), and invisible (e.g., psychological, hearing, learning or developmental issues (Statistics Canada, 2007)

Why focus on disabilities issues in home and community care?

Equity and human rights. Disability is a prohibited ground of discrimination in Canada under the Canadian Charter of Rights and Freedoms and under provincial and territorial human rights legislation. This means that people with disabilities have the right to (among other things) accessible health and social care services.

As well, Article 19 of the UN Convention on the Rights of Persons with Disabifify (httD://w.un.ors/esa/socdev/enable/riahts/c onvtexte.htm) states that countries such as Canada, which is a signatory to the Convention, must recognize the equal right of all persons with disabilities to live in the community, choose their place of residence and living arrangement, have access to a range of in-home, residential and other community support services, including personal assistance necessaly to support living and inclusion in the community, and, be able to access similar community sentices and facilities that are available to the general population.

Poorer health and unmet care needs. People with disabilities are less likely than the general population to report good health and be able to obtain needed health care and social supports (Canadian Council on Social Development, 2003). While people with disabilities tend to be older and have poorer health, the health differences remain after taking age into account.

Increasing numbers of people with disabilities.

Between 2001 and 2006 the number of Canadians (excluding persons living in institutions and on First Nation reserves) who reported having a disability increased by roughly threequarters of a million people. This increase is attributed in part to an aging population (Statistics Canada, 2007). However, aging does not explain the entire gain. When the impact of population aging is controlled for, disability rates increased for nearly all age groups. The data suggest a combination of changing disability profiles and higher

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rates of self-reporting due to reduced stigma attached to having a disability (Statistics Canada, 2007).

I in 7 or 4.4 million Canadians who do not live in institutions or on First Nations reserves reported having a disability in 2006 (Statistics Canada, 2007).

The disability rate is higher among women aged 25 and over than men in the same age group.

Excluding the territories, First Nations reserves, and institutions, an estimated 3.7% or 202,350 of children aged 14 and under live with some type of disability. This proportion is up from 3.3% in 2001(Statistics Canada, 2007).

Shift from institutions and hospitals to communities. For over forty years in Canada, trends in care provision have shifted responsibility from large institutions toward community-based responses. Increasingly people with complex and ongoing care needs that are often associated with many disabilities are being supported by home and health care workers and families in the community although some people with high level needs remain in hospitals. In Ontario, three remaining large institutions for people with mental health issues - Huronia Regional Centre in Orillia, Rideau Regional Centre in Smith Falls, and Southwestern Regional Centre in Blenheim will be closed by March, 2009.

Deinstitutionalizing care has in large part been driven by cost and legal considerations. Care in the community was believed to be more cost effective than care in hospitals and institutions. Furthermore, hospitals and institutions wished to avoid possible legal challenges over "involuntary" hospitalization or institutionalization after laws were changed to protect the rights of people with disabilities by narrowing the conditions under which involuntary hospitalization and treatment were legally permissible (Hartford et. al., 2003).

Finally, deinstitutionalization also reflected changing values. People with disabilities, their families and the agencies that provide supportive services to people with disabilities have long advocated for more options around their services, including supports to enable them to remain independent. Unfortunately, support for people with disabilities has shifted out of institutions and hospitals without appropriate or sufficient resources for health and social services in the community. As a result, the burden has increased for families, informal carers and other sectors of our health and social system.

Home and community care promotes independence and well-being. Respecting that people with disabilities have varying levels and diversity of needs, they often require assistance with daily living activities. According to the Canadian Council on Social Development, the most common types of assistance required include:

housework getting to appointments

0 meal preparation

This is consistent with Statistics Canada data showing that mobility limitations were the most frequently reported form of disability for seniors (Statistics Canada, 2007).

Community-based agencies can often provide assistance with daily living activities and thereby enhance quality of life and enable people with disabilities to live relatively independently in the community at relatively low costs.

According to the Canadian Council on Social Development (2005) however, only about two- thirds of individuals needing such assistance get it, with women more likely to get assistance than men. Furthermore, the majority of help is provided informally by family and friends. While assistance from family and friends is much appreciated, this type of informal help does not promote independence, autonomy, self management and control. People with disabilities may have to adjust to the schedules and time frame of

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their helpers and may feel that they are a burden to them. In contrast, agencies providing home and community care do so in a scheduled and predictable way (Lum et al., 2005). People with disabilities tend not to feel that they are a "burden" to community agencies whose goals are to provide home and community supports.

As far children with disabi(ities, parents of one-third of these children required some type help with daily activities, including housecleaning, meal preparation, and time off for personal activities because of their child's condition. Most of the help was informal assistance from friends and family. Only 44% received formal assistance from government organizations or agencies (Behnia & Ducios, 2003).

Caring for a child with a disability presents special challenges for parents, which can affect their employment status (e.g., not taking a full-time job, working fewer hours, or having to arrange a modified work schedule):

54% of the parents of children with disabilities reported that caring for their child affected their employment in some way. This figure increases with the severity of the disability.

The impad on employment status affects women more acutely than men. Among families of children with disabilities where the parents' employment status is affected, only the mother's employment status was affected in 71% of cases; the father's employment status was affected in 11% of cases; the employment status of both parents was affected for 14% and in the remaining 4%, family members other than the parents were affected as well.

Models of disability

Before identifying barriers to accessing home and community care, it is important to understand the social context within which barriers are, or are not, identified.

The medical model of disability was prevalent historically. It regards disability as a medical problem to be "cured by professionals. Those who cannot be "cured" are deemed functionally inferior to "normal" people, and are expected to see their impairment as their problem - something they will have to make the best of. Society really has little role in facilitating independence and well-being.

Alternatively, the social model makes a distinction between "impairment" and "disability." While impairment refers to a person's condition, disability is a social and political problem of society's barriers. Instead of trying to cure people with impairments, this model places responsibility on society to get rid of barriers so as to accommodate and include people with disabilities. Barriers, prejudice and exclusion (purposely or inadvertently) are the ultimate factors defining who is disabled and who is not in a particular society.

'

Barriers to accessing home and community care

Implicit in identifying barriers to accessing home and community care is the social model of disability described above. For people with disabilities and their families to have choice and control over their care, services need to be accessible in all respects.

Environmental or physical - ensuring that facilities or transportation is appropriate by, for example, replacing stairs with ramps, using automated doors, having doors wide enough for scooters; providing audio cues in elevators, announcements in public transportation and audio and visual cues for life safety systems such as fire alarms, emergency exits.

Structural, institutional or systemic - ensuring that services are available and appropriate by, for example, giving people

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with disabilities more time during for appointments as opposed to inflexible time allotments; and re-examining overly narrow eligibility requirements for supports or services.

Informational - by providing clear guidance about where and how to get assistance, particularly for assistance in activities of daily living. Information needs to be in an appropriate format or be linguistically or culturally appropriate, for diverse populations with disabilities.

Attitudinal - by ensuring they do not stigmatize service users. If people with disabilities fear negative experiences, they may avoid needed services until a crisis occurs.

Geographical - by making sure appropriate supportive services are within reasonable distance of users including those living in suburban or rural areas.

Financial - by making them affordable. High costs of assistive aids such as home adaptations and scooters, or high co- payment fees for community-based care can place financial burdens on people with disabilities and their families.

Challenges to providing home and community care to people with disabilities

One size does NOT fit all. People with disabilities may have varying ideas about what independence means and how best to achieve it.

0 Some may want to live as well as possible with their disability using minimal assistance from assistive aids and skilled professionals.

Others may be less concerned with accomplishing daily tasks unassisted but want to control the direction of their lives by defining their needs, making decisions,

managing and taking charge of nearly all of the administrative responsibilities associated with their own care (Bush, 2000; Helgey et al., 2003). This is called the self-managed model of care, but even here, different variations exist. They include:

the “agency-sponsored, but user- directed model, where a service provider organization is responsible for the hiring, training, supervision and payment of employees but the service- user and provider collaborate to arrange a personal support regime:

the “brokerage” model, where an intermediary acts as a liaison between the person with disabilities and the government to arrange a personal support plan (e.g., model used in Quebec):

the “Individualized Funding” model, which involves a transfer of funds directly from the government to persons with disabilities or their support group so they can purchase care at their own discretion. They are responsible for recruiting and supervising care providers and for how funds are spent (Bush, 2000). This is the most common type of self- managed care program in Canada.

In some cases, institutional care may still be the best choice for some individuals with disabilities.

What is disability appropriate care?

Disability appropriate care is care that is sensitive to the varying needs of people with disabilities. it is important to understand that people with disabilities are diverse both in their disability and cultural background. Service providers must take these differences into account when delivering home and community care.

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Agonda

,

Kaiser Permanente (2007) has developed guidelines for culturally competent care for people with various disabilities. They include:

Using “person first language” such as “people with disabilities“ instead of “disabled people;“

Considering the person with the disability to be the expert about hidher condition;

Considering the nature of the disability;

Identifying yourself and addressing the person with disability directly;

Not making assumptions about the person with disability;

Letting the person with disability ask for assistance when it is required;

Allowing sufficient time for tasks and procedures

Selected ‘!best practice” examples

There are many examples of best practices in home and community care for people with disabilities. Here, we highlight some that exemplify important principles specified by key organizations providing supports to people with disabilities.‘

Age appropriate care Some argue that age appropriate care is segregation by a different name. Others however claim that living in age appropriate settings is vital to quality of life. While some younger people with disabilities (like older people with disabilities) may prefer to live in

’ These organizations include: The Canadian Coalition for Seniors’ Mental Health, Canadian Nehyork for Mood and Anu’ety Treatments. CanChiid Cmtm for Childhood Disability Research, Centre for Addlctlon and Mental Health. Connections for lnformatlon and Resources on Community Living. Health Charitm Goalltlon of Canada, lndivlduallzed Funding Coailtion for Ontario. Public Health Agency of Canada, Michigan Department of Community Health, Natlonal Children’s Alliance for the Firs National Roundtable on Children with Disabiiities and the Older Persons’ Mental Health and Addictions Nehyork of Ontario.

mixed age settings, there should be choices available for those who prefer to live with neighbours closer to their age category (Pape, 2006). Here are some examples.

Castleview Wychwood Towers, Toronto is a long-term care home, mainly for seniors, but has a 19-bed younger adult unit. Many residents of this special unit have neurodegenerative diseases or MS or have experienced a stroke. http://w.toronto.ca/ltc/castleview. htm

Disabled Persons Community Resources, Ottawa serves 54 clients in four buildings; three are standard apartment buildings, with an average of 16 clients in self-contained units. The fourth is a group home for younger people. All provide housekeeping, meals and 24-hour attendant care services. http://www.dpcr.ca/english/about-e. html

Privacy and respect. We all face crises from time to time and appreciate if these crises can be solved with minimal disruption and intrusion. Likewise, people with serious mental or physical illness would like services that can assist them in resolving dilemmas and crises using minimally intrusive options. Doing so preserves dignity and respects the extent of their ability to act independently.

Cheshire Southwestern Ontario provides attendant services for people with permanent physical disabilities in the London area. These services can be user-managed, and any restrictions on the activities of the service user are implemented only after consultations and agreement with the individual.

Encouraglng social engagement and participation in the broader community

LOFT (Leap of Faith, Together) Community’ Services provides supportive housing and integrated support services for people with disabilities that include serious mental illness challenges, addictions, physical health challenges, and homelessness. Staff members provide opportunities for joining clubs, social networks and religious/cultural

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groups while also encouraging individuals to participate in the mainstream of community life according to personal choice and preference. The setting allows for stability, social relationships and a variety of community activities. Volunteer opportunities and sometimes paid employment are available.

Opportunities for caregiver training. More complex “high tech” care is now being delivered in homes and communities, but current training programs do not adequately prepare home care providers for the level of care they expected to provide. Informal caregivers are also being asked to perform complex procedures or monitor technologies with little or no training. Both formal and informal caregivers need more appropriate training, and access to the right technologies

To implement the principle of self- determination and autonomy for people with hearing impairment, Bob Rumbell Home for the Deaf emphasizes the right of seniors to understand and be understood in a communication mode of their choice-- not someone else’s. The Rumbell Home therefore provides continuous staff training in various modes of communication and requires ongoing upgrading of skills.

0 Bellwoods Centres provides support services and independent living education programs for people with physical disabilities and promotes formal staff educational upgrading through the Personal Support Worker (PSW) certification program.

Bellwoods Centres also initiated a service plan to transition Cooperative Living Project clients and staff from a cooperative living model to an apartment living model, including education for clients.

Older Persons’ Mental Health and Addictions Network offers education and training opportunities for service providers and caregivers on topics such as depression and substance misuse issues among seniors.

http://w.ontario.cmha.ca/opmhan/index. asp?clD=6683

Respite for family, friends and other informal care providers. Respite care is critical to help relieve the financial, emotional, and physical stress that informal carers experience. Strong parental or carer involvement in respite service development can ensure the relevance of such programs.

Huron Respite Network provides emergency and planned respite care for children, youth, and adults with special needs in Huron County so as to support family life, relieve stress, and fulfill emergency needs/situations. It works with carers to identify respite options and develop a respite plan. It also provides a Screening Service in order to optimize the match between the needs of the person with disability, carers andl or families and the respite provider. www. huronresoitenetwork.com

Canadian Coalition for Seniors’ Mental Health has excellent educational materials giving informal caregivers across Canada access to information regarding the mental health problems and issues seniors may face, and solutions or resources that can be used for support. http://ww4/.crncc.ca/download/CCSMHlnfo rmalCareqiverEducationalMaterials.pdf

How can I learn more? Link to the following sites:

Bellwoods Centres for Community Living delivers supportive services, supportive housing and independent living services for adults with physical disabilities in the Greater Toronto Area, enabling them to live as independently as possible in the community. Support services for daily activities are delivered under clients’ direction in their home or workplace. Supportive Housing combines housing with 24/7 service access. The Independent Living Programs promote independence

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and quality of life by helping with life skills. h t t D : / / W . beiiwoodscentres.ora/index. ht m The Bob Rumball Home for the Deaf (Barrie, Ontario) aims to enhance the quality of life of deaf seniors by preventing social isalatian through creating a sense of belonging and dignity. It emphasizes accessibility, communication and visual orientation. An integrated model of care allows residents to be assisted in all areas of daily life in a home-like environment. http://www.bobrumball.ora/BRFD/ionclterm - .html

Canadian Coalition for Seniors’ Mental Health (CCSMH) is a knowledge exchange and advocacy network for promoting seniors’ mental health. CCSMH has created national guidelines for seniors’ mental heakh, as well as numerous education and training modules for specific mental health issues facing seniors and their carers. www.ccsrnh.ca

Cheshire Southwestern Ontario supports adults with disabilities to help develop their independence and dignity. The organization aims to promote self- determination, choice and ability to participate in community life through outreach programs and supportive housing. Outreach programs are available in London and 5 surrounding counties, where consumers live in their own homes and attendant services are available on a prescheduled basis, 7 days a week. Supportive housing is available in London and 3 surrounding counties, each with a range of 6-17 residents who have access to 24 hour services, on a schedule or on- call basis. www.cheshirelondon.ca

LOFT (Leap of Faith, Together) Community Services offers pemanent housing, supportive housing and outreach programs. it provides programs for vulnerable and homeless youth, adults and seniors living with mental health, addiction and physical health challenges in over 60 sites in the Greater Toronto Area

and York Region. It aims to help residents recover their health, dignity and self- esteem. http://www.loftcs.orq/

Older Persons’ Mental Health and Addictions Network of Ontario (OPMHAN) is a cross-sector and interdisciplinary network with a focus on improving the system of supports for seniors coping with mental health and addictions issues as well as their carers. http:/lw,ontario.cmha.ca/oomhan/index. zee See also: In Focus: Seniors’ Mental Health and Addictions htt~://www.crncc.ca/knowledae/factsheets/ download/lnFocus- SeniorsMentalHealrhandAddicitions pdf

Written by Janet Lum

Assistance from student researchers: Khadija Khan, Will Rassenti, Sarah Smith, Alexandra Williams, Alvin Ying

In consultation with: Claire Bryden, Bellwoods Centres for Community Living Inc.; Suzanne Crawford and Jim McMinn, LOFT Community Services; Randi Fine, Older Persons’ Mental Health and Addictions Network of Ontario; Judi Fisher, Cheshire Southwestern Ontario; and Kimberly Wilson, Canadian Coalition for Seniors’ Mental Health.

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Bibliography

Behnia. B.. & Duclos, E. (2003). Statistics Canada Participation and Activity Limitation Survey 2001: Children with disabilities and their families. Ottawa: Statistics Canada.

Bethune-Davies. P.. McWilliarn. C. L.. & Berrnan, H. (2005). Living with the health and social inequities of a disability: A critical feminist study. Health Care for Women International, 27, 204-222.

Bolton, C., 8 Allen, B. (2000). Developing supported living services: A guide to essentials for service agencies and regional centers. Arcadia, CA: Connections for Information and Resources for Community Living. Retrieved June 6, 2008 from httu://www.dds.ca.qov/livinaarranq/docs/develoDinasuDDo~edlivinase~ices.udf

Bush, L. (2000, November). Self-managed care and individualized funding: Not the same thing! Paper presented at the 1" CLC National Disability Rights Conference, Montreal, QC.

Canadian Council on Social Development (2003). CCSD's disability information sheet No. 9: The health and well-being of persons with disabilities. Ottawa: Author.

Canadian Council on Social Development (2005). CCSD'S disability information sheet No. 17: Supports and services for persons with disabilities in Canada. Ottawa: Author.

Centre for Addiction and Mental Health. (2008). Best practice guidelines for mental health promotion programs: Children &youth. Toronto: Author. Retrieved June 6,2008 from httD://www.camh.netbout CAMHlHealth Promotion/Communitv Health Promotion/Best Practice M HYouth/index.html#quidelines

Clarke Institute of Psychiatry. (1997). Review of best practices in mental health reform. Ottawa: Health Canada. Retrieved June 6,2008 from http:i/www.phac-asoc.qc.ca/mh-sm/pubs/bo review/pdf/e bo-

Hanvey, L. (2002). Children with disabilities and their families in Canada: A discussion paper. -Ottawa: National Children's Alliance. Retrieved June 6, 2008 from htt~://www.nationalchildrensalliance.com/nca/pubs/2002/hanvev02.pdf

Hartford, K., Schrecker, T., Wiktorowicz, M., Hoch, J. S., & Sharp, C. (2003). Four decades of mental health policy in Ontario, Canada. Administration and Policy in Mental Health, 31(1), 65-73.

Health Charities Coalition of Canada. (2007). Position statement on access to home care. Ottawa: Author. Retrieved June 6, 2008 from htto://www.healthcharities.ca/documents/position statements/Access%20to%2OHoine%2OCare%2OPo - sition%20Statement%20Ap~roved%20Julv%2023%2007.~df

HelgPry, I., Ravnberg, B., & Solvang, P. (2003). Service provision for an independent life. Disability & Societyc 18(4), 471-479.

Individualized Funding Coalition for Ontario. (2006) Understanding individualized planning and funding. Toronto: Author.

Kaiser Permanente. (2007). Culturally competent care and individuals with disability. Vallejo, CA: Kaiser Foundation Rehabilitation Center.

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I Lum, J. M., Ruff, S., &Williams, A. P. (2005). When home is community: Communitysuppotf services and the well-being of seniors in suppotfive and social housing. Toronto: United Way of Greater Toronto. Available at httu://www.crncc.ca/download/FinaIReuortWhenHomeisCommunitv.pdf

New South Wales Government. (2006). Accommodation and support paper. Retrieved 12 April, 2006 from htt~://www.dadhc,nsw.qov.au/NR/rdonlvres/FAEl24D6-C6EA-4EE8-8686- 30DDB98ABB4E/1787/AccommodationandSuur~ortPaoer 230106,udf

Palsbo, S. E., & Kailes, J. 1. (2006). Disability-competent health systems. DisaMity Studies Quarterly, 26[2). Retrieved April 12,2008 from httu://w.dsq-sds archives.orq/ articles htrn1/2006/st1rinq/oalsbo kailes.asp.

Pallev. H. A,. &Van Hollen, V. (2000). Long-term care for people with disabilities: A critical analysis. Health &Social Work, 25(3). 181-189.

Pape, E. (2006). Finding my place: Age appropriate housing for younger adults with multiple sclerosis. Toronto: Multiple Sclerosis Society of Canada, Toronto Division. Available at httrJ://www.crncc.ca/downioad/MSCanadaFindinqMvPlace.pdf

Social Union. (2004) Supports and services for adults and children aged 5-14 with disabilities in Canada, Section II: Help with daily activities. Retrieved April, 2008 from httr~://www.socialunion.ca/pwd/section2.html

Statistics Canada. (2007). Participation and Activity Limitation Survey 2006: Analytical report. Ottawa: 'Author.

Stewart, D., Antle, B. J., Healy, H., Law, M., & Young, N. L. (2007). Best practice guidelines for transition to adulthood for youth with disabilities in Ontario: An evidence-based approach. Hamilton: ON: CanChild Centre for Childhood Disability Research.

Verick, M., & Fullwood, D. (1998). Standards in action: Practice requirements and guidelines for services funded under the Disability Services Act. Sydney, New South Wales: New South Wales Ageing and Disability Department.

Yatham, L. N., Kennedy, S. H., ODonovan, C., Parikh, S., MacQueen, G., Mclntyre, R., Sharma ,V., Silverstone, P., Alda, M., Baruch, P., Beaulieu, S. , Daigneault, A,, Milev, R., Young, T., Ravindran, A,, Schaffer, A., Connolly, M., & Gorman, C. P. (2005). Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: consensus and controversies. Bipolar Disorders, 7(Suppl. 3, 5-69.

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A N E W S L E T T E R F O R T H E C O N S U M E R S , S T A F F A N D F R I E N D S O F C H E S H I R E L O N D O N

Ann Van Sickle

Ann is no stranger to Cheshire, the relationship between her and the organization began in 1989. London born and raised, Ann was working at Red Deer College in Red Deer Alberta as a Coordinator for Disabled Students. She wanted to return to London for a few days to visit with family and friends while on summer break and was looking for a respite stay. A close friend and Cheshire consumer suggested she contact Judi Fisher, there may be an opportunity for her to stay at the Group Home located at 534 Princess Ave. From that point on Ann's visits to London became almost annual, the summer visits became longer a id after 1991 Ann would often stay for up to two months. She was thrilled to have the opportunity for the respite so she could come back home to spend time with her family and friends.

In 2005 Ann moved back to London. In that same year she was offered the opportunity to move into the new Group Home located at 559 Topping Lane. Ann has a progressive neurological disorder called Charcot- Marie-Tooth (CMT) disease that is deteriorating her nerves and muscles but that has not stopped her from pursuing her dreams and overcoming barriers. Being the independent person she is, Ann was interested in moving into her own apartment along with her helper dog Keep'er, an 8 years old yellow Labrador retriever.

[n January 2008 her dream became a reality and she moved into her own accessible apartment on the ground floor at 98 Baseline Road West. Ann says she has the best of two worlds, being on the ground floor for her dog and being close to the Cheshire I11 office. Keep'er assists Ann in many ways from picking up items as small as a dropped pill to gently removing her coat in the winter. With the added assistance her helpa dog gives, Ann is able to save energy and also advises it is cost effective - she doesn't need help 24/7!

Ann has been active in her community, serving and volunteering on many Boards and Committees contributing to her home town by working with the March of Dimes, Ontario Society for Crippled Children and PUC Parks and Recreation Dept. She has received the London Sport Award for

rcellence at the Ontario and Canadian ;ames for the Disabled, the Outstanding Young Londoner award from the London raycees and the Life Style Award from the Minister of Health and Welfare. At this ime, Ann and Keep'er can be seen around h e halls at Mount Hope where they volunteer their time three days a week visiting with residents.

When asked about how Cheshire has made a difference in her life, Ann states, "Being an active member of society, being in control over my life, being free to make decisions and being independent in the past twenty five years has come as a result of the support I have received. Cheshire has enabled me to live the type of life I have always wished for myself. They come in daily and assist me in many areas. For me at 62, maintaining my independence and taking full responsibility for myself is crucial. I have always felt I had a type of calling to ensure that special needs individuals were given every opportunity to live up to their own potential. Whether I was accomplishing this in the field of recreation, counselling, education, or if I was lecturing writing articles, on a committee, or volunteering, it was essential that I be out in the community and visible. By being visible I have constantly been improving the lives of others. The reality is, I couldn't do my job if Cheshire wasn't doing theirs.

When asked if she had one wish to share for herself or Cheshire, Ann could only think of one response for both. . . a wheelchair van. A van would not only provide her or other consumers the ability to travel - it would certainly make Everyday Dreams a reality.

I had the pleasure of visiting the two programs that we have "twinned" with this year. Cheshire has "twinned" with a program in Madurai, India since 1978 and a program in Livingstone, Zambia since 1998. I came away from those visits amazed at what they can do with very limited resources, stunned by the abundance in our country in contrast and armed with the knowledge that the work that we are doing with and for our "twinning" partners does make a difference. Over the next few months I will share some of my experiences in different locations and ways.

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Twinning Bv Judi Fisher. Executive Director

International Day of Persons with Disabilities, December 3rd, 2008

The 2008 theme of the International Day of Persons with Disabilities is "Convention on the Rights of persons with Disabilities: DivniQ and Tustice for all of us". Cheshire will be hosting a workshop on December 3rd to celebrate the International Day and to discuss the UN Convention and its implementation.

Twinning Committee - Contest: Cheshire's Twinning Committee has resolved to change the name of the committee and expand its work to include a more global focus. To this end we would like to invite your suggestions for a Name Chanoe. Some suggestions have been:

Global Relations Committee Global Disability Awareness

Global Village Committee Committee

If you have a suggestion please submit it to me at judi.fisher@cheshirelondon.ca or call (519) 439-4246 ext. 226 by Friday, August 22nd, 2008.

There is a prize for the best suggestion ... a hand carved basket from Livingstone, Zambia with carvings of the "big five" - elephants, giraffes, lions, water buffalo, and I can't remember the fifth!

If you would be interested in joining this committee just drop me a note..

Summer is a Great time for cooking on the BBQ! It is also important to keep safe while grilling your favorite foods. Here are some helpful hints to make sure it is in good working order after a long winter: If you change the propane tank it's a good idea to inspect your RBQ. You can do this by spraying soapy water on the connections and supply lines to make sure there isn't a gas leak while the " Q is on. Remove the grates and lava rocks to check out the burner. Once fired up the flame should be even throughout. If not, it might be time to replace it. It's a good idea to clean out the ash and grease that has accumulated at the bottom of the BBQ. Check the unit for rust and any signs of deterioration. Check out the tubes that deliver the gas to the burner because if they get plugged up the gas will get diverted elsewhere which could cause some harm.

When Rarbequing . . make sure the BBQ is at least 5 feet or more from the house or any materials that could catch on fire only open your propane tank M to M turn because that's ail the gas your BBQ needs to operate and if you have a problem it is much easier to shut off always open the RBQ lid before you light it - if it doesn't light the first time, shut it down and try again after about 5 minutes Always make sure that the BBQ is in a safe place, where children and pets won't be touching or bumping into it. After you've finished Barbequing, always make sure you not only shut it off, but shut off the propane tank as

Cheshire Chat Page Two

Welcome to Vera! My name is Vera Pavlovets. I immigrated from Russia 17 years ago with my husband and four small children. I humbly began life in a new country and made Canada my new home. Over the past 13 years I‘ve been working as a Team Leader at Robarts Research Institute. Last year, I realized my dream of going to College and started taking Office Administration courses at Fanshawe College. After graduating from my program I was eager to gain experience and further my skills, which has led IIL~ to Cheshire working on a volunteer basis.

I would like to thank everyone for their warm welcome and for the opportunity to work with the great people of Cheshire. In this short time I have already learned so many things about how Cheshire supports persons with disabilities in the community and am glad to be a part of it.

Besides working a full-time in the evening, I am an entrepreneur. In 2005, I opened my own janitorial company called Clean Solutions. We service businesses, big and small, all over London. In my very limited spare time I enjoy spending time with my family, especially my grandson and granddaughter. I also enjoy reading, hiking, and gardening.

Welcome to Mike! Hello .... my name is Mike Van der Vlist and I was recently provided the opportunity to join Cheshire as the Team Leader for Elgin County. I have enjoyed meeting everyone, and look forward to meeting those I have not yet had the chance.

My background includes past opportunities with a variety organizations in supportive housing, outreach, rehabilitation, and day programs.

I greatly enjoy being involved in the community from service clubs, food banks, emergency response teams, to support groups, among others, and in every capacity from bpard member to the guy flipping burgers at a fundraiser. I also tend to use the words neat, cool, and awesome quite often, believe duct tape is an essential item for everyone’s life, and like to make anything I am doing fun. Plus anytime I can paddle, camp, hike, play frisbee, grab a swing in a park, sit on a beach, have a fire, build stuff, swim, paint, read, wander and or putz about, is always a good day

Welcome to Amy! Hello, my name is Amy Kortvely. I will be taking Leslie’s role as the executive assistant while she is on maternity leave.

I was born in Budapest, Hungary. My educational background is psychology and human resources. This reflects my personality -I am outgoing and I like meeting new people. To keep a balance, I also enjoy working on the computer, playing card games, or talking to my family in Europe.

In my free time I enjoy playing squash, hiking, and reading.

I would like to take this opportunity to say thank you to everyone who I have been working with during my training period. I look forward to meeting you all in the future!

Cheshire Chat Page Three

As summer is officially here it is time to look at options that can help us make the most out of the good weather. Some of Toronto's urban beaches provide great accessibility and even beach wheelchair rentals.

"The Beaches" in Toronto "The Beaches" is a district in Toronto. It is roughly defined as bounded by Woodbine Avenue to the west, Victoria Park Avenue to the east, Kingston Road to the north, and Lake Ontario to the south. Locally, there is a fair bit of debate as to whether the area. is known as "The Beaches" or "The Beach. Nonetheless, both names are widely recognized.

It is a large sandy beach along the eastern shore of the Toronto

Accessible Tripping

waterfront, close to residential area and many amenities. As an urban beach it is easily accessible from downtown hotels.

How to get there By car, from the north: Take Highway 401 to Don Valley Parkway South, exit at Lakeshore Blvd. East. Follow Lakeshore Blvd East until it becomes Woodbine Ave. Turn right onto Queen St. East.

By car, from the west: Take the QEW Toronto to the Gardiner Expressway. Follow Lakeshore Blvd East until it becomes Woodbine Ave. Turn right onto Queen St. East.

What to see This section of Lake Ontario shoreline is known as the Eastern beaches, and includes, from east to west, Balmy Beach, Kew Beach, and Woodbine Beach. The 3.5-kni Boardwalk winds along the beaches from Silver Birch Avenue to Ashbridge's Bay Park, west of Woodbine Avenue. The Boardwalk is a great place for strolling and people-watching, especially in the summer, when it's always a bit cooler at the lake than elsewhere in the city.

What are beach wheelchairs? They have large balloon tires, allowing easy movement over dry or wet sand and along the water's edge.

Some of them come equipped with an umbrella.

Leuty Lifeguard Station, on the beach at the foot of Leuty Avenue. This Beach landmark was built in the 1920s.

R.C. Harris Water Treatment Plant, Queen Street at the foot of Victoria Park Built in the 1930s, this beautiful Art Deco building is Toronto's largest water treatment facility and has been designated a national historic civil engineering site. It's been featured in a number of films and TV shows.

Kew Gardens, at the foot of Lee Avenue. This park includes a large children's playground and wading pool in the north-west corner. In the winter, there's the outdoor ice-skating rink. The Beaches Library, one of three Toronto Carnegie libraries, is located in the north-east corner. The Kew Williams House, also known as the Xew. Gardener's cottage, is located at 30 Lee Avenue and is one of the most photographed buildings in the Beach. It was originally owned by the owner of Kew Gardens.

Cheshire Chat Page Four

They are designed for use on land only, though they can be pushed through no more than 6 inches (15 centimeters) of water. They require assistance -beach wheelchair users need a helper to push the chair and assist with transfers and personal care.

They can be borrowed for up to 2 hours per visit.

They are available during beach lifeguard hours. To borrow a beach wheelchair: Reserve a chair up to 24 hours in advance by calling 416-392-7688.

A second chair is available on a first- come, first-serve basis at Donald D. Summerville Outdoor Pool (1675 Lake Shore Blvd. E.) - vehicle access is via Queen St. E.

Dates and times available in 2008: June 26 to August 31, every day between 11:30 AM to 630 PM.

Exchange your mobility aid for a beach chair at the Donald Summerville Pool reception area (accessible washrooms available).

Remember to bring a buddy to push the chair. Be sun safe and be prepared to have fun on the beach!

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ENGAGE Udate At Christmas time the consumers at Cheshire IV received hand-made ornaments from a group of grade 3 students from London Christian Elementary, The children delivered them in person. The student that made my ornament was Ethan. It is something I will always have and a good memory.

On Valentines Day, we were surprised again by these same students and were each given a red cup 0-f soil. The kids planted Marigolds for

Chris, our Team Leader, and I decided we would like to do something special for them. We had planned a pizza lunch for last Friday and discovered at the last minute that they were already having a pizza party that day. The teacher suggested that we could share ice cream together. So we brought lots of goodies to make sundaes and the kids each made their own.

The kids were jumping with excitement and made interesting combinations to top their sundaes. They were happy to be surprised by our visit. Chris, Nadine, a staff at Cheshire IV, and myself were so pleased to be able to do something special for them.

The children then had an opportunity to ask me questions about my disability. I was pleasantly surprised by types of questions they did ask:

1. How old were you when you found out that you had MS? Judy asked them if they knew what MS was. They said it made your muscles not work.

2. Thev asked me what I was able t,

us.

do. I explained that just because

Chwshira Chat Page Five

I am in a wheelchair it doesn't mean I can't do things. That is why I am at Cheshire IV.

3. Can you get out of your chair? Chris reminded them about the lift they saw last time.

rheir insight absolutely amazed me. rhese kids didn't just want to see people with disabilities. They Nanted to make our day special too.

After the questions, I went on a tour of the school. The kids wished to show me around and it was truly amazing. There arc a couple of children with

disabilities that attend the school and the building is very accessible.

We then went outside where they were playing baseball. A number of them asked me questions about my wheelchair. They wanted to see how fast it would go. They said that they would walk along beside me. When I got to third speed they were running and they were very impressed with this.

This was a unique and wonderful experience for me. The last piece that touched my heart was when one of the girls who was new to the class and didn't know anything dbout Cheshire told me that she would like to see me again. She said she often goes for drives with her mother and her mother takes her anywhere she wants to go. So she wanted my phone number and 1 suggested that she talk to her teacher.

I truly enjoyed the outing, the luds are marvelou>! l'hank you to Jodi, or Miss W., the k ids teacher for initiating this relationship through the North Park ENGAGE Program.

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Global Alliance Update - General by Judi Fisher, Executive Director

In May, Michail Bantseev, a consumer who uses services from London Outreach, his attendant Sebrina Shearing and I attended an International Conference on the UN Convention of the Rights of Persons with Disabilities and the General Assembly meeting of the Leonard Cheshire Disability Global Alliance General Assembly

If you see Michail ask him about his experience in Ethiopia. I’m sure that he will tell you that it has given him an inaeased knowledge of the term “inaccessible”!

The Leonard Cheshire Disability Global Alliance is an alliance of over 250 disability and development organizations in 55 countries. Currently 45 countries have signed up to the AUiance and others are likely to sign up soon. Canada is one of those countries.

Currently there are 20 active Cheshire organizations in Canada (16 in Ontario). Each organization is a member of the Global Alliance but m autonomous programs and services in the area in which they work.

The Cheshire Global Alliance exists to h g e attitudes towards disability around the world and foster mutual support amongst the members. You can learn more about the Alliance by going to the International web site at www.lcint.orE.

There were several action steps agreed on at the General Assembly They fall under the following categories:

Modemising Cheshire Services Maintaining the Standards and practices of the Global AUiance Service User Involvement Campaigning . Global communications for the Alliance

the Alliance . Pros and Cons of registering

I will be working on the Global standards. If you are interested in more information about the above please don’t hesitate to e-mail me at judi.fisher@cheshirelondon.ca.

\ / -‘r : cheshi r&. making independence possible

Vision

Independence

Freedom

Life

Mission Statement To support individuals with physical disabilities to live independently in their communities through the provision of personal support services that:

are mutually respectful and value the contributions of all;

enable individual responsibility and self-determination;

promote inclusion and choice; and,

facilitate creative leadership and community development.

Amy Koltvely, Executiie Assistant Judi Fisher, Executive Director LeeAnn James-Sammut, Team Leader at London and Middlwex

Adriana Hurst. Team Leader at Cheshire il l Chris Moss, Team Leader at Cheshire IV

Mike Van der Vlist,

Vera Pavlovets, Receptionist Assistant Ann Van Sickle, Cheshire Consumer Judi O’Brien. Cheshire Consumer

Team Leader at Elgin County

I We walcorna your cornmanis. Please contact Leslie Colllns at small 1eslie~cheshlrelondon.ca or at the numbers listed below: I

Cheshire Chat Page Six

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Cheshire has supported people with significant disabilities in southwestern Ontario for the last 28 years. Just the other day we heard someone talking about a thirty year celebration. l l i s is a tremendous accomplishment in an environment that is ever changing.

This year saw the dosing of the area office of the Ministry of Health and Long Term Care and a transfer of resources to the Local Health Integration Network (LHIN). It was the ending of an era and the beginning of an exciting transition in Health Care in Ontario. We, at Cheshire, are looking forward to the changes. We are working with the s t a a n d Board of Directors of the LHIN to ensure that the needs of people with significant physical disabilities are included and reflected in the planning and implementation of the work that they are undertaking.

In this time of transformation in terms of the organization, delivery and funding of services it is imperative that we take time to review our current strategic directions and to make sure that we are properly positioned for the future.

Our current strategic plan was intended to guide us until 2009 but the health system is changing rapidly. To ensure that we continue to provide high-quality service and ,e

! support to our current consumers while at the same time exploring potential new opportunities for our organization, the following new strategic directions are emerging from discussions:

Continue to Strengthen Our Organization’s Culture

Every organization has its own unique internal culture which shapes how things get done. Organizational culture is typically defined as “the collection of values and norms that are shared by people and groups in an organization and that control the way they interact with each other and with clients and external stakeholders.” At Cheshire, we have a strong commitment to our vision of ‘Independence, Freedom, Life’ and place a high value on doing our veery best to meet the needs of our consumers. But we also strive to motivate our employees to be the best they can be. Because we are a large and geographically diverse organization with different teams across five’counties, it will be important for us as we move forward to retain our core values and principles as an organization and at the same time celebrate and support the unique strengths of our

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Contlnue to Enhance Our Organization’s Proflle

We are a mature service organization with deep roots in London and southwestern Ontario, and are well-known for our work with disabilities. In addition to the quality services we provide to our consumers, we are also an organization that has a variety of core competencies with much to offer as the transformation of the health system

us to communicate to the community, our partners and the Southwest LHIN the value of what we offer today as well as the new innovations we can offer in the future.

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I unfolds. As we move forward and explore new opportunities, it will he important for

’ , ’ Tyw ?- I ! Mv Lynne Patterson Continue to Strengthen Our Partnerships in Support of an Integrated System i I President

At Cheshire, we have been actively pursuing a variety of different partnerships for many years so this is not really a new strategy for us. But as the integration mandate of the LHIN continues to unfold, it will be increasingly important for us to highlight our existing partnerships and to identify new partnership opportunities that will allow us

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Le new sen s andlor 0101 le existing services more e& I ndy. In addition to pursing partnership opportunities in the southwest LHIN area, we will continue to strengthen our provincial, national and international partnerships for purposes of advocacy and knowledge acquisition and transfer.

We have been involved with the Global AUiance with Leonard Cheshire International and there has been a resurgence of interest in Cheshire organizations across Ontario in this International endeavour which has as its goal to change attitudes to disability and to serve disabled people round the world. One exciting focus is on the recent UN Convention on the Rights of People with Disabilities. With our global work we have also seen increased excitement and interest in our Twinning activities with Madurai, India and Livingstone, Zambia.

On a day to day basis we have worked hard to continue to implement a Balanced Scorecard methodology which helps our Board and senior staff to stay focused on out key strategic priorities and to monitor progress in all key aspects of our operation. The methodology is also important to us because the Ministry of Health and Long Term Care and the new LHIN are placing increasing emphasis on accountability of all healrh-funded agencies through performance measurement. We are always striving for continuous improvement and some of our outstanding challenges include:

Recruitment and retention of excellent attendants; Ongoing health and safety challenges; Shortfall in funding for Supportive Housing programs; Increasing resources through fund development and volunteers to assist in meeting people's needs.

The Cheshire story continues and would not be possible without the work of the many talented men and women who work for the organization. They are dedicated and committed to the people they support and for this we thank them. We would also l i e to thank the men and women who work on the Board of Directors and provide exemplary leadership to the organization. For their dedication and support we thank them. Together we will continue to shape the Cheshire story in southwestern Ontario.

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Balance Sheet as at March 31,2007

Operating Fund

Assets 2007 2006

The organization keeps cash on hand in the accounts $ 60,855 $ 403,488 with theToronto-Dominion Bank

Investments 585,159 560,879

owing to the organization

We have prepaid certain expenses 7,691 50,705

The organization owns building, equipment, furniture 2,615,634 2,564,062 and fixtures used in operations (net bookvalue)

At any point in time we have amounts 53,198 44,537

$3,322,537 $3,623,671

Replacement Reserve Fund

The organization keeps cash on hand with theToronto- $ 14,125 $ 20,024 Dominion Bank (these funds are used to replace assets At various locations)

Investments 78,333 73,014

$ 92,458 $ 93,038

Cheshire Fund

Cash $ 65,526 $ 237,020

Investments 540,346 353,292

$ 605,872 $ 590,312

Most revenue comes from Government Agencies

Rental Income

Interest Income

Other Income

Personnel

Purchased Services

Rent

Transportation

Interest (mortgages)

Appropriations to replacement reserves

Depreciation

General and administrative

(96.5%) !

!' Revenue

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/ ' (0.4%) - . .

(79.3%)

(3.6%),

(2.4%)

(0.6%)

(0.3%)

Expenses

(3.4%) (7.0%)

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Balance Sheet as a t March 31,2007

Operating Fund

Liabilities 2007 2006

Accounts payable $ 970,842 $1,335,239

The organization owes mortgages on the buildings it owns 932,982 983,162

Equity Fund equity 1,418,713 1,305,270

$3,322,537 $3,623,671

Replacement Reserve Fund

Due to Operating Fund Fund Equity

$ 638 $ '14,147 91,820 78,891

$ 92,458 $ 93,038 Cheshire Fund

The organization has established a Fund to finance $ 605,872 $ 590,312 non-budgeted costs

Income Statement for the year ended March 31,2007

Revenue 2007 2006

Most of our revenue comes from various $8,400,482 $7,958,776 Government agencies

Rental Income 203,179 197,247

Interest Income 71,264 51,102

Other income 30,547 37,212

$8,705,472 $8,244,337

Expenses Personnel: staff salaries and benefits

Purchased services: we hire outside help to assist our consumers

Rent: We rent premises for some of our consumers

Transportation

$6,745,713 $6,454,446

291,625 345,786

309,439 302,700

207,298 165,348

Interest: we pay interest on our mortgages 47,213 65,708

Appropriations to replacement reserves: we allocate funds 21,832 20,400 to replace worn out equipment

Depreciation 288,856 280,587

General and administrative: all other costs 596,091 572,308

$8,508,067 $8,207,283

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Changing Lives Celebrating I nde pendence

In 2001, Owen Noels was diagnosed with Multiple Sclerosis alter five months of testing to determine why he was experiencing numbness on his left side.

With his diagnosis came the fatigue that he experienced from day to day tasks. Owen also required some special needs living in his wheelchair. In March of 2007, Owen made a move that would give him independence and a much happier life.

Owen was recommended to view one of six wheelchair accessible apartments in Cheshire’s Oxford Supportive Housing Program in Woodstock. He was impressed at how wheelchair accessible everything was in his new found home and took the apartment immediately.

Instantly, Owens’ life changed. His old apartment was poorly maintained and he often had to rely on his father for assistance. If Owen had a fall, he would be left in uncomfortable situations for two to four hours until help arrived. Cheshire visits five times a day helping Owen conserve the strength he needs to complete daily tasks that others would take for granted. Owen’s stress levels have also dropped dramatically.

?he biggest bonus is that Owen has more time to enjoy hanging out with friends and his dog Fleev. He also has the ability to pursue one of his true loves, building web sites.

“Cheshire really listens to all of my needs,” says Owen. “It is very comforting to know that the staff can be here in 10 to 15 minutes if I need them. It is great to have the support that allows me to get out more into the community.”

. . , . .

Jamie McKee and Alison Letnmond celebrate independence, freedom and life -- together. In June of this year, they celebrated their marriage and their new lives living with each other on their own.

Jamie and Alison both have Cerebral Palsy with Jamie requiring a wheelchair. Before getting married, Alison lived with her patents. Jamie had lived with his parents until finding a new way of independence, moving out on his own into Cheshire’s unit at 98 Baseline Rd.

“I was getting older and Mom and Dad were getting older too,” Jamie says. “My needs were changing yet I still wanted to maintain my independence. Alison and I have many friends that live here at 98 Baseline and we heard great things about the building. That, with

to take care of him, he would be in great hands with the Cheshire staff.” says Alison.

The couple met at a London Tiger’s game where Alison was led onto the field by Jamie to throw out the first pitch. Both play actively in a floor hockey league that has seen them travel to Calgary, Toronto, Minnesota with future hopes of playing in Chicago. Most of all, the two enjoy each other’s company and the life they share with their friends and family at 98 Baseline Rd.

the excellent, friendly, helpful and understanding staff here at Cheshire made the decision to move here on my own very easy. It feels very complete having Alison with me now.”

Before living with Jamie, Alison took comfort knowing that Cheshire and Jamie’s family and friends provided him with a supportive network. “It was peace of mind for me because 1 knew if I couldn’t be around

Jamie says that he has a great relationship with Cheshire. “When I first met with Cheshire, they made me feel really comfortable and understood where I was coming from and were willing to help. B e y are very open with their communication. If there is a problem, I let them know and they will work it out. X e y represent a major part of my new found independence.”

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$--

Cheshire thanlo the individuals and businesses lisred below for their generous supporr over the past year. I n addition, a personal thank you to all the dedicated Cheshire ernployees who have contributed regularly co ourTwinning Projects chrough payroll deduction.

1675083 Ontario Ltd.

Adriana Hurst

Agnes Pearce

Barry Card

Beth English

Betty Naylor

Bob Loveless

Carry On Cloggers

Cornerstone Buyet's Protection Cowan Insurance

Daniel's Salon

David Reid Debruyne Property Dianne Whittaker

Donna Freeman

Esam Construction

Evelyn Pepper

Ford Keast

Gina Palmese

Grant Inglis Hanford's Tire

Helen Field

Isobel Skinnet Janet Meert

Judi Fisher

Leslie Collins

Lily Annand Little, Inglis &Price Lor -Don Contractors Luz Zubieta Market Crafts

Maty-Anne Stewart Mr. and Mrs. Tom Ewer Omni Communications Parkside Property Pat Curtin Pat Jewitt Patti Lake PC Consulting Peter Lawton Rowland Safety Associates Sallie Morrison Siskind, Cromarty, Ivey & Dowler Stoneybrook Auto Service Sue Morgan Sunningdale Golf & Country Club

Dorothy McNaught Mary Jo Dunlop Tracy Rowland Dr. Baxter Mary Lynne Patterson Trevor Tolton

. ! I .

*I I

In September of 2006, Cheshire Homes of London Inc. hosted Corkyai-d, an uncorlced wine casting event. This w e n t included live music, a silent auction and local art doiiatecl with a portion of all proceeds going to Cheshire. We would like to t l iank the following individuals who generously supported Cheshire at Corkyard.

Audrey Errington Janet Meert Sallie Morrison Chester Pawlowski Julie Girard Sue Hillis Dianne Whittaker Kerry Leeson Sue NicMe Donna Freeman Lori DeWitt Marshall Susan Morgan Frank Murch Mary-Anne Stewart Tracy Rowland Jacqueline McCarhy Pat Jewitt

Paul Cavanaugb Sept. 21/06 Gina Palmese Sue Hillis Judi Fisher Sue Morgan Lois Grimes Susan Nickle Mary Lynne Patterson Agnes Pearce Nancy Ambrogio Betty Naylor

Scotia Mckod Elizabeth Clarke Janet Christensen Jennifer Lamb Rowland Safety

. . . ;

. . .

. . . ,

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-

th 14 Annual Empowerment & Action Day

“Decent Work For Persons With D isa bi I i ties”

Saturday October 4,2008,9:00 am - 3:OO pm

London Public Library, Central Branch (251 Dundas Street)

Sessions: ADMISSION IS FREE! - Debunking the

myths of hiring persons with disabilities

Registration is required Please register by Tuesday September 30,2008

Online: www.londonpubIiclibrary.ca/programs trends Call: 51 9-661 -51 22 In Person: At any library location

- Future employment

Workshops: - Starting your own

When you register, please let us know if you have anv special needs.

business

techniques - Useful interviewing

- Employment support ASL Interpreters will be available programs

- Assistive A light lunch and beverages will be technologies. provided Free! - TourofLPL‘s

Employment Resource Centre

5

Hope to see you all there! For more information,

Contact: Kash at 519-472-7842 Organized by the City of London

Accessibility Advisory Committee C A N A D h

EMPOWERMENT AND ACTION DAY

'Decent Work for Persons with Disabilities'

Saturday, October 4,2008 - London Central Library

Proclram At A Glance

Time

8:30 am - 9:15 am

9:15 am - 9:30 am

9:30 am - 10:15 am

10:15 am - 12:OO am

11:OO am - 11:15 am

11:15am-I2:00pm

Topic

Registration

Opening Remarks

Session # I - Panel Presentation This panel will discuss the challenges faced by persons with disabilities, as they seek meaningful employment. Topics such as: unfounded myths, barriers, statistics.

Session #2 - Panel Presentation This panel will discuss employment opportunities. Topics such as: emerging trends, new job opportunities, skill-set needs and education requirements.

Break

Workshops

Workshop A Be your own Boss! The Entrepreneur in You'

Workshop B Employment Support Programs

Workshop C Tours of the Central Library Employment Resource Centre

Speakers

A. Kash Husain - Conference Chair

Michelle Pinchev - Representative Canadian Manufacfurers and Exporters

Anne Perkins - Setvice Canada Barbara Symington -

Leads Employment Services

Jack Smits - Small Business Centre Michelle Easby - Goodwill Industries

Colleen Manning - MCSS, ODSP Office

Danna Bushfield London Public Library

Time Topic Speakers

12:OO pm - 1:OO pm Exhibits Display Tour & Lunch

1 :OO pm - 1 :I 5 pm Greetings from City of London Introduction of Guest Speaker DeCicco-Best

Mayor Anne Marie

1 :I 5 pm - 2:OO pm Special Guest Keynote Speaker The Honourable David C. Onley (TBC)

2:OO pm - 2:15 pm

2:15 pm - 3:OO pm

Break

Workshops

Workshop D Jeanne McLaws Adaptive Technologies I Aids ATN Accommodation

Training & Networking

Goodwill industries Katie Froussious - TD

Workshop E Sonja Burke Preparing Yourself for the Interview

Workshop F Danna Bushfield Tours of the Central Library Employment Resource Centre

London Public Library

3:OO pm - 3:15 pm Closing Remarks Roger Khouri, Chair London Accessibility Advisory Committee

* Note: Public Exhibits remain open until 3:OO pm.