March of Dimes Canada is pleased to present its Pre-Budget Submission to the Standing Committee on Finance and Economic Affairs for Ontario’s fiscal year 2023-24. As a transfer payment agency and key stakeholder in delivering an array of services for people living with disabilities and their families, caregivers and friends, March of Dimes Canada welcomes the opportunity to deliver insights into how we can build a more equitable and inclusive Ontario. In developing this submission, March of Dimes Canada has listened to the priorities of our community and stakeholders. 

Ontarians have expressed that they want to receive care in their own homes and communities. But while over three-quarters (78 per cent) of Canadians want to age in their current homes, just 26 per cent predict they’ll be able to do so.¹  Not only is care at home more cost-effective and efficient but receiving care in one’s own home and community improves quality of life, and prevents unnecessary hospitalizations, emergency room visits and premature institutionalization. The community support services sector delivers services to enable people to live well at home and in their community. 

We applaud the significant funding for care at home and in the community in Ontario’s Budget 2022. However, while this funding increase is positive, it will not address the current stresses on the sector on its own.

As the largest transfer payment agency providing Ministry of Health-funded community support services for Ontarians with disabilities, March of Dimes Canada has seen firsthand the impact of inadequate funding for the sector – from under-utilization, to system strain, to staffing shortages. For this reason, we support the Ontario Community Support Association (OCSA)’s 2023-24 Pre-Budget Submission recommendations regarding the need for increased investment and strategic allocation of funding within the sector.²  

Building upon the priorities outlined by OCSA, we would highlight a home-first approach, health human resources (HHR) and supportive housing as specific areas requiring action.

We know that Ontarians want to receive the care they need at home, that it is more cost-efficient to do so, and that community-based care reduces pressure on other areas of the system. Care at home and in the community is a stated priority of the Ontario government. In Budget 2022, it was stated that, “people, including seniors, should have the option to stay in their homes and receive the care they need if they choose and if it is possible… A strong home and community care sector is key to the government’s plan to end hallway healthcare and build a connected, patient-centred health care system.”³ 

For many people with disabilities, including people with physical disabilities, brain injury survivors and seniors, inappropriate admission to long-term care or another institutional setting severely curtails independence, dignity and choice. For many others, the complexity of their needs means that they do not qualify for many institutional settings, and so they remain in community. But due to inadequate service hours to match their changing needs as they age, they struggle to “make do” with a patchwork of services and low staffing levels which places them and their caregivers at significant risk. 

Our current health system does not prioritize care at home and in the community. The current ratio of home and community care spending to institutional long-term care spending in Ontario is 49% to 51% -- as compared to a ratio of 64% to 36% in Denmark, where a home-first approach has been embraced.⁴ Truly adopting a home-first approach in Ontario’s healthcare system is essential to ensuring that people with disabilities of all ages experience true patient-centred care, independent lifestyles, and better health outcomes. 

Rebalancing our system to focus on care at home and in the community requires:

The HHR crisis is being felt across the entire health system, and it is having an outsized impact on non-profit community support services. In the home and community care sector, there is a vacancy rate of 12.8% for the three key frontline positions (PSWs, RNs, RPNs).⁵  At March of Dimes Canada, we have felt this acutely, with a current voluntary turnover rate of 26% for our community support services positions in Ontario. This means increased waitlists for our essential services, and we are not alone in feeling these pressures. In OCSA’s pre-budget survey, 76% of organizations stated that the HHR crisis and inflationary pressures had forced them to either cut services or increase waitlists.⁶

Addressing the HHR crisis in home and community care requires: 

Increased wage parity will add new PSWs to the home and community care labour force, as well as retain many more PSWs who are at risk of leaving the sector. New research estimates that this could create over 23.5 million additional yearly care hours for Ontarians, while resulting in a return on investment of 26% in saved health care expenditures.⁹

Supportive housing is an essential piece of the home and community care puzzle. For people with disabilities who require support with the activities of daily living, a supportive housing program enables them to live independently and maintain connection to the community, while accessing the support they need, all without entering an inappropriate institutional setting. 

March of Dimes Canada provides services in over 40 supportive housing programs through its community support service funding across Ontario. This is exclusive of other housing supports such as mental health funding, developmental disability and initiatives driven by home and community care such as long-term care homes. Our attendants provide physical assistance with activities of daily living such as personal grooming, transferring, dressing, bathing, meals, ventilator and tracheotomy services, and more.

Yet more and more people with disabilities are struggling to access programs such as ours due to insufficient supply of accessible, affordable supportive housing. As of January 2023, March of Dimes Canada’s waitlist for attendant services supportive housing has more than 1,000 people on it, and they will wait an average of 1,060 days to access the housing and services they desperately need. For brain injury-specific supportive housing, 98 clients are waiting, for an average of 802 days. 

On top of this, supportive housing providers such as March of Dimes Canada are experiencing significant barriers in acting upon opportunities presented by new affordable housing developments with designated accessible units. Increasingly, we are being approached by developers – who have received public funding for their projects – to act as the supportive housing service provider of choice for new builds. However, there is a lack of Ontario Health funding available to support the ongoing operations of services once the building is completed and ready for occupancy.

Enabling more people with disabilities to access the supportive housing they need requires:

As highlighted by the Ontario Nonprofit Network, prioritization should also be given to mixed use developments that further multiple policy objectives including supportive housing, childcare, etc.¹⁰ 

As a community support organization, March of Dimes Canada is a major provider of brain injury services across the province, providing supportive housing, case management, day programs and outreach services to individuals living with the effects of a brain injury. Increasingly, we are seeing that a growing population amongst brain injury survivors are those impacted by stroke.

More than 36,000 people in Ontario experience a stroke each year.¹¹ With advancements in medical care, the survival rate for stroke has increased dramatically, and more people are surviving stroke than ever before. However, as more people survive a stroke, stroke has become one of the leading causes of adult disability in Canada. 

Today, more than 878,000 Canadians live with the wide-ranging, disabling effects of stroke.¹² Nearly two-thirds of stroke survivors leave hospital with a disability, such as aphasia and communication challenges or debilitating fatigue. Stroke impacts every aspect of a person’s life, from physical health to mental health, family life, financial, and social and community participation. 

Recognizing this increased need, we applaud that Ontario Health has identified stroke as one of four priority conditions requiring a common clinical pathway to improve patient care, including touchpoints with primary, hospital and community care.¹³ It is crucial that the final part of this equation – community-based support– is prioritized for stroke survivors transitioning back to their homes and communities while navigating the path forward after a stroke.

As a response to the increasing needs of stroke survivors, March of Dimes Canada’s After Stroke program was created in collaboration with stroke experts and people with lived experience of stroke to directly fill the gap. Guided by lived experience and evidence-based design, the After Stroke program provides world-class stroke support and is based on Stroke Best Practice Recommendations. This support centres on March of Dimes Canada’s After Stroke Coordinators, who serve and support stroke survivors as system navigators at a time when the health and rehabilitation systems are new and overwhelming to survivors and their families and caregivers. Our After Stroke Coordinators fill the gap by giving stroke survivors and their families a seamless transition from hospital to home and community.

After Stroke puts stroke survivors and their families at the centre of care, helping them meet their personal recovery goals and connecting them to community supports through in-hospital support, coordination and community navigation, personalized planning and goal setting, emotional support, stroke-focused education and training, and peer support. To promote consistency and fill gaps across the board, After Stroke was enhanced and relaunched in regions across Ontario in 2021.

With the goal of closing gaps for stroke survivors across the province, March of Dimes Canada is seeking new funding to complement and deepen our currently funded brain injury community support services with the After Stroke program, which is tailor-made for the needs of stroke survivors. 

An essential community program for stroke survivors and their families and caregivers, the After Stroke program can, with public funding, be a sustainable and long-term support for the growing population of stroke survivors in Ontario, reducing the burden on existing funded brain injury services by providing support laser-focused on this specific population.

In partnership with the Northern Independent Living Agencies, March of Dimes Canada has been funded by Ontario Health North to provide post-stroke services in Sault Ste Marie and Timmins since 2014. In Waterloo-Wellington, Home and Community Care Support Services has recognized the importance of peer-to-peer support by funding the Hospital Visitation component of After Stroke, through Grand River Hospital and March of Dimes Canada since 2010.Our goal is to bring the invaluable support of After Stroke Coordinators to stroke survivors in every region across the province.

March of Dimes Canada will continue to build on these relationships and partnerships, as well as our expertise as a Ministry of Health-funded brain injury service provider, to support the growth of the After Stroke program.

As a service provider, March of Dimes Canada plays a key role in supporting Ontarians with disabilities in accessing the full scope of financial security benefits available to them, such as the Disability Tax Credit (DTC), the Registered Disability Savings Plan (RDSP) and the Seniors Home Safety Tax Credit, as well as employment services and supports for employers to hire people with disabilities. We are committed to focusing on financial security and will continue working with our clients, their families and caregivers, and with community stakeholders to build this foundation of dignity and independence for all people with disabilities in Ontario.

 

People with disabilities in Ontario are three times as likely to live in poverty than those without disabilities.¹⁴ While March of Dimes Canada welcomes recent changes to the Ontario Disability Support Program (ODSP), such as indexing to inflation and increasing the employment earnings exemption, even with these changes, current ODSP rates do not enable recipients to move beyond deep poverty – especially as the affordability crisis persists.

To ensure Ontarians with disabilities can thrive rather than simply surviving, the federal government’s incoming Canada Disability Benefit (CDB) is needed to augment existing provincial benefits, bringing ODSP recipients and others above the poverty line. While March of Dimes Canada is advocating federally that the CDB is non-taxable income, it is essential that all provinces and territories work to proactively identify and mitigate any impacts on existing benefits and programs.  The CDB should not be considered income in regard to determining eligibility for social assistance, community housing, and other income-tested programs and services – otherwise people with disabilities will be no better off than they are currently. 

March of Dimes Canada is leading work to ensure that people with disabilities in Ontario and across Canada are prepared to receive the CDB as soon as it is implemented. This includes promoting the uptake of income-enhancing benefits such as the DTC and the RDSP, and encouraging tax filing among people with disabilities who receive ODSP. There is much more to be done, including delivering financial literacy and empowerment support. We know the government of Ontario is an essential partner and we are looking forward to continuing to work together on these important benefit uptake initiatives.

With the CDB anticipated in 2024, federal/provincial/territorial discussions on the benefit will be underway throughout fiscal year 2023-24. We ask that the government of Ontario, under the leadership of the Honourable Merrilee Fullerton, Minister of Children, Community and Social Services, ensure that all those eligible realize the full value of the upcoming federal Canada Disability Benefit, in harmonization with the federal government, without unnecessary downstream impacts.

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¹ March of Dimes Canada, Transforming Lives through Home Modification: A March of Dimes Canada National Survey, 2021, https://www.marchofdimes.ca/en-ca/aboutus/newsroom/pr/Pages/MODC-Home-Modification-Survey.aspx