Introduction
March of Dimes Canada is pleased to present its Pre-Budget Submission to the Minister of Finance for Ontario’s fiscal year 2024-25. As a transfer payment agency and key stakeholder delivering an array of services for people living with disabilities and their families, caregivers and communities, 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 of service users and stakeholders.
About March of Dimes Canada
Founded over 70 years ago, March of Dimes Canada is a national charity committed to championing equity, empowering ability, and creating real change that will help people living with disabilities across the country unlock the richness of their lives. As a leading service provider, resource, and advocate, we’re paving the way for people living with disabilities to experience full and meaningful lives in an inclusive world.
March of Dimes Canada delivers services under two core program areas:
-
Community Support Services delivers services to people with disabilities (including seniors) that enable them to live in their community and remain in their own homes, such as attendant care services, assisted living and other supports, including brain injury services and our best-in-class After Stroke program. Our services are designed to ensure service users feel empowered, healthy, and equipped, through tackling daily living, social, institutional, and navigational barriers.
-
Skills Development and Employment Services provides comprehensive support through a range of services to assist people with disabilities learn, grow and achieve their goals for healthy growth and development, education and training, employment and financial security. This includes SkillingUp, our free digital skills training program, which gives people with disabilities the skills and self-confidence to be successful in careers that require digital skills; and community programs designed to unlock the potential of children, youth, and adults with disabilities in an inclusive Canada.
Summary of Recommendations
-
Recommendation 1: That the government of Ontario prioritize funding care at home and in the community to enable Ontarians with disabilities to have independence, dignity and choice, by adopting a home-first approach, addressing the health human resources crisis, and investing in Assisted Living programs.
-
Recommendation 2: That the government of Ontario support stroke survivors by complementing and deepening brain injury community support services with investment in March of Dimes Canada’s After Stroke program.
-
Recommendation 3: That the government of Ontario enhance the financial security of people with disabilities by partnering with the federal government to ensure Ontarians receive the full impact of the upcoming Canada Disability Benefit.
Recommendation 1: Investing in Care at Home and in the Community
Ontarians have expressed that they want to receive care in their own homes and communities. But while 78% of Canadians want to age in their current homes, just 26% predict they’ll be able to do so.i Not only is it 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. We applaud the significant funding for care at home and in the community in Ontario’s Budget 2023.
However, while this funding increase is positive, it will not address the current stresses on the sector on its own. The community support services sector delivers services to enable people to live well at home and in their community. The demands on the sector are increasing and are expected to continue to do so. Projections show a 53% increase in home care demand from 2019 to 2031 in Canada. Approximately 1.2 million Ontarians will need home and community care by 2031.ii Furthermore,
home and community care can offer cost savings to Ontario’s health care system, with an average cost per client per day of $103 (compared to $730 in hospital, and $201 in long-term care).iii
As the largest transfer payment agency providing Ministry of Health-funded community support services and Ministry of Seniors and Accessibility-funded home and vehicle modification grants for Ontarians with disabilities, March of Dimes Canada has seen firsthand the impact of inadequate funding for the sector in the forms of under-utilization, system strain and staffing shortages. For this reason,
we support the Ontario Community Support Association (OCSA)’s 2024-25 Pre-Budget Submission recommendations regarding the need for increased investment and strategic allocation of funding within the sector.iv
We urge the government to invest in care at home and in the community by adopting a
home-first approach, and by investing
health human resources (HHR) and
assisted living.
A Home-First Approach
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 2023, it was stated that, “The only thing better than care close to home is care at home. Having strong home and community care is a key part of the government’s plan for connected and convenient care."
v
Home & Vehicle Modification Program
Enabling the home-first approach is March of Dimes Canada Home and Vehicle Modification Program (HVMP), delivered on behalf of the province of Ontario in partnership with the Ministry for Seniors and Accessibility. Two years ago, the HVMP investment in Ontario was increased from $10M per year to $15M annually due to the exceptional program delivery, customer satisfaction, and the value derived from ensuring Ontarians with disabilities of all ages return to or remain in place safely and independent.
We thank the government of Ontario and Hon. Raymond Cho, Minister of Seniors and Accessibility, for this investment and for their confidence in March of Dimes Canada to continue to build on this successful partnership.
From 2022-2023, this increased investment in HVMP and modernizing program guidelines allowed the program to serve 1,515 Ontarians of all ages with disabilities, an increase of 84% from the previous year. HVMP grants enable people to complete basic living tasks such as eating, bathing, toileting and mobility, allowing them to remain in their homes and age-in-place longer.
We encourage the government to continue investing in this proven program, and we look forward to working with MPPs across the province to publicly feature the successes of the program in 2024.
Assistive Devices Program
People with disabilities with low incomes are often forced to decide between buying food or being able to shower or toilet independently, safely, and with dignity. Without access to assistive devices, including those in good working order, they cannot safely care for themselves. For example, the cost of a new wheelchair can mean not being able to afford to pay rent, which could force people into homelessness. In the alternative, not being able to pay for an assistive device can mean an inability to access basic human needs and worse, can result in being hospitalized or institutionalized.
Current supports do not adequately support low-income seniors with disabilities, especially with the rising cost of equipment and the increasing cost of food and shelter in Ontario.
The current Ministry of Health’s Assistive Devices Program provides 100% coverage for those on ODSP. However, once individuals turn 65, they are eligible for only 75% for medically necessary assistive devices. The program criteria also narrowly interpret what equipment is considered essential, and funds the cost of replacement every five years, and entirely excludes the cost of repairs. The demand for this program and number of service users over the age of 65 (60% in 2017/18) is expected to continue to grow.vi
-
To that end, we recommend that Hon. Sylvia Jones, Deputy Premier and Minister of Health reimagines Ministry of Health’s Assistive Devices Program to provide seniors with 100% coverage for the costs of equipment essential to remaining independent and to live with dignity, including implementing improved processes to better meet the rising demand and expanding the list of equipment considered medically essential.
Home and Community-Based Care
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.vii 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 by adopting a home first approach requires:
-
Providing additional funding for non-profit community support service providers to support their organizational and human resources capacity, ensuring they have the infrastructure to deliver increased service volumes.
-
Investing in more prevention, rehabilitation and wrap-around services that improve long-term outcomes for people with disabilities and reduce the need for hospitalization or long-term care admission.
Services for People with Brain Injury
For many people with disabilities, including people with physical disabilities, brain injury (including stroke) survivors and seniors, inappropriate admission to long-term care or another institutional setting severely curtails independence, dignity, and choice. Others have complex, high acuity needs but do not for many institutional settings, and so remain in community –
but without enough funded care provider service hours, they struggle to “make do” with a patchwork of services and low staffing levels which places them and their caregivers at significant risk.
Addressing this issue requires:
-
Adding more funded hours of community support services to provide the right care at the right place at the right time and meet the needs of the majority of Ontarians who wish to receive care at home. This means a prioritization shift from institutional to community settings.
Health Human Resources Crisis
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 front-line vacancy rate of 20%.viii 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. Wages have not increased significantly for supervisory positions and other community support service positions for years. This means increased waitlists for our essential services, and we are far from alone in feeling these pressures.
A recent report based on a survey of Ontario’s community health sector demonstrates that due to the rising cost of living and a competitive health care job market, the community health sector staff experienced an average salary increase of only 1.53% in 2023. This is in stark contrast to the 11% increase awarded to hospital nurses and the 8% increase for emergency medical services, further exacerbating the wage gap. As a result, the community health sector is witnessing an exodus of workers to staffing agencies, institutional care, and other provinces and countries, making it increasingly challenging to recruit and retain essential health workers, leading to the difficult decision to either cut services or increase waitlists.ix
Increasing access to community care for Ontarians by appropriately funding home care and home care providers has been identified by the Ontario Medical Association as a key strategy to increase community capacity and tackle hospital overcrowding.x Increased wage parity will add new PSWs to the home and community care labour force, as well as retain many more PSWs and supervisory staff who are at risk of leaving the sector. If the additional care hours created through wage parity investment kept more individuals at home instead of in long-term care, this would reduce total health care expenditures and
lead to savings of approximately $6 billion per year.xi
Addressing the HHR crisis in home and community care requires:
-
Implementing wage parity across the health system, ensuring non-profit community support services staff are not paid less than their agency, hospital, long-term care and for-profit care colleagues. The wage gap between community support services workers and their agency and long-term care counterparts must be eliminated to stem the flow of workers leaving our sector, stabilize the workforce and increase capacity.
-
Extending the $3/hour PSW wage enhancement to all worked hours, including travel and training, to create better, more equitable working conditions for home and community care workers, reducing barriers to service for more remote service users, and reducing the administrative burden for non-profit service providers.
-
De-compressing wages between frontline workers and other community support services positions, to address the additional HR crisis among supervisory staff, (such as onsite supervisors) in community support services. Wages have not increased significantly for these roles and other community support service positions, while frontline workers have seen an increase of roughly $7.63/hour over seven years. There have been no significant corresponding increases for those providing leadership in key supervisory roles since 2015.
The investments required to address these three recommendations are included in OCSA’s 2024-25 budget submission, which proposes:
- Up to $77 million for retroactive pay increases to prevent wage disparities from worsening.
- $116 million in increases to keep pace with increases in other sectors and start closing the gap between the sectors.
- Approximately $50 million to apply the permanent $3 an hour PSW wage increase to all hours of work, not just direct care hours.xii
Assisted Living
Assisted Living is an essential piece of the home and community care puzzle. For people with disabilities and seniors who require support with the activities of daily living,
an Assisted Living 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 Assisted Living 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 attendant care staff provide physical assistance with activities of daily living such as personal grooming, transferring, dressing, bathing, meals, ventilator and tracheotomy services, and more. Our brain injury services staff provide support with achieving goals related to continued rehabilitation, life skills development, community integration and personal independence.
Yet more and more people with disabilities are struggling to access programs such as ours due to insufficient supply of accessible, affordable assisted living housing. As of January 2024, March of Dimes Canada’s waitlist for attendant services in assisted living topped 1,800 – and we are only one of many service providers. People on our waitlist wait an average of 1,060 days (almost three years) to access the housing and services they desperately need.
Moreover, assisted living 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 housing developers – who have received public funding, land, or both for their projects – to act as the assisted living service provider of choice for new builds.
However, Ontario Health does not make funding readily available for assisted living operations once the building is completed and ready for occupancy.
Enabling more people with disabilities to access the assisted living they need requires:
-
Investments in assisted living programs to address the ever-growing waitlist of individuals seeking affordable, accessible housing with supports. Our recommendation is in line with OCSA’s submission calling for “$290 million to increase service providers’ operational budgets by 3% this year to meet growing community need and to build a comprehensive basket of home and community care services in each community across the province.”
xiii
-
Establishing a local integrated planning requirement by working across ministries, sub-sectors and organizations to ensure that investments in affordable, accessible housing developments include a consideration of long-term system planning, including funding to support the operations of assisted living services upon project completion. This requires a four-corners approach to enhance collaboration between the Ministry of Finance, Ministry of Municipal Affairs and Housing, the Ministry of Health and the Ministry of Children, Community and Social Services to eliminate barriers for people with disabilities accessing the housing and services they need.
-
Ensuring that a community support services lens is included in assisted living planning and consultation, recognizing the unique needs of people with disabilities, brain injury and seniors with regards to housing and services.
Recommendation 2: Supporting Stroke Survivors
As a community support organization, March of Dimes Canada is a major provider of brain injury services across the province, providing assisted living, 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.xiv 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.xv Nearly two-thirds of stroke survivors leave hospital with a disability, such as mobility and cognitive disabilities, aphasia and communication disabilities, and/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 the Ministry of Health for identifying stroke as one of four priority conditions requiring a common clinical pathway to improve patient care, including touchpoints with primary, hospital, and community care.xvi 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.
After Stroke: Tailor-Made for Stroke Survivors’ Needs
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. Health navigations systems support is delivered by March of Dimes Canada’s After Stroke Coordinators 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 peer connections, coordination and community navigation, personalized planning and goal setting, emotional support, stroke-focused education and training, and peer support. To promote consistency, March of Dimes Canada invested this program, enhanced the suite of services, and relaunched the After Stroke program in regions across Ontario in 2021.
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 the After Stroke program to stroke survivors and their families, in every region across the province.
With the goal of closing gaps for stroke survivors and their families across the province,
March of Dimes Canada is seeking provincial investment in After Stroke, which will complement and deepen our currently-funded brain injury community support services. 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 service for the growing population of stroke survivors in Ontario,
reducing the burden on existing funded brain injury services by providing investment focused on this specific population.
Recommendation 3: Partnering toward the Canada Disability Benefit
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 Ontario’s 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 service users, 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.xvii While March of Dimes Canada welcomes the 2023 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) must supplement existing provincial benefits, bringing ODSP recipients’ income above the poverty line. While March of Dimes Canada is advocating federally that the CDB must be designated as non-taxable income, it is essential that all provinces and territories work to proactively identify and mitigate any impacts on existing benefits and programs.
To this end, we ask that Hon. Peter Bethlenfalvy, Minister of Finance, and Hon. Michael Parsa, Minister of Children, Community and Social Services, work together to
place the CDB in Ontario’s policy directive on exempt income sources related to eligibility for disability income support. In addition to preserving eligibility, there must be no claw backs to other benefits such as dental or prescription drug coverage, housing and transportation supports, and other funded benefits, programs, and services once the CDB is implemented.
With regards to private disability insurance coverage, we are asking the federal government to enter a Memorandum of Understanding (MoU) with the Canadian Life & Health Insurance Association (CLHIA) which ensures all private insurance providers in Canada categorize the CDB as a supplemental benefit with no impact on the insurance providers' determination of the eligible applicant's private insurance income benefits.
At the provincial level, we ask that Hon. Peter Bethlenfalvy works with the federal government and private insurance regulators to ensure that any required legislative, regulatory or policy amendments are completed to enshrine the requirements in the MoU in law.
Conclusion
We must all work together to build a build a more equitable and inclusive Ontario. Although the demands and unprecedented pressures faced by Ontario’s healthcare and social support systems may seem overwhelming, meaningful change is possible. March of Dimes Canada urges the government to invest in care at home and in the community by adopting a home-first approach, and by investing health human resources and assisted living. Additionally, we are seeking provincial investment in our After Stroke program to provide sustainable and long-term support service for the growing population of stroke survivors in Ontario, reducing the burden on existing funded brain injury services by providing investment focused on this specific population. Finally, we ask that the Canada Disability Benefit (CDB) be placed in Ontario’s policy directive on exempt income sources related to eligibility for disability income support, and that there be no claw backs to other benefits such as dental or prescription drug coverage, housing and transportation supports, and other funded benefits, programs, and services once the CDB is implemented.
ii Zagrodney, K., D. Simon, E. King, P. Boily, K. Nichol and S. McKay. Unlocking Potential: The Power of Wage Parity in Home and Community Care. Community Re-Connect: 2023 October OCSA Conference.
v Bethlenfalvy, P. 2023 Ontario Budget: Building a Strong Ontario. P.87
vi Auditor General of Ontario. “3.01 Assistive Devices Program.” Annual Report, December 5, 2018.
vii OCSA, 2023 Pre-Budget Consultation, January 2023.
xi Zagrodney, K., D. Simon, E. King, P. Boily, K. Nichol and S. McKay. Unlocking Potential: The Power of Wage Parity in Home and Community Care. Community Re-Connect: 2023 October OCSA Conference.
xv Ibid.
xvi Ontario Ministry of Health, Ontario Health Teams: The Path Forward, November 2022.
