1996 ANNUAL REPORT,
PROVINCIAL AUDITOR
MINISTRY OF COMMUNITY AND SOCIAL SERVICES
CONTENTS
Thursday 7 November 1996
1996 annual report, Provincial Auditor
Ministry of Community and Social Services
Ms Sandy Lang, deputy minister
Ms Sue Herbert, assistant deputy minister, program management
Mr Brian Low, director, developmental services
STANDING COMMITTEE ON PUBLIC ACCOUNTS
Chair / Président: Mr Dalton McGuinty (Ottawa South / -Sud L)
Vice-Chair / Vice-Président: Mr Mike Colle (Oakwood L)
*Ms Isabel Bassett (St Andrew-St Patrick PC)
Mr Marcel Beaubien (Lambton PC)
Mr Dave Boushy (Sarnia PC)
Mr Gary Carr (Oakville South / -Sud PC)
*Mr Mike Colle (Oakwood L)
*Mr Bruce Crozier (Essex South / -Sud L)
*Mr Gary Fox (Prince Edward-Lennox-South Hastings / Prince Edward-Lennox-Hastings-Sud PC)
Mr Steve Gilchrist (Scarborough East / -Est PC)
*Mr John Hastings (Etobicoke-Rexdale PC)
Mr Gerard Kennedy (York South / -Sud L)
Ms Shelley Martel (Sudbury East / -Est ND)
Mr Dalton McGuinty (Ottawa South / -Sud L)
Mr Gilles Pouliot (Lake Nipigon / Lac-Nipigon ND)
Mr Toni Skarica (Wentworth North / -Nord PC)
*In attendance /présents
Substitutions present /Membres remplaçants présents:
Mr Ed Doyle (Wentworth East / -Est PC) for Mr Boushy
Mr Jim Flaherty (Durham Centre / -Centre PC) for Mr Gilchrist
Mr John L. Parker (York East / -Est PC) for Mr Skarica
Mr E.J. Douglas Rollins (Quinte PC) for Mr Beaubien
Also taking part /Autres participants et participantes:
Mr Erik Peters, Provincial Auditor
Clerk / Greffière: Ms Donna Bryce
Staff / Personnel: Ms Elaine Campbell, research officer, Legislative Research Service
The committee met at 1038 in room 228, following a closed session.
1996 ANNUAL REPORT, PROVINCIAL AUDITOR
MINISTRY OF COMMUNITY AND SOCIAL SERVICES
The Vice-Chair (Mr Mike Colle): Good morning. Deputy Minister Lang has been with us before. Could the other presenters please identify themselves to the committee. Give your name and role.
Ms Sue Herbert: I'm Sue Herbert and I'm the assistant deputy minister for program management.
Mr Brian Low: I'm Brian Low. I'm the director of the development services branch.
Mr Bruce Crozier (Essex South): Mr Chair, I always have this little question that I never know whom to ask, but how many other people here are ministry staff people?
Ms Sandy Lang: Four.
The Vice-Chair: Would the deputy minister like to begin?
Ms Lang: We're returning today to speak to the committee about the auditor's report on the ministry's payments in support of supportive services for individuals with developmental disabilities in our developmental services sector.
As I begin today, I would like to reconfirm that we believe, as a ministry, that the auditor's review of this program area is in fact a constructive process that is already leading to improvements in service and accountability. In response to the findings of the report, we have developed a comprehensive work plan to address the issues that it raised for us.
Today, I'd like to begin with an overview of this program area and then address the specific recommendations that the auditor made and provide you with an update on our work plan to deal with those recommendations.
The developmental services program supports approximately 50,000 people across Ontario who have specialized needs. This is the second-largest program area in the ministry after our social assistance system. Our ministry's role is to provide the policy, legislative and fiscal framework for the developmental services system and to manage an affordable and effective system for children and adults with developmental disabilities.
As I'm sure you are aware, it has been the policy of successive provincial governments to try to serve people with developmental disabilities as close as possible to their own communities. In July of this year, the minister announced the next step in the ongoing move towards community-based services. Over the next four years approximately 1,000 people with developmental disabilities will move out of the remaining six ministry-operated facilities and into community settings. This will result in the closure of three of these facilities in the next three years. This long-standing move towards community living is one that is happening in many other jurisdictions. It has been a worldwide trend for some years now.
In Ontario, development of community-based services has been largely led by families of people with developmental disabilities who formed associations for community living and created agencies to serve people with special needs. These agencies are directed by community-based boards made up of parents, professionals and other knowledgeable and committed citizens. These community boards of directors are responsible for the governance of the agency; that is, they are expected to exercise authority, direction and control over their particular organization. The ministry respects the responsibility of these community boards to manage programs and at the same time also ensures the boards are held accountable for contracted services and supports.
To give you an indication of how the picture has changed over the last two decades, in 1975 only 4,600 people with developmental disabilities were served in community-based settings. As a result of our province's move over the last 20 years towards community living, today about 50,000 of Ontario's people with developmental disabilities live in community settings and participate in programs at the community level. A relatively small number of people, slightly more than 2,000, continue to reside in ministry-operated facilities. As I mentioned, we'll be moving 1,000 of those individuals out of the settings over the next four years.
Community-based services have grown to the extent that now the ministry works closely with some 400 community-based developmental services providers across the province. In his report, the auditor has provided us with recommendations of how we can improve our practice in our ongoing work with these community agencies.
Before I turn to the specifics of the auditor's report, I would like to speak in general terms about the nature of supportive services, which was the subject matter of the audit. They are intended to be individualized, responsive, flexible and available in a timely manner to respond to a variety of needs of individuals. This is not a one-size-fits-all program. Rather these variable factors represent ongoing challenges for service delivery and auditing, and we appreciate the auditor's assistance in providing us with advice on how to meet this particular challenge.
The auditor reviewed the supportive services line within the ministry, which includes our community support programs for adults, our community support programs for children, special needs programs, sheltered workshops, supported employment and homes for special care. The provincial audit focused on the first three components, that is, community support services for adults and those for children and special needs programs. The report concentrates on the fiscal years 1993-94 through to 1995-96. Expenditures for supportive services were approximately $371 million in 1993-94 and have increased to $387 million in 1995-96.
Just to give you an appreciation of the numbers I've just mentioned, the services we are talking about today include a wide range of supports. Here are a few examples: providing personal support for daily living; training in life skills; behaviour management training; respite care to provide relief for parents and the primary caregivers; assessment and counselling and assistance in developing life plans; day programs; sheltered workshops; and infant stimulation programs for infants with developmental delays.
While I have talked earlier about the challenges of delivering the types of support described and the equal challenge to applying traditional audit approaches, we remain strongly convinced that the individualized approach to planning and delivery is key to our future and provides value for money spent.
In his work, the auditor had two objectives: to assess whether ministry transfer payments to agencies are adequately controlled and to assess the adequacy of the ministry's monitoring of services and supports provided. As an overall observation, the auditor said that, "The ministry's administrative procedures did not adequately ensure that transfer payments to agencies were reasonable, or that services purchased were monitored to ensure that the ministry was receiving value for money spent."
We've already begun to address the issues raised in a number of areas where the auditor has recommended corrective action: funding decisions, historical inequities, reasonableness of cost of similar programs, recovery of program surpluses and service contracts.
Ministry activities include our ongoing work on a developmental services accountability initiative started a few years ago, our ministry-wide initiative on governance and the provincial work plan for special services at home. The ministry continues to clarify the accountability relationship between the ministry and the boards of directors responsible for transfer payment agencies through a very new consolidated service contract introduced in the 1995-96 fiscal year and new requirements implemented in this fiscal year's service contracts.
I will describe other ministry actions in more detail as I turn to the specific recommendations now of the auditor's report and describe the progress we've made to date.
The auditor addressed specific themes in his report: administrative procedures, accountability framework, the monitoring of services provided and the special services at home program. I'd like to address each of these themes in turn, if I could.
On administrative procedures, I want to talk about those recommendations. In his report, the auditor said, "The ministry should ensure that all agencies include sufficiently detailed and accurate information in their program budget submissions and submit them for analysis on a timely basis." The auditor said that this should be done "to help provide an appropriate basis for making funding decisions and to help ensure that actual expenditures are appropriate."
In the 1995-96 fiscal year, the ministry introduced a revised generic service budget submission package which will ensure that agencies include relevant information that is required for the ministry to make informed decisions in the budget process. I would like to note that the government's estimates process influences the time frame for the negotiation and approval of agency budgets. The evergreen clause that we have in our legal agreements allows agencies to continue to operate until a new budget is negotiated.
The auditor also recommended that the ministry should take into consideration a program's prior years' financial performance and changes in demand for program services in order to ensure that annual funding decisions are appropriate. Wherever possible, the ministry tries to consider a program's prior years' financial performance and changes in demand for program services when making annual funding decisions.
The auditor also said that to ensure program funding is reasonable and consistent, the ministry should analyse and compare the costs of similar programs across the province. Significant variances in costs should be explained and justified. The ministry is aware that there is a range of funding for individuals with similar needs and that there is a need to rationalize service costs in support of individuals. We have been developing and testing an assessment tool to measure how resources are currently being used for individuals in accommodation programs. The information collected will lead to funding ranges being established for categories of residential support through the winter of 1996-97.
The auditor also recommended that to ensure equitable treatment and consistent compliance with legislation, all group homes for people with developmental disabilities should be funded under the same legislation. We recognize that the current Homes for Retarded Persons Act is no longer adequate by itself to support developmental services operations. We are taking steps to clarify and simplify the consistent application of legislation, regulations and funding mechanisms.
The auditor said that to improve the effectiveness of the expenditure reconciliation process in supporting funding decisions, information submitted by agencies should be sufficiently detailed to permit the reconciliation of program expenditures and approved budgets with the audited financial statements; and the reconciliation should be reviewed and approved, and recoverable surpluses, if any, should be recovered on a timely basis by the ministry.
We have developed a recording and tracking system to monitor the annual program expenditure reconciliation, fondly known in the ministry as APER, a process which will facilitate the provision of information by local management to our corporate offices of the ministry. For this sector, as of November 1, 1996, more than 99% of the APERs had been completed for the 1992-93 and 1993-94 fiscal years and more than 98% of the APERs had been completed for the 1994-95 fiscal year.
1050
On the accountability framework, the auditor made two recommendations: (1) The ministry should strengthen its implementation of the Management Board directive on transfer payment accountability in order to hold the transfer payment agencies accountable for their management of public funds; and (2) the ministry should review the governance structure over agencies with a view to clarifying the boards of directors' responsibilities and their accountability for the appropriate use of funds.
The ministry has tested various contracting mechanisms from the developmental services accountability initiative which, once refined and implemented, will address accountability issues in transfer payment and directly operated operations.
Full implementation of the accountability initiative will result in the setting of expectations, improved contracting mechanisms, improved reporting and monitoring mechanisms and corrective action taken by the ministry if appropriate. For developmental services, this initiative will be phased in starting early in the new year.
Through the accountability initiative, the ministry will contract for results to be achieved with public funds invested at the client level as well as at the level of service provider. For instance, agencies will be expected to contract for services or supports with individuals. The individual support agreement will identify the supports provided, the associated costs, who is responsible for providing this service, and time frames for completion. Governance policy, which is currently being drafted, will clarify the ministry's expectations of boards of directors for all ministry-funded programs.
The auditor has provided us with several recommendations to improve how we monitor services delivered by our transfer payment agencies.
First I'd like to address the recommendations regarding program placement for individuals. The auditor said that to ensure individuals receive cost-effective services, the ministry should define appropriate levels of service to be provided to individuals and establish criteria for and monitor program admissions.
The ministry is developing and testing an assessment tool to measure how resources are currently being used for individuals in our accommodation programs. Using the resulting information, we will establish funding ranges for various categories of support. The ministry, in the context of its governance initiatives, continues to set the expectations that transfer payment agencies develop program placement polices which are in compliance with government legislation.
Turning to the issue of service quality, the auditor said that to ensure that it is receiving value for the money spent, the ministry should establish acceptable standards of service and criteria for evaluating service quality and on a periodic basis evaluate the quality of the services provided. The ministry has taken steps to ensure that it is receiving value for money by implementing the developmental services accountability initiative. This initiative will result in improved service quality, service standards, a governance policy and a review process. Ministry standards will set out minimum expectations of quality and practice, will advise service providers of their responsibilities when providing a service and will guide ministry staff in monitoring the services.
Another initiative under way entitled the quality of life study will provide valuable information to the ministry on whether policies and services principles are having the intended effect of improving the quality of life for individuals who receive services.
I would like to now turn to the last specific theme addressed in the auditor's report, which is the special services at home program. The auditor made recommendations in several areas: eligibility, funding approvals, program duplication and administration fees.
Regarding eligibility, the auditor said that to ensure and demonstrate that only eligible individuals receive supports, the ministry should verify information provided by applicants, adequately document the assessment of each applicant's needs, and require recipients to report changes in their circumstances which could affect their eligibility.
The ministry's response is that documentation by a registered psychologist or a physician is required at the time of initial application to substantiate the presence of a developmental or physical disability. The ministry has procedures in place to ensure that eligible individuals and families receive funding from special services at home at the time of application. Additional verification of application information is completed on an exception basis.
The auditor said that to ensure that funding decisions are equitable, the ministry should clearly document both its assessment of the factors considered in the funding decision and the basis for the individual funding levels approved, and ensure that individuals with similar needs receive similar levels of funding within and between area offices, as is required by the program.
In 1995-96, the ministry introduced changes to ensure fair and consistent decision-making for all applicants. Families can expect similar treatment and support across all areas. Reapplications will receive the same priority ranking as new applications. Families are expected to use other resources that are available in their communities before accessing special services at home funding.
Looking at program duplication, the report recommends that to streamline program delivery and ensure the consistent treatment of all applications, the ministry should fund similar services under one program with consistent eligibility requirements. Regarding this point, the special services at home program offers support to any eligible family, subject to available resources. The handicapped children's benefit is a benefit which is income-tested and acts as a safety net for low-income families. The two programs can be used to complement one another to support a family with a child with a disability.
Regarding administration fees, the auditor said the ministry should maximize the cost effectiveness of the program by making every attempt to limit administration fees to the 5% to 10% funding range noted in the draft procedures manual. I want to assure you that the ministry is taking steps to ensure that administration fees are kept to the 5% to 10% funding range, as recommended.
In closing, I want to again express the ministry's appreciation of the work done by the Provincial Auditor, this time in relation to supportive services. We believe the services we provide to people needing these programs are of a high standard. However, we also recognize that we can be benefiting from continued improvement.
Thank you, Mr Chair. We would be happy to answer any questions.
The Vice-Chair: Thank you, Deputy Minister. I'll start with the government side. I don't know if you'd like to make any comments.
Mr John Hastings (Etobicoke-Rexdale): In your presentation about this whole area of supportive services and dealing with the developmentally handicapped, the ministry has headed down a roadway which everybody else is going down, deinstitutionalization. Can you provide specific documentation as to how effective this particular roadway is in terms of affordability, cost-effectiveness, customer satisfaction, consumer choice and all those things you talk about in your accountability framework?
I've had two constituents come to me in the last year over their children -- they are young adults now -- in the autistic area. The particular agency that was dealing with them essentially told the lady -- this is the mother of the daughter -- "This is where your daughter is, and if you don't really like it then I guess you can take her back." It seems to me that's not just an isolated case either. I don't want to name the agency.
I have a whole set of concerns around this inevitable, inexorable push where it seems the only way you can go is to deinstitutionalize everybody because everybody else is doing it, because that's the literature. I have a major, major reservation as to whether that's the route to go when you have properties available that you have focused clearly in your mind that are institutionalized when in fact there are components within the institution which operate in a very community-based setting and have the potential for that even if they aren't formally doing it. So my question is the whole philosophy and whether it's the best way.
What are you going to do in your business plan with young adults who are now in their 20s and 30s, who are autistic, as an example, or other categories, where they're completely out of control by their families, where the families can take them on a very limited basis? Because if you have a gorilla in your home -- I've seen a couple of these guys. They're bigger than me, and when they decide they're going to do something, you just become a feather, and the families have had their places completely or almost destroyed.
1100
Those are dramatic circumstances in those cases, but it's this whole question that we seem to think that community-based is the only route to go, there's no other alternative, and if that's the route we're going, where's your accreditation? Where's consumer choice for people who don't like the one agency they've been assigned? Is there another one? Probably not.
Ms Lang: I think there were a number of questions there, Mr Hastings, and I'll attempt to respond to them as I understand them.
In terms of the direction for deinstitutionalization, I think we have very clear assurance from the government of the day and previous governments that this is a preferred policy direction, and certainly there has not been a change in the thinking that I'm aware of.
We have been able to, over the years, provide very good information about the cost-benefit of this strategy and this direction, and I think it's fair to say that as a province we have enjoyed tremendous benefits from community-based programs and downsizing of our facilities. When we closed out the facilities over the last several years, we were able to redirect a significant amount of money not only to provide services for those individuals leaving the institutions, but also to enhance services in the community for other individuals who are in need of supports, who could no longer live at home with their parents.
We also have some preliminary results from our quality of life study, which was commissioned I think in the late 1980s or early 1990s to assess the impact of community living on those individuals who have left institutions. I can indicate to you that the preliminary results would suggest that the quality of life has been enhanced for those individuals who have left institutions. We are continuing to monitor that research, and the research will hopefully in the next short while be able to empirically substantiate that finding.
I think there is some very clear evidence that individuals do benefit from a move to community living. We have a very strong indication from many parents across this province that they do not want their sons or daughters to live in institutions. As a matter of fact, the entire movement to create community-based services emanated from families. The associations for community living in this province were set up by parents who did not want their only option for their children to be an institutionalized option. Over the years they have made a very strong case, and continue to make a very strong case, for a range of community service options for their sons and daughters.
I think we have seen, certainly in the time that I've been around, a very broad range of supports and services created in the community to respond to a significant range of needs. No longer are we simply providing one or two options. When institutions were originally closing and we were moving people out or not placing people in there, the only option that parents had was a group home and a workshop space. I would argue quite strenuously that this has changed dramatically. The range of community-based services out there and the degree to which they can respond to a significant range of needs is quite amazing, and I do see that continuing to be the trend certainly in Ontario and certainly across North America.
Mr Hastings: You don't convince me 100% on a lot of those points. I guess I would just leave you with the thought that with all due respect to the Association for Community Living, with which I've had some contact, they do not speak for all parents in this province when it comes to the future of their sons or daughters, especially those who are now in their 60s, 70s and 80s. Those families -- there's nobody around. I don't know what you're going to do with that group of individuals over the next decade as you go this inexorable other route.
The final point I'd like to make is, when can we expect that there will be a real system of accreditation or consumer choice within agencies, even for all these families who love going this other route, so that when one agency can't seem to handle complaints, consumer dissatisfaction, you will have another agency with similar services available to fulfil that particular family's needs? Right now they're straitjacketed in most instances, I believe, especially in urban areas. I don't know what's going to happen in the rural areas, where the choice simply isn't there.
Ms Lang: I can respond in two ways to your question, Mr Hastings. One is that with the introduction of individual service agreements in our contracts with agencies we are expecting agencies to contract with individuals and to respond in a very flexible way to the varying needs of those individuals. We are going to be setting out clear expectations that in their contractual agreement with individuals, they're clear about what they're going to provide and whether the individual is going to benefit from that service. That is one of the initiatives we have under way.
We are also in significant discussion with some of our umbrella organizations who are asking that we engage in some accreditation development with them. We are taking a look at the extent to which that could be put in place, not only for this sector but for a variety of community-based sectors. That is an active discussion that's under way at the moment.
Mr Hastings: The March of Dimes from the United States -- my God, I'm not supposed to use that term; the Americans can't ever do anything well. They do have a very sophisticated model, from what I can see, that the Ontario March of Dimes is trying to readapt.
Mr Gary Fox (Prince Edward-Lennox-South Hastings): I certainly agree with what you said about the clients who have moved in the past because of the higher calibre they have. But at the same time, now you're dealing with a different group that you're trying to move out into the community.
In my particular case, and I'm one of these where it's being closed out, we have a village complex where there are recreational facilities, education, workshops. When you move those people out into the communities now and put them into the group homes, where are they going to go for these facilities, to be able to continue with the lifestyle they've got now?
Ms Lang: If I can comment a bit on our experience to date, because we have closed out many institutions, I would argue, Mr Fox, that we have also been able successfully to return individuals with very complex needs to communities as we have closed out facilities. What we have seen happen with many of those individuals is that they can either benefit from the resources available to the placement agency taking them or they are engaged in other community services. We do have a very deep and broad range of services in communities across Ontario now for individuals with developmental disabilities and individuals who could partake in those kinds of community activities. We have developed specialized resources to deal with an ongoing range of needs of those individuals, and we would assume that as they move closer to their home community they will partake of those services available out there or we will be able to enhance some of those services to provide those supports to them.
Mr Fox: Who's going to pick up the cost of this? Are you going to transfer it over to education and put them in the classrooms that are out there now?
Ms Lang: The individuals who are moving out of our institutions are not likely going into schools because they are all well beyond school age. They will go into programs that are available in the community, whether they be day programs, whether they be behaviour management programs, whether they be programs available within the community settings the individual will be living in. It will depend very much on the needs of those individuals. The money that is currently used to finance the institutions will be redirected to those communities to support those individuals.
1110
Mr Fox: Can you give us the stats, which I have asked for now for a couple of months, as to the cost of doing this in relation to the cost that's there now?
Ms Lang: I would like to refer that question to Brian Low. I think he can give you that information.
Mr Low: With the initiative that we announced in July, which announced the closure of three facilities and the downsizing of three others, over the four-year time period we will see a transfer to the community of approximately $67.5 million. Of that, a little over $53 million is to be used to support the placement for people who currently reside in the facilities who will be moving out. That will support the placement. The additional resources that have been identified that make up the $67 million will be available to address specific needs within the social service sector and within the developmental services sector as it's included in that. That's the overview of the initiative for all of the six facilities that are identified this summer.
Mr John L. Parker (York East): I would like to put forward a concern that has come to me from some of the people in my riding, and this picks up, in some degree, on the line of questioning my colleague Mr Hastings was pursuing with you.
We have a sheltered workshop in my riding; I represent the riding of York East. I'm speaking of I think 20 Overlea, where there's a sheltered workshop that functions quite well and deals mainly with young people with needs. The message I get from the parents of the young people in that sheltered workshop is that they are quite pleased with the work done there, with the support they receive there. It's a situation that's working quite satisfactorily for everyone involved, particularly for the young people who are in there. They enjoy what they do, they enjoy the community they have established within that workshop, and they get some support and comfort and collegiality out of being there together. That has become their community, and when we speak of community living, as far as the people in that location are concerned, that is their community. The point has been made to me that this is similar in other situations around the province.
The specific concern that has been expressed to me is that this level of support and assistance that is so beneficial to the young people in that particular workshop and similar environments cuts out a certain age. As these young people grow up and reach whatever the age is -- whether it's 18 or 21 or what have you -- the kind of facilities available to them are no longer in place. They are expected to graduate and move into some other level, presumably move out into the broader community, get jobs stocking shelves at Loblaws or something like that.
But it doesn't work, and the reason it doesn't work is that the people in question have developed a sense of comfort in the community they have come to know and then they are forced to face the adjustment of moving into another community. It doesn't work because they're not accepted in the other community they are expected to move on into. At best it's a forced fit and it requires a lot of cooperation by a lot of other bodies, which may be doing their best but aren't really equipped to handle the kind of needs these grown-up people have.
The other concern, and this is possibly the single largest concern, is that the parents who have taken care of the young people in the sheltered environment are not really in a position to look after these young people after they've grown up because the needs of the people with disabilities have increased as they've got older. My colleague Hastings has discussed some of those difficulties. It's one thing to look after a young child with needs; it's another thing to look after a grown adult with needs. And just as those needs increase and become more difficult to cope with, the parents have grown older and have less energy to deal with them. They find themselves less able to deal with the needs, they find that the needs are increasing, and the message they bring to me is that there are fewer resources available to them to help them cope with those needs.
I'd like you to respond to that. First, tell me if the picture I've put forward is an accurate one, and if it is, what steps might be taken to address that.
Ms Lang: If I can comment on the first part of your question, if I understand it accurately, I think you may be describing an education-based program where individuals may be registered and there until they're 18 or 21 years old, financed through educational programming.
Our programs providing sheltered workshop or day programs don't have an age limit, quite frankly. The individuals, as they are participating in those programs, can be a variety of ages: largely adults between the ages of 21, and in some cases they may be 65 or 70 years old. The workshops financed through the ministry are not in any way, shape or form confined to ages.
I'm assuming the program you've described may be an education-based program where the Ministry of Education, through the school boards, does provide educational resourcing to individuals with developmental disabilities up to and including the age of 21. I'm assuming that may be what you're referring to.
Once those individuals leave the educational programming area, we do have a range of options available to those individuals, we do have transition from school-based programs to adult services that are financed through our ministry, so there may be a variety of choices available to those individuals. Some of them may in fact choose to go work in Loblaws, and we have over the years managed to create a number of available supports to individuals to be able to do that. We have a supported employment program which, through job coaching and other supports, can allow individuals to work in regular workplaces if they want to. Others may decide that they want to participate in sheltered workshops or day programs of some kind.
The other question I think you were raising was related to parents and the extent to which they can benefit from other services and supports once their sons and daughters get older. We are striving to address that as much as possible. We have, I think, a situation where many parents have chosen, for their own personal reasons, to have their sons and daughters stay at home, but those parents are aging and those parents are now feeling the need for some assurance that their son or daughter is going to be cared for in some way. We are struggling, with the capacity we have, to try to respond and address those needs, either through our community agencies or through individual supports to those parents until a more fully developed program can be available to their son or daughter. But it is a concern and it is an area that we are attempting to address.
Mr Parker: I appreciate your response. Can you help us out with any specific initiatives that are being undertaken to meet that particular need?
Ms Lang: The one area that offers us some opportunity is that as we move individuals out of facilities we will free up some resources. It is our hope to redirect those resources, and we are now looking at what priorities we want to address those resources to. Certainly the issue of individuals' parents who are aging, having sons or daughters at home and needing some assurance of support, is an area we are looking at.
Mr Parker: I might just close with this comment. I invite your response, but I'm not soliciting it. As a government, I think we have recognized the needs of our aging population. Certainly in our health policies, we are recognizing that as the population ages generally, that presents certain demands and certain needs on our system, and we are attempting to adjust our budgets to address that. In other ways we are attempting to address the needs of an aging population. In fact, Cam Jackson has just been given a new assignment to address specifically the needs of an aging population.
I would suggest to you that this might be another need of the aging population, that as parents who have been looking after children with needs age, there is a particular burden placed on them. As I was saying and as you've recognized, the needs of their aging child increase, the capacity of the aging parents to deal with those needs decreases as they age, and some parents have come to me and quite candidly said, "The day is coming when I'm not going to be around and I have to be concerned about who's going to pick up the ball when I'm just not here to look after my child." That says to me that it's important as a government, as we look at the needs of an aging population, that we not neglect that particular aspect of the needs of an aging population. I welcome your recognition that that's an issue that requires attention.
Ms Lang: Yes. I think we can assure you that that certainly is an area that we are mindful of. It has been a concern for us for a number of years. We have been able to address over time some of those needs, but they continue to be there and we are continually challenged to find ways to address them.
1120
Mr Jim Flaherty (Durham Centre): I'd like to address some of the concerns expressed in the auditor's report, the 1996 annual report, at page 77, dealing with monitoring of services provided, program placements for individuals. Dealing specifically with severely handicapped persons -- and I know this isn't a simple subject and I may oversimplify it simply because there's a limited amount of time -- my concern relates to the relationship between institutions and group homes; at-home living by persons with severe disabilities; the role of the associations for community living; the role of parents; the role of agencies which operate group homes.
Like other members, I see persons fairly regularly who are caught in this mesh -- or are involved in this mesh perhaps I should say -- and it's confusing to many. I'm also not convinced, and certainly the auditor is not convinced from what I read here, that there is an adequate level of assessment by the ministry of the appropriateness of programs for individuals with severe disabilities and auditing of the appropriateness of what's being spent on specific individuals.
For example, in my own communities that I represent in Whitby and Oshawa, I see individuals who are at home who are receiving very substantial funding with the same difficulty that Mr Parker raises about aging parents. I also see group homes which have tremendous support from those parents who are participating -- they're dealing with children with severe disabilities -- being run at lower cost. My first question, then, is to what extent does the ministry monitor the appropriateness of the program for the individual?
Ms Lang: Let me comment a couple of ways, if I can, Mr Flaherty, on your question, because I think you describe a situation where the system has grown up and evolved over time, and incremental growth has contributed to some confusion because we now have a very wide range of services out there, a number of new options that weren't available to parents and to individuals many years ago. As we have deinstitutionalized, we have created more and more organizations in communities to provide services, which has led, I think, to some confusion on the part of many parents and individuals about where they go to get service.
As a result of that, we are now engaging with the various organizations out there the notion of restructuring the service system so it makes sense to parents, and whether we can look at how we integrate access so that there is a single capacity to determine the range of service that should be available to an individual rather than having parents and individuals have to shop around to a whole host of agencies in a given community. It's conceivable that there could be 30 or 40 separate organizations in one community providing a range of services and it's quite complicated for parents to know where to go. We are engaging in an effort over the next little while to look at how we might restructure the service system so it starts making sense to those individuals as they try to access a range of supports.
We are also attempting to put in place, as a result of some experimental work we've been doing, a new funding approach which speaks to levels of support, because as you accurately reflected, there is a wide range of funding levels available to individuals and it has been, to some degree, a bit haphazard. We want to bring some rigour to that; we want to bring some order to that. We are looking at a policy, through some research we've been doing that tries to define levels of care and associates financing with those various levels of care, which we hope to introduce into our organizations over the next couple of years if we can.
The third area is the extent to which the ministry monitors. We have a range of program supervisors across the province who are employed through our area offices and are charged with the task of managing the relationship with the community agencies and ensuring they are complying with our legislation. They do all the budget negotiation and, where licensing is required, they are significant in ensuring that the organization complies with the licensing requirements for those services.
So we have an infrastructure that tries to monitor as much as possible, but I think the real challenge for us now is to define the policies and the standards in a way that is in keeping with the system that has evolved over the last 10 or 15 years.
Mr Flaherty: Are you moving towards some sort of objective basis of needs analysis?
Ms Lang: As a matter of fact, what we're attempting to do is to define outcomes and to work with our organizations around how their services and the resources that are associated with their services are achieving outcomes that will benefit the client, so we are looking at an outcomes-based approach to managing that relationship as well.
Mr Flaherty: All right. And that would then relate to the cost-effectiveness of the program being proposed for an individual?
Ms Lang: That's right.
Mr Flaherty: I won't take much more time. With the associations for community living -- this is a basic question which I probably should know the answer to but I'm not really sure of how it works. If parents are taking care of a child at home, is the funding direct to the parents or must they go through the agency?
Ms Lang: Actually, both circumstances could be possible. It is possible, through some of our special services at home program, that we are providing funding directly to parents if they have sons or daughters at home. There also may be some funding that goes to parents for services through the associations for community living if they have worked out an arrangement where they can provide supports to them or they can assist them, or an association for community living may be offering a program that the parent may be taking advantage of. It happens in a variety of ways at this point in time.
Mr Flaherty: Is the ministry inclined to simplify that, to choose a path?
Ms Lang: Absolutely. Everything we want to do is an attempt, as much as possible, to simplify, recognizing that we are dealing with a very broad range of human needs and we have to be able to accommodate that range of human needs. But clearly we need to simplify our relationship and be clear about the accountability.
Mr Crozier: A reference in the auditor's report on page 74 has been made to the Developmental Services Act and the Homes for Retarded Persons Act. You've said in response to a comment by the auditor that you recognize that "the Homes for Retarded Persons Act is no longer adequate by itself." When was that act first enacted, approximately?
Ms Lang: We believe some time in the 1970s.
Mr Crozier: And the Developmental Services Act, when was that enacted?
Ms Lang: Later in the 1970s.
Mr Crozier: So they've both been in place for approximately 20 years.
Ms Lang: Right.
Mr Crozier: When you respond by saying that you will "take steps to clarify and simplify the consistent application of legislation, regulations and funding mechanisms," since you recognize that one act is no longer adequate by itself, why wouldn't you take the initiative to look at both acts and take the best of both and combine them and come forward with an initiative that way?
Ms Lang: I think, in essence, that's what we will do. As we look at the policy changes that we are contemplating now and the need to introduce levels of support financing and a much more individualized approach to services, we will be examining all the legislation and coming back, hopefully, if we are able to have time on the legislative agenda, with some revised legislation to guide the services for the next several years. We will be examining all of our legislation.
1130
Mr Crozier: Have you recognized for some time that the Homes for Retired Persons Act was not adequate by itself?
Ms Lang: Yes.
Mr Crozier: May I ask then why you had to wait for the auditor to bring it up, why the initiative hasn't been taken before now?
Ms Lang: Because I believe as we've looked at this with each of our successive governments, it has not been able to get the legislative time that's required to make the changes. We have been able to use the flexibility of the Developmental Services Act to maintain and enhance services in a way that we believe is appropriate and can manage the service system until such time as we can get a decision and a legislative change made. We are accommodating the needs out there through the variety of legislation we have, but in the best of all possible worlds we would like a chance at some point to have the legislation consolidated in a more up-to-date piece of law.
Mr Crozier: Okay. That wasn't intended to be loaded. I know if we were in a perfect world the auditor wouldn't have any comments and then what would we do with him?
I want to ask a few questions with regard to the program placement for individuals. I know we spent a bit of time on that. I want to get some idea of how difficult the problem is, and I'm going to make a comparison that's probably not fair but it may give you an idea where I'm coming from.
We have certain standards by which we have to maintain aircraft; otherwise they shouldn't fly or can't fly and it will risk people's lives. When you assess what an individual needs, you have budget constraints. How big a problem is it that you may have to say to some individuals: "I understand what your needs are. We've assessed you and here's what you require, but I'm sorry, we don't have the funds"? How big a problem is that?
Ms Lang: I'm not sure that off the top of my head I could quantify that. Are you referring to our special services at home program?
Mr Crozier: Well, it could be. I suppose that would be the main area, yes. I'm just trying to get a handle on how big is the need, how close are we to being able to satisfy it, and to what extent, if any, are we restricted by budgeting? I don't have any answer for it. This is not a game; it's not a loaded question. I'm just trying in my own mind to get a handle on it.
Ms Lang: I'll ask Sue Herbert to answer that question for you.
Ms Herbert: I think you raise a really important question. I think many of you in your constituencies would hear that many families feel that all their needs aren't being met, so there are families who will say that the government hasn't supported all the needs that they have identified for themselves and for their families.
In the program that we directly operate, special services at home, there are families whose own assessment of their needs is greater than the funding we've provided to them. On the reverse side, just to go back to the earlier question, which was that there's a confusion about who gets what levels of service, our belief is that through both the downsizing in the facilities and moving that money out into the community and then looking at levels of support funding, we'll be able to rejig the service system so that it's more efficient and more effective for families.
Mr Crozier: I guess that goes to a comment again that the auditor made -- and quite frankly, I don't have my finger right on it -- where there was a wide discrepancy. It may be $5,000 for one and $45,000 for another. Is that part of the problem? Does the assessment go astray somewhere when that happens? I suppose you can legitimately have that wide range.
Ms Herbert: Yes. I was going to say in some ways that wide a range is a credit to a program that's trying to tailor services to individual needs, because in this area there's a wide variation, as the deputy has said, in the human needs. People can have a multiplicity of handicaps, which require more support, and other individuals have a need for just small amounts of support in order for them to be independent and to be supported.
The balance here for us as bureaucrats is to provide a program that's tailored to individual needs and at the same time, from an audit perspective and an outcome perspective, that we can justify that this amount of money is indeed what that individual needs, compared to another. There's a very fine balance in a program like this which tries to tailor supports to individual requirements, but at the same time has to justify how those decisions were made. Some of the improvements that the deputy talked about in her speech are what we are trying to do to establish that balance. But we would think that we would have a program failure if everybody got exactly the same amount of money, because we know that doesn't match the range of needs that are out there for people.
Mr Crozier: I appreciate some of the comments Mr Hastings was making when we all face the situation where constituents come to us and, for a variety of reasons, may not be totally satisfied with the service that's provided. It would seem to me that ideally what we should try to do -- maybe you can tell me the extent that you try to do this -- is that, once assessed, if there's a need there and it's assessed as a legitimate need, then there should be no reason why we can't satisfy that need.
I know we have budgets and I'm certainly not saying that you just simply open your pocketbook, but you've got this difficulty where, in my servicing analogy, you've got a certain standard to meet and you've got a need there. We shouldn't then have to say, "But I'm sorry, we can't support that need." I don't know what the answer is.
Ms Herbert: I would just indicate at this point, in the whole envelope for services to people with developmental disabilities -- we estimate we're serving about 50,000 people -- we have an expenditure of close to $1 billion. Our sense is that we need to tackle how we're spending that money. Some believe -- the auditor has said this, and we agree with him -- we can make sure that money is being spent well. So I appreciate your comment; it's around wanting to meet the needs. We believe that with some of the work that the deputy talked about in her speech, we can begin to address that more effectively.
Mr Crozier: Just as a comment, I suspect each of us encounters some of the same problems, where every step is taken to satisfy the need and the assessment says, "There it is," and the family may not agree. In other words, they may not take no for an answer and they'll keep going and going until they get yes. That's one of the frustrations I feel. It's nobody's fault, but the fact that we just can't sign a piece of paper and send it off to you and get it corrected, I know, must be frustrating to the constituent but it's equally frustrating to us and you that every allowance has been given and that's what everybody in their professional opinion says, and yet the family is still not satisfied. It's too bad, but I guess that's the way it has to be.
1140
You've pointed out in raw numbers how the service has grown. I think you relate it to the 1940s when it was several thousand and now we're in the area of 50,000. Certainly the population has grown over that period of time. Again, just for information, can you give any indication as to whether not only are the raw numbers increased, but there is for some reason a difference between 1945 and now as to the percentage of population that need this kind of assistance? Are there any medical reasons, any environmental reasons, or is it diagnosis and treatment and other things that have led to that?
Mr Low: The figures that were quoted in the deputy's speech were from 1974 to the present time. The prevalence of people with developmental disabilities in general probably has not shifted. As you say, the population has increased. The prevalence is approximately the same through that time but the types of needs that are presented for support become quite different.
Many young people who had no services or supports in the early years were not being provided with support; there were just no supports available. We now provide early intervention supports to allow them to function more successfully within their community, and so that's where we are providing the supports for more people. Because of the miracles of modern medicine, we are seeing young people who may not have survived years ago now surviving and having a multiplicity of needs through their formative years that we are providing supports to. So the type of service certainly has changed over that time and the types of needs may have changed, but generally the overall prevalence has not significantly shifted.
Mr Crozier: And the lifespan has increased.
Mr Low: Absolutely. That's right.
Mr Crozier: Mr Chair, I have no reason to simply use up time.
Mr Hastings: I would like to move a motion, if I may, that would have ministry staff report back to us in about a month with a proposal to create a model of standards or comparators. The deputy was saying they already have agencies that get the direct moneys for developmentally handicapped/disabled folks directly to the agency, they get a global budget, and they also have an agency or agencies where the moneys are directed right through the consumer, if I understood her correctly.
My motion would be that we get some kind of handle on the specific criteria as referenced in your recommendation about "define appropriate levels of service to be provided to individuals, establish criteria etc." I would like to narrow Mr Peters's recommendation down and suggest the following: that the ministry staff report back within a month some pilot project whereby you could choose either autistics or some other specific group of users, not the multiplicity of disabilities, and compare a model that would have agencies -- two agencies, one or three -- anywhere in Ontario where they get direct global budgeting for the services and agencies where they have to get their moneys through the consumer, either the family or the disabled person himself. They could leave it up to the ministry to make the decision as to what group it would be. They could be autistics. There are several categories. Then maybe we could get some precise numbers and standards in terms of how they're handling their $1 billion in this area, because right now all we've got is this broad-based accountability framework. They've set some criteria.
It would be nice if in a year or six months you could say, "Agency A in Thunder Bay for autistics used the direct global budgeting system, and somewhere else in Toronto or Ottawa used another approach" -- the direct voucher approach, if you want -- to the consumer, to the family, and went to an agency where they could handle that kind of operation. We could get some numbers out in terms of how efficient they are, what model provided the greatest level of family satisfaction, and any other measuring indicators you wanted to use to give you some guidance or data on where you're going in this area. You'd have hard data. You could say, "This model doesn't work as well because," and you could give us information on the variables that created those situations.
That would be my proposal, that we get back some kind of report or proposal along those lines, the pilot projects that drive this, so we get a more specific handle on the auditor's recommendation on page 77.
The Vice-Chair: I'm just wondering if the deputy minister could comment on the possibility of doing that within a month.
Ms Lang: I think it would be helpful, if the committee is asking, that we get a little more clarity on the expectation. Depending on how detailed and how broad the scope is of this request, I'm not sure that a month is an adequate turnaround time. I would welcome a little more dialogue on what the specific request is in order to understand the scope of work required to respond to it.
The Vice-Chair: Perhaps I could suggest, Mr Hastings, that you put on paper your specific request so that we can see the parameters of it in terms of ministry time and maybe work out something that is plausible for this committee to deal with in the time frame you suggested.
Mr Hastings: I'd be more than happy to do that if the Comsoc staff could provide me with the geography of where this could be done realistically, or is already, as I understand it, being done. I heard you say to Mr Flaherty that you had most of the agencies, if it's for autistics -- most of them, I know, do not serve just one category; they serve two or three. They've got a global budget. If I heard you distinctly, you were saying that users also got money. Maybe it's not called a voucher, it's called something else. That's fine. Names aren't important; it's what's coming out the other end, to me.
Ms Lang: Mr Chair, I would certainly be quite prepared and I know my staff would be quite prepared to sit down and discuss in some detail with Mr Hastings the range of services, the range of mechanisms we have in place now to finance the programs. If something comes out of that, we could follow up on a specific request.
Mr Hastings: Okay.
The Vice-Chair: Certainly in terms of trying to clarify this, does the committee agree that Mr Hastings will be contacting Comsoc staff to work out a --
Mr Hastings: Comsoc staff can contact me.
The Vice-Chair: Well, either way, to work out, let's say, a workable proposal here to --
Mr Hastings: I still want to have the motion on record that this thing get handled one way or the other. The route of getting there I don't mind, but I would like to move a motion that we pilot-test something on this whole area.
1150
The Vice-Chair: I just want to try to narrow it down exactly to what the motion will read. If you could take a minute while we have another question to write it down, Mr Hastings, and then we'll come back to you, I think that might be a bit more fruitful. Mr Fox?
Mr Fox: ARC Industries comes under your program. What's the future of them? I know there have been a number of them closed throughout the province over the last few years, yet we have a number of them still out there. I happen to have one in my riding that I'm very proud of. It's very successful and it's a big asset to the community and it also creates employment for 60-some clients. What's the future of them?
Ms Lang: We actually see ARC Industries, and sheltered workshops that may not be part of the ARC Industries group, having a place and continuing to have a place. But if in our discussions with them and their board they want to experiment with other ways of providing supports to individuals, I think we're quite open to looking at that as well.
We've had, as you know, a number of sheltered workshops in the province convert their program to supported employment because they wanted individuals to work in community settings and be more a part of community services. So we've been fairly receptive and responsive to those kinds of requests and we've had some successes. But at this point in time we do not have any plan to do anything drastic with sheltered workshops. However, we are prepared to be quite responsive if they want to experiment with other ways of providing day services or employment supports for individuals.
Mr Fox: When you move these people out into the communities in these group homes, in my area you're talking about only putting them into three agencies. I have a little trouble with that because I've had people approach me from the private sector, now that they know this is going to happen, who wanted to get in on this because they have big homes adequate for renovation to do this. I understand that even with the agencies, if you move these people out into them, you're actually going to spend money in renovations of these homes, that the government itself will spend the money in renovations?
Ms Lang: I'm sorry, Mr Fox. I didn't hear the question. I was conferring with my colleague here.
Mr Fox: When you move these people out into these agencies, into the community, the government itself is going to spend money in the renovations of some of these facilities. Is that correct?
Ms Lang: Yes.
Mr Fox: That's like me making a deal with the Ontario Milk Marketing Board to sell them milk and at the same time they come along and tell me, "We'll spend the money and build you a new barn." I don't see that as something that should happen. I would think that if they are contracting on a per-client basis to maintain and look after these people for you, they would be responsible for the renovations.
Ms Lang: The question I think becomes one of, do you pay through a capital grant for that kind of accommodation or do you pay through an operating fund for that kind of accommodation? I think one way or another, when you are moving people into those kinds of facilities in communities, there will be an expectation that the taxpayers' dollars pay for it. We have found over the years that using capital grants is probably the most economical approach rather than providing funds in ongoing operating budgets for costs of accommodation.
Mr Fox: Well, I kind of challenge that because when private enterprise is spending the money on the renovations, it's done a little more selectively, where if the government is forking out the money to do the renovations, it can get quite costly. That's just my opinion.
Mr Flaherty: I have a specific question with respect to the children with severe disabilities and section 63 schools under the Education Act. Comsoc does participate in some funding in that regard, does it?
Ms Herbert: It would be in section 27, but that's a different issue.
Ms Lang: I'm not sure that we have a --
Mr Flaherty: In facilities such as the Grandview rehabilitation centre for children, I think what actually happens is that the school is funded separately and then some money from Comsoc would go to the funding of the programs at Grandview. Is that right?
Ms Lang: It depends on whether Grandview is a program for children with developmental disabilities or whether it's a children's treatment centre financed by the Ministry of Health. I'm not familiar with that particular agency.
Mr Flaherty: Never mind. I can -
The Vice-Chair: Thank you. Sorry to interrupt, Mr Flaherty. We have the motion from Mr Hastings, if you could just read that into the record and have a vote on it.
Mr Hastings: Do you want me to read it into the record?
The Vice-Chair: Please do, yes. It will save time.
Mr Hastings: I move that community and social services staff develop for comparative purposes a pilot project applying the global budget model and a specifically directed user payment model to carry out in a more refined manner auditor's recommendation as cited on page 77 of "Monitoring of Services Provided" as outlined in S.3.0J Provincial Auditor's Report, appendix A.
The Vice-Chair: All in favour? Opposed? That's carried.
Given the time, we'll move adjournment. All in favour? Opposed? Carried.
The committee adjourned at 1157.