CPA Ontario-Pre-Budget Submission 2010

Canadian Paraplegic Association Ontario

Everyday, one Ontarian sustains a permanent spinal cord injury. From the moment of injury, it takes enormous energy, time and money to rebuild the day-to-day life of individuals with SCI and their families. Since 1945, the Canadian Paraplegic Association (CPA) has worked to support Ontarians to achieve independence, self reliance and full community participation. CPA Ontario believes that in order for people to reach their full potential as contributing citizens, fair and equitable access to disability supports is essential.

CPA Ontario and its members have eagerly followed the Ontario government’s plan for change. We have been encouraged by the recent investment in long-term economic growth. To build and strengthen Ontario's economy for the future; recognizing your commitment to retaining jobs, skills and training initiatives, and assistance for the most vulnerable Ontarians being readily available. These initiatives have a significant direct and indirect impact on people with disabilities in this province.
In this period of economic uncertainty the government can address the growing needs of Ontarians with disabilities, caregivers and their families without cutting funding, programs and services in other areas. There are ways for the Ontario government to re-work funding models for critical social programs, keep spending at its current level, while increasing services to those who need it most.

Executive Summary:

CPA Ontario welcomes the opportunity to provide its perspective to the Finance Committee as it forms recommendations for the 2010 federal budget. We thank the members of the Finance Committee for their time and consideration.

People with spinal cord injuries (SCI) & disease (SCID) who uses respiratory supports deserve to live a full life in Ontario society. Many pioneers have succeeded, living for decades in our communities, establishing a high quality of life and making valuable contributions to our society
But many have encountered barriers and some are forced to reside in institutional settings. Some who live in the community feel vulnerable and unsafe. People who are newly injured or diagnosed face interminable hospital stays and inadequate access to rehabilitation and primary health care. Their overburdened caregivers contend with insufficient and uncoordinated supports and wait lists.

With collaboration of other stakeholders we will compliment the existing initiatives:

1.Aging at Home,

2.Direct Funding,

3.Critical Care Strategy (component of the Access to Services and Wait Time Strategy)

4.Supportive Housing

CPA Ontario’s response to Minister Duncan’s Questions:

1.What processes should the government put in place to enable it to move out of the deficit?

2.What steps should the government take to streamline and provide better public services to Ontarians?

3.Government priorities are job creation, health care, education, strong fiscal management and economic growth. How should the government balance this multitude of priorities? Given the considerable fiscal challenges, what should be the core priorities of the 2010 Budget?

Recommendations:

CPA Ontario recommends that the Finance Committee address the following subject that we believe will have a significant impact on people with disabilities using respiratory support in the coming year:
SCID is a chronic condition affecting approximately 12,000 Ontarians.

Between 350 and 400 new incidence of SCI occur each year in Ontario. The most vulnerable of the SCI population are individuals that require intensive ventilator support.

The current care model for ventilator dependent individuals with SCI involves a transition process from acute care to rehab and into the community.

The current transition process is badly disjointed, inefficient and costly.

-Attendant service:

Access to adequate attendant service is a fundamental pre-requisite for people with SCID and other disabilities who require respiratory supports and live in the community.

Issues affecting people’s access to adequate attendant service include:
·Wait lists,
·Hours of service available,
·Flexibility in how the service can be used/ability to direct and control one’s own supports,
·Supply of workers with basic training and the required skill level.

Many people require more hours of attendant service than are currently available. People with third party coverage or other personal resources may have access to 24hr support, however most people are limited to 3hrs/day of attendant service, which can sometimes be augmented by support offered through Community Care Access Centres. The maximum number of hours theoretically available via government funding is 6 hours a day, through the Direct Funding program.

Recommendation #1: Remove the existing barriers to accessing attendant service.

-Housing:

Accessible housing is another fundamental pre-requisite for living in the community. Personal financial circumstances influence whether or not people can purchase an accessible home, renovate an existing home, or live in a rented or subsidized apartment.

If personal resources are not available people must wait for accessible affordable housing which is in short supply. In either case planning for accommodation must begin in the acute setting to ensure accommodation is ready upon discharge from rehab.

Access to appropriate housing is intertwined with access to attendant services. In some cases supportive housing, which includes attendant support, is the most appropriate living arrangement.

Recommendation #2: Increase the number of supportive housing units that include arrangements appropriate for people who require respiratory supports.

The Solution for Ontario

The government, LHINs and stakeholders have contributed significant energy, expertise and time to develop priorities, recommendations and strategies for delivering care to people who require long-term ventilation. Every day that implementation is delayed wastes valuable health care resources. Implementing these recommendations now is the right thing to do to effectively use health system resources and allow Ontarians using respiratory supports to maximize their quality of life.

-The cost of an ICU bed ranges from $2,024 to $3,745 per day.
-The cost of a facility bed ranges from $548 to $1,500 per day
-Supportive housing costs $205 per day.

By adding community supports, we can help alleviate the pressures on ALC beds and Emergency Department wait times. We can give people with SCID the opportunity to achieve independence, self-reliance and full community participation and most importantly, quality of life.

Repectfully Submitted,

William Adair,
Executive Director
CPA Ontario
Bill.adair@cpaont.org
416.422.5644 x 225