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A.
Introduction
In the fall of 2001,
the Steering Committee on Social Assistance [SCSA], a provincial organization
representing social assistance advocates in Ontario community legal clinics,
launched a concerted public law reform campaign to work for changes in
the Ontario Disability Support Program [ODSP] disability determination
process.
The SCSA asked clinics,
either on their own or in conjunction with other community groups, to
hold public forums, focus groups, or inter-agency meetings on the theme
of "Access to ODSP". At the same time, the SCSA joined forces
with other concerned organizations, including the Canadian Mental Health
Association [CMHA], Centre for Addiction and Mental Health [CAMH], Coalition
of Family Practitioners, and CONNECT/Canadian Hearing Society, to develop
recommendations and discuss lobbying and media strategy aimed at raising
public awareness of the issues and potential solutions. This expanded
"Access to ODSP" campaign committee took on a new name - the
"ODSP Action Coalition".
"Access to
ODSP" forums were held in many parts of the province throughout
2002. These events proved to be valuable two-way information sharing occasions.
Clinic staff and other activists had an opportunity to speak about the
issues, and people in attendance had an opportunity to provide examples
of their experiences with the system, and to discuss changes that could
and should be made. These forums and the reports that were generated from
them served as the practical underpinning for the ODSP Action Coalition's
ultimate recommendations for reform of the ODSP disability determination
process.
B. The Forums
"Access to
ODSP" forums and focus group meetings took place in the following
Ontario locations:
- Toronto (18 March
2002)
- London (27 March
2002)
- Lindsay (10 May
2002)
- Cobourg (15 May
2002)
- Scarborough (16
May 2002)
- Barrie (22 May
2002)
- Hamilton (29 May
2002)
- Thunder Bay (7
June 2002)
- Toronto - Parkdale
(27 June 2002)
- Renfrew (September
2002)
- Windsor (20 September
2002)
- Durham Region
(7 October 2002)
- Georgina (17 October
2002)
- Kitchener (21
October 2002)
- Cambridge (24
October 2002)
- Sarnia (22 November
2002)
Clinics were asked
to organize their forums in the same general way and to follow the same
general format in producing subsequent reports, so that forum results
could be compiled and interpreted as easily as possible,
Participants at many
of the forums split up into small groups. Either as a group or in small
groups, forum participants generated a list of problems, with specific
examples, under the following categories:
- the application
process (e.g. the complexity of the process, confusing forms, length
of time it takes, lack of help for applicants, etc);
- who gets accepted
and who doesn't: the definition and how it is applied by the Disability
Adjudication Unit;
- the internal review
and appeal process;
- reassessments:
the two year reviews of disability status;
- client service:
the way of treating clients, the phones, the "team" approach,
the computer-generated letters, repeated demands for the same information;
- additional benefits/special
needs: transportation, special diet, community start-up, extended health
coverage, etc.;
- employment supports
and employment income;
- amount of income
support, deductions, overpayments, etc.; and
- other issues.
Each group then listed
recommendations for change under the same categories.
Each group was asked
to assign priority to their top recommendations for change, and to report
back only those recommendations that had not been mentioned already by
other groups. Notes from all the groups were compiled to produce the main
forum reports.
C.
The Main Themes
The main themes that
emerged from the Access to ODSP forums were:
- It's too difficult
to get information about ODSP benefits and programs and too difficult
to apply for them
- The application
forms don't ask for enough information or the right information
- It takes too
long to find out if a decision has been made and too long to get through
the appeal process
- Individuals
- especially those with additional needs - aren't getting enough support
at any stage
- ODSP administrative
processes are designed to treat applicants and recipients as files rather
than human beings
- ODSP benefit
rates are far too low
D. Specific Concerns
"When
you set up a system that has at least four steps in it, in which the
person who has the least ability-the person with disabilities-has to
collect all the information and run around and make sure doctors and
ministries and tax departments send in all these papers, is it any wonder
why so many people give up even before a decision is made?"
[quote from Parkdale Town Hall]
The concerns voiced
at the Access to ODSP forums touched on many and varied issues. However,
there were three main areas of concern - the application process, Disability
Adjudication Unit [DAU] adjudication and client service.
1.
The Application Process
Forum participants
described problems at all stages in the application process. Many observed
that these problems are compounded, and can become insurmountable when
an applicant with disabilities is facing other barriers as well.
Many people called
the application process too complicated, and pointed out that just obtaining
the necessary application forms was difficult. Specific issues included:
- applicants do
not know when or where to apply, or how to get application forms
- the Ontario Works
[OW] telephone intake system does not work well, it is very difficult
for non-English speakers to access it properly, and it is hard to bypass
the system to get through to a live person
- an ODSP application
cannot be completed in one step - applicants have to go through a separate
financial screening before even getting the medical application forms
- some OW offices
are either not making requested or needed referrals to ODSP, or making
late referrals, and some ODSP offices are refusing to accept direct
applications - in any of these situations, the result is lost benefits
for the individual
- people who need
additional help to navigate the application process and assemble the
necessary information to establish eligibility - for example, because
of homelessness, mental illness, cognitive impairments or language difficulties
- are not getting the resources and support they need from ODSP, and,
as a result, many are falling through the cracks or simply giving up
There were many criticisms
of the Disability Determination Package [DDP] itself. Participants described
the application forms as overly lengthy and complex, and very often confusing
to both applicants and the health professionals who have to complete them.
Specific issues included:
- the forms are
only available in English and are not written in "plain language"
- the forms do not
contain the statutory definition of disability
- the forms do not
adequately capture the nature and extent of mental health problems,
recurrent impairments, impairments with a pattern of "good"
and "bad" days, or the cumulative impact of multiple conditions
- the instructions
on the Health Status Report form state that the Intellectual and Emotional
Wellness Scale should not be completed if the person's principal problem
is physical, and this may result in mental health conditions going unreported
- the Activities
of Daily Living rating scale is complicated and often misunderstood
by applicants and health professionals
- the list of persons
permitted to complete the forms is too restrictive - it does not include
social workers who may be most qualified to provide opinions as to an
applicant's ability to accomplish activities of daily living
- the forms do not
capture socio-economic factors such as education, employment experience
and skills, which often compound a person's functional restrictions
- the Self Report
has little practical value as its completion is optional and it appears
to be completely ignored by the DAU
Another major area
of concern was getting adequate medical documentation in time to satisfy
the application requirements. Specific issues included:
- chronic shortages
of both family physicians and specialists mean that people who wish
to apply may not be able to find a doctor to complete the forms, especially
if they do not have a regular family doctor, and may have to go on long
waiting-lists for specialist appointments
- the fees paid
to doctors to complete the forms are too low - consequently, doctors
are often reluctant to complete the forms and may do a less than thorough
job, and some applicants are charged extra by their doctors for the
form completion
- the 90-day time
limit for submission of medical information is too short - some applicants
are unable to meet the deadline because of long waits to get forms completed,
or receive rushed reports from doctors at the last minute
- doctors are not
clearly advised as to the importance of submitting consultation reports
and test findings - as a result, key documents are often missing from
applications
- doctors often
complete forms without direct input from the applicant and may therefore
often not have sufficient information about the restrictions on the
applicant's activities of daily living to provide an accurate picture
to the DAU
2. DAU Adjudication
Many concerns were raised at the forums both about recurrent administrative
problems at the DAU and about the quality of DAU adjudication.
Administrative problems
identified by participants ranged from lost documents to unacceptable
delays. Specific issues included:
- the DAU does not
always acknowledge receipt of DDPs, causing uncertainty for applicants
- forms and letters
too often get mixed up or lost altogether at the DAU
- the DAU often
notes that additional information (such as X-ray reports or test results)
has not been submitted, but does not take the initiative to obtain documentation
that it needs to make its determination, and does not always advise
applicants when information is missing
- it takes too long
for the DAU to make its initial decisions
Participants were
very critical of the substance of DAU decisions. Specific issues included:
- little information
is available as to the qualifications of DAU adjudicators and the criteria
they use in making their decision - when they do identify criteria,
they often seem to be using tests that are more difficult to meet than
the statutory definition
- the DAU denial
letters (both on initial adjudication and on internal review) are form
letters citing the statutory definitions and do not contain meaningful
reasons
- the DAU appears
to automatically refuse to recognize certain medical conditions as resulting
in impairments (for example, fibromyalgia, chronic pain syndrome, environmental
sensitivities)
- the DAU tends
to discount opinions of family doctors, particularly where mental health
conditions are involved - the DAU often cites a lack of specialist treatment
without recognizing the shortage of specialist resources and limited
referral options
- the DAU often
denies eligibility on the basis that an individual is not seeking or
has refused treatment, without recognizing that an individual's attitude
towards treatment may actually stem from his or her medical conditions
3. Client Service
The way in which individual
applicants and recipients are treated by ODSP staff appeared to be the
most significant area of concern for agency workers and individuals alike.
Specific issues included:
- the implementation
of new computer technology and the shift away from individual case management
to a call-centre or "team" style of case management have created
a client service system that is impersonal, inefficient and inadequate
- the system appears to be used to avoid dealing with client problems
rather than to resolve them
- the automated
telephone system is very problematic - clients have difficulty using
it (particularly where they have any language or communication barriers),
messages are often not returned in a timely fashion, and special access
needs are not adequately addressed - many clients do not have telephones
at all
- attending at ODSP
offices can be a stressful experience for clients both because of the
office design and staff attitudes - some clients reported harsh and
inappropriate treatment from ODSP workers - others reported a lack of
privacy or a feeling of being in a "jail cell" environment
- still others reported a particular lack of respect for psychiatric
survivors
- file transfers
from OW and Consolidated Verification Process [CVP] interviews are lengthy
and onerous - individuals may be told to provide information that is
out of date, information that they are unable to or cannot afford to
obtain, or the same information over and over again - information is
not being properly communicated between different social assistance
offices (e.g. between ODSP and OW; between ODSP and the DAU) and this
often leads to file errors and delays
- clients are sent
too many computer-generated form letters, and too often these letters
are either incomprehensible or inaccurate - contact information is rarely
included and follow-up can be difficult and frustrating
- clients are expected
to understand and comply with their rights and responsibilities and
are given little guidance or assistance by ODSP staff, even where medical
documentation indicates that they need additional support
4. Other
A number of other
important issues were raised at the Access to ODSP forums. Participants
expressed concern about the complexity of the internal review and appeals
process, the unpredictability of the eligibility reassessment process,
access to discretionary benefits, the treatment of employment earnings,
and the basic inadequacy of ODSP income support.
Specific issues included:
- the timeframes
for internal review and appeal are too short, the procedural requirements
are too rigid, and applicants who have been denied eligibility are rarely
referred to clinics for legal assistance
- the chance of
success on internal review is minimal - as a result, the internal review
process appears to be little more than an additional procedural hurdle
for applicants, especially as the DAU cannot consider new medical evidence
at this stage
- it takes too long
for an appeal to the Social Benefits Tribunal [SBT] to be heard - participants
estimated that the current wait time is about a year
- the DAU's practice
of only looking at new medical evidence 10 days before an SBT hearing
results in unnecessary appeal costs - even if the DAU then reverses
its decision, it is too late to schedule another appeal into that hearing
slot
- the eligibility
reassessment process is confusing and traumatizing for recipients -
the usual reassessment period of 2 years is too short - doctors should
not be required to complete a whole new application package for a person
whose condition has not changed
- the income reporting
cycle for employed ODSP recipients is error-prone and complicated, resulting
in many incorrect suspensions and overpayments, and the rapid reinstatement
provisions are too restrictive - the result is that ODSP recipients
are discouraged from attempting any work
- information provided
to recipients and community agencies about additional discretionary
benefits that may be available is inadequate and often inconsistent
- the current drug
card coverage is inadequate and the medical transportation policy is
too cumbersome and restrictive
- ODSP Employment
Supports are difficult to access and the actual results of the program
are unclear
- current policies
make it difficult for ODSP recipients to find and maintain housing -
in particular, recipients are unable to obtain "pay directs"
for shelter and utilities, and are unable to obtain timely responses
to community start up benefit (CSUB) requests
- the ODSP benefit
rate is inadequate to meet basic needs of food and shelter
E. Specific Recommendations
1.
The Application Process
- pamphlets on self-help
and where to get assistance with an application should be available
at all ODSP offices and should be given to all applicants
- ODSP offices should
ensure that applicants who need special help to get through the application
process are matched with appropriate support groups or advocates
- consideration
should be given to the establishment of a funded advocacy office with
a mandate to assist individuals with the ODSP application process
- ODSP applications
should be made available at community agencies and institutions
- ODSP workers should
be permitted to send forms and correspondence to applicants through
designated agencies or individuals where applicants are homeless or
transient
- ODSP offices and
the DAU should be given adequate resources so that applications can
be processed in a timely fashion
- the application
forms should be revised and simplified to make them more "user-friendly",
with clearer plain-language explanations of the information required
and the tests to be met - they should also be made available in different
languages
- individuals should
have access to an effective doctor-referral service
- doctors should
be given clearer instructions on the completion of the application forms
- in particular, doctors should be told to attach relevant specialist
reports and test results - and they should be provided additional space
on the forms to include further information
- the fees paid
to doctors for ODSP applications should be sufficient to cover both
completion of the application forms and attachment of consultation reports
- the categories
of people who are legally qualified to complete the ODSP application
forms should be expanded to include social workers
- the 90-day deadline
on the return of applications should be extended
- the transition
between OW and ODSP should be streamlined to avoid unnecessary delays
and OW referrals to ODSP should be confirmed in writing to the applicant
2. DAU Adjudication
- substance addiction
should be recognized as a disease and the statutory bar on eligibility
in addiction cases should be eliminated
- the DAU should
apply the ODSP disability test in accordance with the principles established
by the courts and the SBT, and should consider the individual's whole
picture, including the cumulative effect of all impairments and the
compounding effects of socio-economic barriers
- DAU adjudicators
should be required to have certain minimum qualifications
- DAU adjudicators
should have greater accountability for their decisions
- the DAU should
be more pro-active in obtaining necessary medical documents and clarification
- the DAU should
provide fuller reasons for its denial at first instance - including
attaching a copy of its adjudication summary to the denial letter
- resources should
be made available so that an ODSP applicant can obtain a functional
assessment in appropriate circumstances
3. Client Service
- bring back the
human element to ODSP delivery - each client should have a specific
ODSP caseworker who is held accountable for actions and decisions taken
on his or her file
- OW offices should
designate specific workers to handle all ODSP application cases, and
the telephone screening process should not apply to ODSP applicants
- telephones in
ODSP offices should be answered by human beings, not voice mail, and
telephone staff should be trained to be able to accurately answer questions
- ODSP offices and
communications should be fully accessible to clients with diverse disabilities
- steps should be
taken to ensure privacy and confidentiality at all ODSP offices
- communication
between offices should be improved so that individuals are not burdened
with duplicate information requests
- all clients should
be given clear and accurate written information as to their ODSP entitlements
and any other available benefits and programs, their responsibilities,
relevant telephone and fax numbers, and their rights of appeal - decision
notices and all correspondence from ODSP should be clear and case-specific,
and should include a contact name and number for any necessary follow-up
- ODSP workers should
receive additional training and ongoing retraining on service standards,
client relations, mental health issues and sensitivity (accommodating
disabilities, anti-racism, cultural issues)
- ODSP workers should
be more pro-active in assisting clients in obtaining necessary information
necessary for eligibility determination
- ODSP should take
steps to increase community presence and awareness - by holding information
workshops, sending representatives to employment resource centres, establishing
liaison workers in community agencies, institutions, hostels and shelters
- ODSP should consider
establishing a standing committee of ODSP clients to advise on client
service issues as they arise
4. Other
- the internal review
process should either be eliminated altogether, or should be overhauled
- in particular, an internal review request form should be attached
to all initial denial letters, the timelines for internal review should
be relaxed, the DAU should be able to consider new medical information
at the internal review stage
- the number of
SBT members and resources should be increased, in order to reduce the
wait time for appeal hearings
- when an SBT appeal
is pending, the DAU should review all new medical evidence as soon as
it has been notified by the appellant that no new reports are expected
and the matter is ready for hearing
- eligibility reassessment
periods should be longer, and the reassessment process should be simplified
- a recipient who
is being reassessed should not have to provide as much information as
on his or her original application
- no reassessments
should be scheduled for persons with chronic, long-term illnesses
- statutory and
policy disincentives to work attempts should be eliminated - the income
reporting system should be improved, the rapid reinstatement rules relaxed,
and ODSP recipients should be given more assistance and support to find
meaningful work
- the drug plan
and mandatory necessities program should be more responsive to the real
needs of persons with disabilities, and all recipients should be provided
with transportation costs
- ODSP recipients
should be permitted to set up rent-direct or utility-direct payment
on request
- CSUB requests
should be processed more quickly and there should be more flexibility
in CSUB allocation
- ODSP should set
realistic timelines for the CVP process and should pay costs associated
with obtaining information necessary to determine eligibility
- benefit rates
should be increased to reflect real current market rents and costs,
and should be adjusted regularly for cost of living
For
further info:
Please visit the website of the Income
Security Advocacy Centre
Access
to ODSP Campaign chairperson is
Nancy Vander Plaats
To send endorsements and/or
personal stories:
please
email
Catherine Manson
mansonc@lao.on.ca
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