The federal government should fast track the Canada Disability Benefit


By Art Eggleton and Rabia Khedr

What do former Health Minister, Allan Rock; Senator Mohamed-Iqbal Ravalia; former Lieutenant Governor of Ontario, David Onley; professional dancer, Luca Patuelli; ‘Mincome’ economist Evelyn Forget; best-selling author, Tara Ross; the CEO of Community Foundations of Canada, Andrew Chunilall; singer-song writer, Christa Couture; disability activists, Ali Mohammed and Meenu Sikand; several order of Canada recipients, noted physicians and academics — along with most major disability organizations from across the country – all have in common?

They are among the more than 200 political personalities, academics, artists, non-profit and business leaders that have signed an open letter asking the federal government to fast track the Canada Disability Benefit — and to do so with the active and genuine involvement of disabled people every step of the way. 

People with disabilities make up 41 per cent of our population living in poverty.

The Canada Disability Benefit was first introduced by the federal government in the Speech from the Throne a year ago and is the direct result of years of advocacy from the disability community.  Legislation tabled before Parliament recessed last summer promised a first: a federally funded income support for persons with disabilities – that would not replace provincial programs and other supports but complement it — so that they are no longer consigned to a life lived in poverty.

Economists predict that poverty in Canada would be reduced by as much as 40 per cent overall by eliminating disability poverty.  It’s an historic opportunity – something no government in the world has ever committed to. 

It’s time now to make the Canada Disability Benefit a reality.

The good news is that Canadians across the political spectrum support the idea. In a recent Angus Reid survey, 89 percent of Canadians say it’s time to end poverty for people with disabilities. And in the recent federal election, all of the major political parties included the needs of persons with disabilities in their platforms.

There is a new awakening, a new dawn in our consciousness with Canadians calling for a recalculating of fairness and justice – and working toward a better future for all, including for people living with disabilities experiencing poverty.

There is no need to study the problem for years first as the federal government has indicated they might do in the last Parliament; we have oodles of data, we have public support, and political will across party lines — now we need action.

As our governments prepare for economic recovery post-pandemic, the sad reality is that people with disabilities may be left even further behind. COVID-19 was especially hard on people with disabilities. 

Currently, a disproportionate number of people with disabilities in Canada are depending on food banks and finding themselves homeless. They are finding themselves without adequate daily living supports. Provincial disability benefits are failing them, falling well below the poverty line. Too many people with disabilities are considering dying from despair.

Canada is a prosperous nation – among the richest in the world.  But in the heart of business affluence in this country, not too far away from Bay Street, there are people with disabilities like Ryan begging money to buy food. There is Mariam living in an inaccessible apartment as her disability progresses toward needing a wheelchair full-time. And there is Precious, whose mental health is deteriorating because she has no job to go back to as a result of the pandemic.

People with disabilities, their families, friends and fellow Canadians want Canada’s 44th parliament to make history and leave a cross-partisan legacy. We expect all-party support for fast action on the Canada Disability Benefit – to make Canada the first country in the world to provide a livable income supplement for people with disabilities.

People with disabilities are ready to work together with the federal government to fast-track consultation, provide the research and move quickly to implement the Canada Disability Benefit.

Let’s work together and make this happen.

The open letter was coordinated by Disability Without Poverty, March of Dimes Canada, the Multiple Sclerosis Society of Canada, Race & Disability Canada and can be found at:

Art Eggleton is a former Senator, MP, Cabinet Minister, and a former Mayor of Toronto. He is a long-time advocate to alleviate poverty in Canada.

Rabia Khedr is a National Director for Disability Without Poverty and a former Ontario Human Rights Commissioner. She is currently a member of the Minister’s Disability Advisory Group appointed by Minister Carla Qualtrough.

Spending more on health care does not guarantee better health outcomes


Michael Wolfson – Quoi Media

Canada’s federal election results had barely been counted when the Premiers resumed making their well-worn demands for more federal health care money. Instead of thanking Ottawa for the billions it has already provided for fighting COVID-19, or asking for short-term pandemic-related funding, the ritual chorus seeks ever-increasing amounts of money for decades to come.

Granted, the need for more money certainly feels urgent right now. Intensive care is on the brink of collapse in Alberta and Saskatchewan, with health officials preparing to make painful decisions around triaging patients as COVID-19 infections surge. A number of provinces are having difficulty even staffing their hospitals, after almost two years of burnout-inducing working conditions for front-line health care workers.

However, the premiers’ multibillion-dollar asks have been for unconditional long-term funding, well beyond the scope of the current crisis. But they have not been clear on how any new money would be used. It is entirely reasonable to ask them to explain themselves – especially since spending more on health care does not automatically mean better health outcomes.

In a recent study, CIBC economists Benjamin Tal and Andrew Grantham found that COVID-related hospitalizations per one million of the population were four times higher in the U.S. and five times higher in Britain than in Canada in early 2021. “Yet, as we all surely recall, the hospital system in Canada during the second wave was at its wits’ end,” they write. “Simply put, we reached capacity at levels that many other countries consider to be acceptable.” They conclude that Canada’s hospitals need more money.

But this is only part of the story. While the U.S. is well known for having much higher health care spending than any other country, both the U.K. and Israel spend significantly less than Canada – and yet neither came close to peaking on hospital capacity. The issue, then, cannot just be a lack of funding; how our health care dollars are being allocated must also be part of the conversation.

One reason provincial governments prefer hounding Ottawa, rather than focusing on more efficiently using the funding they do have, is that passing the buck is painless. As Canadian health economist Bob Evans says, “every health care cost is someone’s income” – that is, controlling or cutting health care costs means controlling or cutting the salaries of doctors and nurses, hospital budgets and pharmaceutical-firm profits. It is much easier politically for provinces to demand more funding than to get into conflicts with such concentrated and powerful interests.

But there is also a deeper reason. The provinces, and the federal government, simply may not have the data to evaluate their health care spending rigorously, even if they even wanted to. If they do have the data, they certainly keep their evaluations hidden.

This is not by accident. The savvier leaders among the key stakeholders have no interest in having such data exist, because they may fear it will lead to results that could embarrass them and turn public opinion against them, possibly in ways that would reduce their incomes or autonomy.

For decades, some of the most important data showing health care waste and inefficiency has looked at variations among small geographic areas – “postal code medicine.” These variations, which are the continuing subject of the Dartmouth Health Atlas, consistently show that while some parts of the U.S. spend two to three times as much on health care as others, key health indicators, such as primary care for diabetic patients and post-surgery complications, are not correlated.

One recent study by leading U.S. health economists concluded that these variations were not due to differences in patients’ needs; instead, they were most closely associated with physicians’ beliefs that were “unsupported by clinical evidence.” The specific examples they studied suggested that 12 to 35 per cent of this health care spending was unwarranted.

Canadians are rightly proud that our health care sector is nowhere near as expensive or inequitable as that of the U.S. But we are not immune. One decade-old study looked at heart attack treatments in Canada and found a threefold difference across health regions with no obvious difference in post-surgical 30-day mortality.

Sadly, no one has updated or extended this study, in part because the data needed are simply unavailable. We could get better value for our health care dollars if we knew more.

Before the federal government signs over any more multibillion-dollar cheques to the provinces with no strings attached, Canadians deserve to know why the additional investment is needed in the first place, how it will be spent – and whether, after all this time, our money has been well used.

Michael Wolfson, PhD, is a former assistant chief statistician at Statistics Canada and a member of the Centre for Health Law, Policy and Ethics at the University of Ottawa.

Canada Disability Benefit too important to leave solely to government

By Jayne Melville Whyte
Quoi Media

A life with disability should not mean a life in poverty.  Unfortunately, that’s the reality for too many persons with disabilities in Canada.  I should know.  I’ve lived with challenging mental health conditions for several decades, and while I’ve had periods of work, I’ve also had long periods of hospitalization, and I’ve relied on government benefits to eat, for shelter, to survive.  I eked out funds from casual contract work when I was well enough and depended on gifts from friends in hard times.

But persons with disabilities should do more than ‘just survive.’  We want to contribute as creative and caring members of the community.

The 2021 federal government budget announced consultations for a new national Canada Disability Benefit to ensure people with disabilities have a basic income.  Last month, the federal government introduced a bill to design a Canada Disability Benefit.

 This is ground-breaking news, at long last, and something to be celebrated.  Now the hard work comes – making it happen.  Persons with lived experiences should be at the table, working alongside government at every stage of the creation of this new benefit, to make sure it’s done in a way that helps those it is intended to.  The popular mantra, “Nothing about us without us,” is not just about engagement, it’s about making the benefit the best it can be.

People who live with disability and poverty bring an essential perspective to planning.  Our perspectives are unique. A story from my past is a reminder of how easy it is for those who’ve never known poverty to be oblivious to its constant piercing presence in every decision and action a person makes.

In 1993, after repeated hospitalizations and divorce, I found myself relying on benefits for survival. My total cheque was $864 per month for rent and living expenses.  A psychiatric bed cost (at that time) about $1000 per day.  Every day I was not in hospital saved the government money but left me in a state of poverty that prevented healthy living. 

In 1994, Senate committee hearings were underway about changes in the now defunct cost-sharing scheme for social programs, the Canada Assistance Plan.  Two national mental health organizations asked me, a woman on social assistance, to make their presentation. The plane from Regina to Winnipeg did not connect as planned with the Ottawa flight. The Senate committee waited until 9:30pm to hear my presentation. 

Before I began the carefully worded speech, I apologized, “I never even thought of coming a day early.  The hotel room costs more per night than I am allowed for a whole month of food and other needs after my rent.”

A Senator responded, “I never even think about the hotel cost.…a whole month?” “Yes,” I responded, “for food, toothpaste, recreation, transportation, gifts for my family….” He shook my hand and shook his head, and I went to the luxury (for me) of a prepaid hotel room for the night.

Ten years later, I worked casual contracts with non-profit organizations, never earning enough to pay income tax; no use applying for the non-refundable federal Disability Tax Credit.  At another national planning meeting, I realized the stark income difference of participants when my new friend mentioned over her glass of wine, “When I worked as Deputy Minister….”   I valued her experience as a person with mental illness who also understands government processes.  But I’m not sure she valued my poverty experience while brainstorming support systems.

In 2014, mental health conference expenses were paid by agencies who invited me to participate: $400 for airfare; $800 for four nights at the hotel, plus meals and taxi.  Five days of conferencing cost more than my monthly benefit.  Some participants were professors at universities — not “rich” but not poor.  Other participants were in deep poverty because of disability and unemployment or underemployment, grateful for the lunch at the meeting as their one meal of the day, worrying that they’d be homeless if their depression kept them from work for another month.  Together we documented the failure of community services to meet the needs of people with disabilities. 

People with disabilities living in poverty offer a perspective essential when planning social programs and income supports.  We should be at every government table in every phase of planning and delivery. Any solution must involve the people who are most affected, the population the program serves. 

The Canada Disability Benefit is too important to leave solely to government. 

Jayne Melville Whyte is a member of the Leadership Team of Disability Without Poverty. We are individuals with disabilities from across Canada working toward a united disability movement. Our mission is to get the Canada Disability Benefit into the hands of people with disabilities as soon as possible.  She lives in seniors’ subsidized housing in Regina, Saskatchewan.

The return of innovation

Alexandra Apavaloae, Polytechnics Canada
QUOI Media

In Budget 2021, “A Recovery Plan for Jobs, Growth and Resilience,” the Government of Canada bets big on innovation, research and workforce development as a means to fire up the economy and pull us out of the pandemic. The vision is clear: Canada can become a leader in artificial intelligence, quantum computing, biomanufacturing and green technology with the right investments now.

Innovation is mentioned in the budget document more than 167 times.

While investments north of $100 billion are ground-breaking, the focus on innovation is not. In Budget 2017, the Innovation and Skills Plan was also designed to make Canada a world leader in key sectors. Four years later, what has changed?

As Canada again places its hopes on improved innovation performance to drive growth, it is essential to ensure this year’s plan is pragmatic, within reach of everyday Canadians, and the businesses that employ them.

For everyone to benefit, innovation needs to be accessible, easy to produce, available on the market and affordable for those who drive Canada’s economy – small- and mid-sized employers. This is the domain of applied research.

Applied research is about solving problems, implementing ideas for iterative improvements, developing new-to-market innovations and laying plans for growth. It looks at real-world problems in areas like healthcare, green transition and digital adoption. It focuses on near-to-market commercialization activity rather than discovery research, which has its own place in the innovation ecosystem.

Applied research lays the groundwork for world leadership in virtually any field by identifying its leaders, nurturing their growth and engaging the talent pipeline necessary for expansion.

Consider Canada’s aging population. Rather than view the stresses on the healthcare sector and its workforce as an overwhelming whole, applied research makes it possible to target discrete, solvable problems. For example, communicating with non-verbal dementia, stroke or autistic patients has long been a challenge. At Seneca, students are testing Linggo, a new app with promising results for older adults, improving functional communication and promoting social interactions.

Sustainability is another daunting problem of global significance. Once again, breaking it down to bite-sized chunks is an important way to identify solutions and make industry-level improvements. Saskatchewan Polytechnic, in partnership with universities, Indigenous groups, the Canada Foundation for Innovation and the livestock industry, is involved in an interdisciplinary project to conserve the bison population. Combining expertise in reproductive technology, cattle health, genomics, microbiomics and bioinformatics, the project may well generate solutions that can also be applied to an $18 billion dollar cattle industry.

Across sectors, experts have raised alarm bells over delayed technology adoption within Canada’s small and medium enterprises. Polytechnic and college students are ideally positioned to work on applied research projects focused on digital adoption, both boosting business productivity and providing relevant experience to new labour market entrants.

But digital adoption doesn’t look the same in every sector or business.

At the British Columbia Institute of Technology, projects encompass everything from the design of nurse scheduling software to search and rescue machine-learning algorithms. Across the country, at Algonquin College, an applied research project sought to address credibility challenges among drone pilots by developing an online social platform that offers profile verification and proof-of-work.

As for Budget 2021, a two-year, $46.9 million investment in the College and Community Innovation Program is an indication that the federal government recognizes the innovation value of partnerships between polytechnics and the private sector. As we work to overcome the COVID-19 pandemic and build back stronger than before, this injection stands to be an important way to get businesses and communities back on their feet. That is, innovation worth pursuing – incremental, practical, achievable.

While world leadership in key sectors may well be the ultimate goal, Canada cannot neglect today’s challenges in favour of some future, paradigm-shifting innovation. Growth and productivity will certainly include, and most definitely start, with steps in the right direction.

Federal budget includes commitment to explore employee ownership – and that’s a good thing

With different rules, companies like Longo’s might now be owned by its employees

by Jon Shell
Quoi Media

Hidden amongst the many newsworthy items in this year’s federal budget is a small, little discussed section with the potential to reshape many Canadian industries.

In it, the government committed to exploring options to remove barriers to employee ownership trusts in Canada.

While that may sound pretty boring, we can look to the recent sale of Longo’s, the beloved Toronto-area grocery chain, to understand just how important this decision might be.

Long rated one of Canada’s best managed companies, and with high marks for its customer service, Longo’s was one of the few major independent retailers left in Canada, where Empire, Loblaw and Metro control 75 per cent of the market. Founded by three brothers in 1956, it remained family-owned and run by one of the sons of the founders, Anthony Longo.

In mid-March that independence ended, as Empire, the owners of Sobeys, announced they would be buying a controlling interest. Media reports described the deal as inevitable; as the Canadian grocery industry continues to consolidate, what chance did a local, family-owned chain have against the giants?

In the United States, however, the fate of grocers like Longo’s is anything but inevitable. A very different option is available with a track record of keeping family grocers both successful and independent: employee ownership.

Publix Super Markets, WinCo Foods, Brookshire Brothers, Harps Food Stores and Buehler’s Fresh Foods are all similar to Longo’s in many ways: humble beginnings, growing through the hard work and risk-taking of the founding family and dedication to tremendous customer experience.

Unlike Longo’s, the founding families of these thriving grocers rebuffed the offers of America’s largest chains and instead chose to sell to their employees.

The difference is due to the Employee Share Ownership Plan (US-ESOP), an employee ownership trust structure created in the U.S. in the 1970s to make it easier for business owners to sell to their employees. Different from share purchase plans, option plans or worker co-ops, the US-ESOP ensures all employees get a stake in the company, at no cost to them, while keeping a traditional management structure in place and ensuring owners receive market value for their shares.

The program has been so successful that tax incentives to increase adoption have been added over time by both Democrats and Republicans, and currently over 14 million Americans hold $1.4 trillion in company wealth under the country’s 6,500 US-ESOPs.
There is strong evidence that employee ownership is better for companies, employees and the economy itself, and grocery might be the best example of that.

No ESOP-owned grocer has ever gone bankrupt. Of the twelve U.S.-based grocery bankruptcies since 2015, eleven were private equity-owned. The twelfth was industry giant Kroger’s failed acquisition of popular locally-owned Lucky’s Market, a grocer of similar size to Longo’s.

Across all industries, employee-owned companies in the U.S. grow faster, are more profitable, are more resilient in downturns, stay in their communities longer and pay their employees more.

US-ESOPs are also a powerful wealth creating engine for workers. On average employee-owners have 92 per cent more wealth than non-employee-owners, while many front-line employees at grocers Winco and Publix have become millionaires.

That doesn’t mean we should blame the Longo family for their choice.

There is very little employee ownership in Canada, as selling to employees here has been a long, complicated and painful process. EllisDon, one of Canada’s largest construction companies, is also one of its most successful employee-owned companies.

But its ownership transition from the founding Smith family has taken decades, and Geoff Smith, its CEO, recently took to LinkedIn to encourage the Canadian government to make it easier.

It appears they listened, and significant employee ownership of the Canadian economy might not be far behind. The UK introduced employee ownership trusts in 2014, providing incentives for owners to choose employee ownership over other options, and investing in awareness building in the business community. Employee ownership has dramatically increased ever since, with almost 100 UK companies choosing this path in 2019 alone.

A recent Canadian Federation of Independent Business survey suggests similar uptake in Canada should be expected.

One day soon, employees at companies like Longo’s might wake up to find they are now owners, with a real path to wealth for them and their families.

Employee ownership trusts increase resiliency, broaden opportunity and reduce ownership concentration, all key elements of a more inclusive economy.

The federal government’s commitment to investigating their potential should be applauded.

From ‘Crip Camp’ to a national disability benefit, it’s time Canada had a disability awakening

by Andrea van Vugt
QUOI Media

Last week at the 93rd edition of the Academy Awards, a movie about an untold American revolution was in the running for one of those shiny gold statues. That movie was Crip Camp: A Disability Revolution, and if you haven’t seen it yet, you should. The movie reveals that if people claim their disabilities, the disability community can unite, take action and make change.

Crip Camp is described as heartfelt, inspiring and emotional. I hit play on the film because I’m a 36-year-old disabled woman, the “R” rating got me curious and, despite the fact that one in five Canadians identifies as disabled, our stories are never on the radar when it comes to popular culture.

I loved the film. I loved it so much I watched it twice. And it blew me away the second time, too. Why? Because it encourages people to claim their disability, it exposes disability civil rights history, and it is a reminder that a movement by the people for the people makes all the difference. Now, not only are disabled people on the big screen, but we’re in the room wearing pretty dresses and freshly pressed suits.

We are telling our story.

So what’s the story? The disability community is the largest minority group in Canada. And – wake up – it’s a minority group that you can become a part of at any point in your life. One in five people is a lot of people.

I didn’t claim my disability until a decade after my epilepsy diagnosis. Although there is no such thing as overcoming a disability, claiming it can be liberating. Of course, not everyone discloses their disability. Many disabilities are invisible, and disclosure can come at the cost of exclusion and judgement.

Thankfully, the rate of exclusion continues to get smaller and our civil rights continue to progress.

There’s more good news on the horizon. For the first time, Canada’s federal government committed to creating a national Disability Benefit in 2020 and elaborated further on the program in the recent federal budget. The mere talk of such an opportunity is a civil rights milestone.

Of all the people living in poverty in Canada, 30 per cent of people in deep poverty have a disability.

I’ve lived in poverty on the $16,000/year that I was allotted from various disability benefits and supports. It was a tiring, isolating cycle, yet it made me thrifty, adaptable and empathetic to other marginalized groups.

We can’t overcome disability, but a national Disability Benefit could allow people in Canada to overcome poverty and participate more fully in society.

So, how do we hold our government accountable to their promise?

We unite. We, as in the disabled, and our allies, unite. Whether you’re a person with a disability, differently abled, disAbled, crippled, handicapped, special needs, specially abled, diffabilitied, Deaf, deaf, simple, special, gimp, impaired… I could go on and on. You. You know who you are.

Let’s take inspiration from the story of Crip Camp and the disability powered movements that created Bill 504 and the Americans with Disabilities Act.

Movements by the people for the people. It’s time Canada had a disability awakening too.

Creating a national Disability Benefit is an ambitious task. There are differences between federal and provincial supports, and each province runs its own system of benefits separately, so a national benefit will be challenging to coordinate.

Disability is also an uncomfortable topic for many, so it can be hard to get the conversation going. There are many pieces to the puzzle, but if there’s anything I’ve gained from COVID-19 isolation, it’s a new love of puzzles.

Crip Camp didn’t end up winning the Oscar, but it shared the inspiring history of a revolution that established disability rights in the United States of America and its message continues to resonate around the world.

It’s time for the disability community in Canada to follow suit and claim our crip, so we can unify our movement and be heard.
Let’s go for it. Claim your disability (if you have one), watch the film (it’s available for free on YouTube and it streams in Canada on Netflix), and let’s work together for disability without poverty in Canada.

Andrea van Vugt is a disability advocate from Calgary, Alberta. She is the founder and president of the Disability Pride Alberta Foundation, a consultant for the Canadian Disability Benefit Initiative, and she is working towards a master’s degree in community development.

Infrastructure-ready talent key to recovery

by Matt Henderson
QUOI Media

In times of economic downturn, investing in infrastructure is often viewed as a way to stimulate the economy and expedite recovery.

U.S. President Biden just announced a $2-trillion infrastructure plan, in part to spur economic activity. Here in Canada, despite less-than-ideal progress on a 12-year, $188-billion Investing in Canada Plan, the truth is that economic and labour market recovery will depend in part on our ability to get building.

But today’s infrastructure investments stand to fulfill additional objectives than those of the past. Rather than solely solving for construction sector unemployment, we need solutions for job losses that have disproportionately affected women and racialized workers. Rather than just building bridges and ports, we need infrastructure investments that stand to help Canada achieve its digital and net-zero ambitions.

The 2021 federal budget laid the groundwork for policies and programs that will enable workforce development and a more inclusive labour market. This is an important start. But as Canada develops a comprehensive plan to recover from the COVID-19 pandemic, we need to better support those who will put the “build” in building back better.

First and foremost, this will rely on broadening the source of talent. Canada’s construction industry was facing labour market disruption well before the COVID-19 pandemic. Across the country, the sector is dealing with an aging workforce, with projections suggesting the need to replace almost 260,000 workers – 22% of the current workforce – in response to retirements over the next decade.

The shrinking supply of construction sector talent represents a huge opportunity in response to an economic downturn that has displaced women, people with disabilities, racialized and Indigenous peoples to a much greater extent than other groups. Smart, focused efforts to recruit and retain a broader pool of workers should be a strategic priority. Where efforts are underway to diversify the talent pipeline, they should be scaled and extended. Financial supports must now be accompanied by wraparound supports like job shadowing, mentorship and childcare.

The next priority will be to ensure the workforce has the skills required to build, repair and maintain a different kind of infrastructure, one that includes high-speed broadband, electric vehicle charging stations and rural public transit. With ambitions to reach net-zero by 2050, Canada needs a greater focus on green retrofits and passive buildings. These pragmatic, incremental improvements require a workforce ready to implement them.

While new entrants can be trained with these transitions in mind, there will also be a huge role for lifelong learning. Changing skill requirements are already a reality for those working in construction, engineering, management and the green economy. With new infrastructure investments, a renewed focus on upskilling and reskilling will be required to keep up with new building materials, the evolution of consumer preferences and emerging sustainable practices.

Where speed is critical, micro-credentials are an increasingly popular way to train individuals in new or emerging areas, like mass timber construction. Navigating both employers and workers to such programs will be integral to ensuring infrastructure investments can meet our aspirations for a digital and green recovery.

Finally, we must nurture and support our apprentices. It is no longer good enough to attract young people to the skilled trades only to see half fail to complete their training. Here, a better connection between supply and demand must be managed.

To do so, the government’s election commitment to establish a Canadian Apprenticeship Service requires some refocus. Rather than another wage subsidy program, the Canadian Apprenticeship Service should identify priority trades and coordinate locally curated solutions to support apprentice completion. Leaving apprentices at the mercy of the labour market without support clearly isn’t working.

Given the requirement for a sustainable talent pipeline, it is also time to get serious about mandating apprenticeship positions on federally funded infrastructure projects.

The ability to recover, restart and reignite Canada’s economy will depend on our ability to deliver on our ambitious infrastructure goals. There is no shortage of prospective projects across the country, and with $188 billion committed, no shortage of available funds either. Budget 2021 is a start, but the only way for us to deliver on these investments and actualize these projects are with people. Let’s not forget about those that do the building.

Matt Henderson is Senior Policy Analyst at Polytechnics Canada.

It’s time long-term care welcomed back essential care partners

by Jennifer Zelmer and Lisa Poole
QUOI Media

There have been two overlapping tragedies that have befallen long-term care homes in Canada during the COVID-19 pandemic.
First, the unimaginable death toll itself from COVID-19. Long-term care and retirement home residents accounted for eight in 10 COVID-19 related deaths in Canada as of October 2020 — and they continue to bear the brunt of the pandemic.

Second, blanket visitor restrictions, which were designed to prevent the transmission of the virus, led to significant unintended distress for many residents, staff, families and friends. Essential care partners – which may include family or friends – were often not permitted on site when residents needed them the most.

Today, some essential care partners may still be denied entry, even as other long-term care facilities begin to loosen restrictions. But recent experience has highlighted that essential care partners are not just visitors – they never were. They are critical members of the care team and their inclusion in long-term care settings is vital to the well-being of residents and staff. It’s time for safe re-entry.

What’s an essential care partner?

Essential care partners are people who provide physical, psychological and emotional support, as deemed important by the long-term care resident. This can include support in decision making, care coordination, and continuity of care (for example, support for minor medical procedures, feeding, ambulation, cognitive stimulation, patient hygiene, medication adherence).

Essential care partners can include family members or close friends and are identified by the resident or substitute decision maker. It is estimated that caregivers in Canada contribute up to $24 billion annually in unpaid care to hospital patients, residents in long-term care, home care and other settings.

Essential care partners offer comfort, compassion and joy to residents, they combat loneliness and can be the eyes, ears and voice of some of the most medically vulnerable residents.

There is limited evidence about essential care partners, when properly supported, transmitting COVID-19 in long-term care homes, but we do know that resident isolation can result in increased depression and anxiety and an overall decline in mental health. Residents living with dementia may also show an increase in symptoms.

There is clear evidence that the presence of essential care partners benefits patient safety, patient experience, patient outcomes and patient care.

The absence of essential care partners to support and assist in resident care has also contributed to staff stress and burnout. In some cases, it has been reported that staff cannot consistently provide the level of person-centred care necessary for resident well-being in the absence of essential care partners. This has led to moral distress amongst staff.

Safely welcoming essential care partners back into long-term care facilities is important across the country. They can be trained to use personal protective equipment (PPE), educated in infection prevention and control, and vaccinated. And they should be provided the appropriate tools and resources for re-entry in ways that recognize and support the important roles they play in improving quality of life.

That’s why we created a resource at Healthcare Excellence Canada to help essential care partners safely re-enter long-term care homes during COVID-19. The resource was co-created by essential care partners, for essential care partners. It provides practical information so essential care partners can navigate the current state of long-term care during the pandemic.

And it’s why we are working with homes and policy-makers on pragmatic approaches to re-integrate, welcome and engage essential care partners as part of care teams, during COVID-19 and beyond – from setting mutual expectations and education to COVID-19 screening protocols and caregiver identification.

These resources have been shared widely with long-term care homes, caregiver associations and healthcare organizations with the hope that they will engage with essential care partners and work together to allow their safe re-entry into long-term care. It’s time.

Jennifer Zelmer is President and CEO of Healthcare Excellence Canada, a new organization that brings together the Canadian Foundation for Healthcare Improvement and the Canadian Patient Safety Institute.

Lisa Poole, an essential care partner, is the Co-Chair of Dementia Advocacy Canada, a member of Dementia Network Calgary’s Strategic Council, AGE-WELL’s Older Adult and Caregiver Advisory Committee and Imagine Citizens Healthy Living and Aging Working Group

3 things health care providers should discuss in serious illness conversations

by Allan Grill and Cindy Dumba
QUOI Media

Canadians with serious or progressive chronic illness are feeling especially vulnerable during the COVID-19 pandemic. It has underscored how quickly circumstances can change.

Talking about a serious illness diagnosis and the impact on life expectancy is difficult.

Many Canadians are uncomfortable having these conversations, even though they know it is important.

Surveys have uncovered this paradox: while 93 per cent of Canadians think it is important to have discussions about goals and values related to their health, only 36 per cent have done so and only 18 per cent have documented them.

As a doctor and a patient, we know these conversations can make a difference to ensure that patients get the care that they want, and avoid what they do not. Research shows that early discussions about goals, values and wishes can improve the quality of life and reduce pain and suffering for a person who is seriously ill.

The tools that health care can offer to prolong life, like CPR (cardiopulmonary resuscitation) or a feeding tube, often do not contribute to improved quality of life, especially for those who are frail and have reached the end of curative treatment options for serious illness.

While most Canadians do not want aggressive medical interventions in these situations, many still receive them because their wishes were not known. They may even become unable to speak for themselves, either because of physical or cognitive impairment. Knowing what patients would want can help guide medical decisions that respect their wishes.

Knowing what to say and how to say it can help people get started.

That’s why Choosing Wisely Canada, a national campaign to engage clinicians and patients about what they need and what they don’t when it comes to medical tests, treatments and procedures, is sharing resources to help support this conversation.

So, as a doctor and a patient we are urging you to have these conversations with your care providers and your loved ones.

Receiving a serious illness diagnosis is life-changing for patients. Their plans and ideas of what the future holds suddenly become uncertain. Too often patients are unprepared for what comes next. Serious illness conversations can help patients plan for the future and better understand what to expect.

Doctors and other primary care providers are often the ones who initiate these conversations after the diagnosis of a serious illness, or when they are concerned that their patients have a life-limiting condition.

Here are three things you should know about these important conversations:

First, talk about your understanding of the illness. Having a sense of what a patient’s disease trajectory looks like can help set health priorities in order to better deal with the uncertainty that accompanies it.

Second, discuss your goals and wishes. In the context of serious illness, this can be things like exploring sources of strength and support, as well as fears and worries. Patients often express concerns about how certain medical interventions will impact their independence, and what possible outcomes might result from tests or treatments.

Third, explore your values that can inform decision making and talk about trade-offs.

For example, we talk about how much someone is willing to go through for the sake of added time. Discuss what to expect from treatments that might prolong life at the expense of quality.

These conversations take time, and we strongly encourage people to start talking with their health care providers as well as their loved ones. Having a trusted person who knows your wishes means that they will be honoured and communicated, even if you can no longer speak for yourself.

Don’t wait until it’s too late. It’s time to talk.

Allan Grill is a family physician in Markham and Associate Professor, Department of Family and Community Medicine, University of Toronto. C ndy Dumba is a patient and family advisor for Choosing Wisely Canada and Choosing Wisely Saskatchewan.

Investing in social infrastructure post-COVID

by Andrew Chunilall, Julie Gelfand and Diane Roussin
QUOI Media

When the pandemic began a year ago, the federal government turned to community sector organizations — the Red Cross, Community Foundations and United Ways — to channel $350 million in emergency funding to areas of need across Canada. With this support, food banks, women’s shelters and other community organizations were able to quickly meet increased and changing demands for their services.

With lean operations and extensive community connections, the charities, non-profits, social enterprises and foundations that comprise Canada’s community sector are governments’ natural partners. This should not only be the case in emergencies, but also in shaping and implementing the larger transitions ahead in the post-pandemic period.

Public policy and finance are understandably focused on resilient recovery and rebuilding, with unprecedented investments in physical infrastructure to create green jobs that address the imbalance between humanity and the natural environment. To fulfill the potential of this great transition, our social infrastructure needs attention too.

“Social infrastructure” includes policies, practices and relationships that enable us to create a more resilient, inclusive and sustainable society, from the grassroots to the global, and spanning healthcare, education, culture and our democratic processes.

COVID-19 has revealed systemic injustices and vulnerabilities including institutionalized racism, substandard seniors housing, the lack of paid sick leave and inadequate childcare. To this list we can add Indigenous reconciliation, the income and wealth gap and the life- and budget-sapping increases in chronic disease.

In the values-based economy that Mark Carney, Mariana Mazzucato and others are calling for, solving these challenges defines pathways to inclusive economic well-being. It is imperative to broaden the scope of infrastructure funding beyond the physical, to catalyze socio-economic transition at the regional, community and household levels.

The 2018 Inclusive Innovation Report from the federal Steering Group on Social Innovation and Social Finance provided a modernization agenda for the social sector which could function as a blueprint as we transition through a post-COVID world. It calls for a federal Social Finance Fund, announced in the fall 2018 budget update but not yet implemented, to invest in social enterprises – focused on such things as the construction of affordable homes, Indigenous entrepreneurship and micro-credit for immigrants.

The report calls for investment in improved data management capacity in community organizations – for designing and measuring interventions in social systems and to support development of a ‘solutions marketplace,’ where public and private investment can complement grants and donations by financing improved outcomes on issues ranging from homelessness to youth employment.

In addition to capital and data, we need evidence. The report calls for the creation of ‘What Works Centres,’ similar to those in the UK — where policy makers, program designers and the public can access plain language summaries of current research on issues such as chronic disease prevention, early child development and mental health.

Government oversight needs to evolve from the current regime, where CRA micro-monitors activities around charitable donations, to one that recognizes that the sector is increasingly networked, linking grassroots civic engagement to national priorities, in collaboration with all levels of government, the private sector and academia, to effect systemic change.

We are all stronger if we work together. In this time of societal transition, governments, businesses and the community sector alike need tools for collaborative innovation focused on systemic change.

The most important recommendation in the report — and something we need urgently — is a permanent social innovation council with government, and eventually the private sector too, so that Canadians know that the organizations they support with their donations and their tax dollars are being heard on matters critical to social and economic well-being while we transition to a zero-carbon economy.

In light of the current crisis, we suggest that this be framed as a ‘transition innovation council,’ involving all sectors in supporting community transitions in line with Canada’s commitment to the UN Sustainable Development Goals. It should be similar to and complementing the recently announced Net-Zero Advisory Body reporting to the Minister of the Environment and Climate Change.
Just as Canada’s health care system integrates contributions by the public, private and community sectors, so too must efforts to recover and build a more inclusive and sustainable society. As governments and the private sector plan multi-billion dollar investments in physical infrastructure, it’s important to involve the community sector in building better social infrastructure too.

Andrew Chunilall is CEO of Community Foundations of Canada. Julie Gelfand is Former Commissioner of the Environment and Sustainable Development. // Diane Roussin is Project Director for the Winnipeg Boldness Project.