Connecting People to Home and Community Care: Survey Results
During the summer of 2020, ARCH was advised by the Ministry of Health that it would be conducting public consultations in the fall of 2020 on proposed regulations under the Connecting People to Home and Community Care Act, formerly referred to as Bill 175. ARCH Alert articles, available on our website at https://archdisabilitylaw.ca/resources/arch-alerts/ have discussed our concerns with the Act, and have highlighted some of ARCH’s work in making submissions to the Ontario Government. One of ARCH’s significant concerns is that the new Act leaves much of the details affecting the delivery of attendant services to the development of future regulations.
In preparation for public consultations on the regulations, ARCH posted a survey on October 14, 2020 asking about current issues in attendant services. The survey closed on October 31, 2020. We received a large number of responses that informed our current understanding of attendant services problems. It is important for ARCH to say that we have not seen any new regulations or a new Bill of Rights. The questions in our survey were designed to provide feedback on possible issues that may arise in any new regulation.
A majority of individuals who responded to our survey are consumers who have been using attendant services for over 15 years. The majority of those persons are women who live in urban areas in Central Ontario.
We separated the remaining topics into three broad areas:
1) Bill of Rights
2) Complaints and Appeals
Bill of Rights
Respondents of the survey suggested the following additions to the current Bill of Rights:
i) The right to choose how attendant services are provided and the right for a consumer to change their mind about how services are delivered over time;
ii) The right to assist in the selection and evaluation of attendants, the right to report your concerns to management and to have those concerns addressed promptly;
iii) The right to participate in training sessions for attendants, including topics like independent living, and conflict management and resolution;
iv) The right to have input into policies, procedures, and complaints processes;
v) The right to a Consumer Advisory Committee in SSLUs; and
vi) The right to an impartial third party for conflict resolution.
Complaints and Appeals
We asked consumers if their service agreements include a Complaints and Appeals Policy. While many people said yes, almost the same number were not sure. This means that close to half of the respondents are not aware of their right to complain about services or how to start a complaint.
When respondents used the complaints process, an overwhelming number said that they were not satisfied with how their complaint was handled or that they were dissatisfied with the result. The issues identified under this category include:
i) Problems created due to the complex structure of home and community services and lack of transparency;
ii) Duplication and many internal levels to escalate a complaint and there being multiple agencies involved; and
iii) Feeling like no one cares at all levels of the service provider.
To resolve these issues, many people suggested that an independent third party should be appointed to hear and resolve complaints. Most people thought that having service providers internally decide complaints about services was unfair and biased. Other respondents suggested that the Health Services Appeal and Review Board (HSARB) should be able to decide quality of service complaints. At this time, HSARB only addresses quantity of service complaints. The primary reason given for needing an independent third party to decide complaints was the fear of reprisal when a complaint is dealt with internally.
The majority of respondents said that they were not getting enough service hours to meet their daily support needs. Reductions in service hours was also identified as a major problem. These issues fall into the category of quantity of services.
Scheduling of attendants, and attendants who do not show up for bookings, were also raised as major concerns. We were told that service coordination amongst different agencies is also a problem.
The lack of adequate training for attendants, negative attitudes toward consumers, and abuse were noted to also be significant concerns in the delivery of services.
Finally, respondents were asked for comments on issues the survey did not address. These included:
i) Disclosure and access to medical and personal files;
ii) A central pool for finding an attendant; and
iii) Fact Sheets or other public information about how to navigate the complex attendant services system.
ARCH and CWDO, in partnership, held focus groups on February 10, 2021. Everyone who participated in the survey was invited to and we advertised for participants as well. The purpose of these groups was to gather additional thoughts and information from consumers about the survey questions.
Focus group participants reinforced the information we collected from the survey.
ARCH will use the information that we have collected to provide submissions to the government about the Bill of Rights, Complaints and Appeals and Services issues from the perspective of consumers of Attendant Services. A copy of our submissions will be posted on ARCH’s website.