Toronto Region ODSP Action Coalition
November 9, 2005 - Ontario Today with Alan Neal - CBC OttawaInterview Transcript
Alan Neal interviews Nancy Vander Plaats, chair of the ODSP Action Coalition, and Sandra Pupatello, Minister of Community and Social Services.
Alan: So it's seems it's going to take more than a doctor's note to be eligible for the special diet allowance, a note from a physician was all it used to take for people receiving welfare and disability support payments to get the funding supplement. It was worth up to 250-dollars each month. But last week, the government changed the form that people must fill out to get that extra money. Now, doctors have to state a specific medical condition that requires a special diet. The change worries Nancy Vander Plaats, she's the chair of the ODSP Action Coalition, she's with us now on the line. Hi, Nancy.
Nancy Vander Plaats: Hello.
Alan: So what concerns you about the change?
Nancy: Well, as you noted, I am involved with people who are disabled and who are in receipt of Ontario disability benefits, so this change isn't just affecting people on welfare, but those as well on the disability program with very serious health conditions.
Alan: Right.
Nancy: And, so, you know, we dispute [the Minister's] claiming she's closing a loophole, what she is doing in these changes, is going to result in severe hardship for many, many people with disabilities and health conditions that are not listed, or are inadequately dealt with on the new list.
Alan: So is the problem that a lot of the conditions -- the medical conditions -- that do require special diets aren't on this list?
Nancy: That's part of the problem. There are many, many things left off. The key problem, however, is the whole assumption behind this version of the special diet. The key assumption they are saying is that people can eat adequately, can eat Canada Food Guide nutritious diets of five to 10 servings of vegetables a day, for instance, and good quality low fat protein, and so on, whole grains; that those things can be afforded on the normal welfare rates. And then, if you have a few very extreme conditions, you can get a little bit more money on top of that of like -- of that balanced diet that you already able to eat. But that is the key assumption that is wrong, and I suggest the government knows every health department in Ontario says that a person can't eat an adequate nutritious diet on the current assistance rates. So to give them 10-dollars if you have Lou Gehrig's disease, or 10-dollars for heart disease, and so on, is just absurd.
Alan: So, the amount of cash that's being given for specific medical conditions isn't enough.
Nancy: That's one of the problems, because, when doctors say that someone really needs to [have] an adequate, nutritious diet, and in the past, when doctors were prescribing diets under the way the regulation was worded before, they were saying, "my client with diabetes needs to eat not only some sugar-reduced items, and less carbs, but they need high fibre, they need good quality protein, they need some vitamins and supplements", and now, they can't do -- they can't prescribe all those things that their clients need.
Alan: Well, can you run me through some of the financial -- shall we say -- differences of opinion here? For instance, for cardiovascular disease, I understand, it's 10-dollars, for Lou Gehrig's disease, there's 10-dollars, what about for say, diabetes?
Nancy: There is an item of 42-dollars listed under diabetes now, and actually, that's one of the things that's the same -- there was always was a 42-dollar item for specific diabetic diet in the past, however, in the past the doctor always had the option of saying, "but this client also needs vitamins, this client also needs high fibre, in order to have the correct balanced diet that I recommend..." so they would sometimes add things to that. It wouldn't necessarily add up to 250-dollars. Most cases I saw didn't add up to the maximum, however, it would add up to considerably more than they can get now, so many, many people are being hurt. And the other thing, is the conditions that are just being left off entirely.
Alan: Well, what illness would now get 250-dollars a month?
Nancy: Well, none. There are none that would get 250. There are a few -- in very extreme cases of some things -- where you have Crohn's disease or HIV or cancer where you've lost a huge amount of body weight, you might get up to 240 but in most cases you'd even get less when you have those very serious diseases. I just had a client with cancer who was undergoing chemotherapy, and his dietician at the hospital prescribed a special diet because you can't -- when you're in chemotherapy you get nausea, you can't digest your food, or you lose your food so she was prescribing supplements. That's not covered here unless you've lost substantial body weight already, from your cancer.
Alan: So do you have to prove that you've lost a certain amount of weight --
Nancy: Well, your doctor has to say you have, yes.
Alan: Because my understanding was for instance with Crohn's that you can get up to 75 dollars if you prove you lost more than 10 percent of the body weight.
Nancy: Well, its 75 if it's only 2 percent, but you can get more than that if you lost more, yes. Yeah, there's sort of a meat-chart approach: different amounts of body weight, different diseases, you know, you get different amounts.
Alan: Now, we are going to hear with the Minister on this in just a moment, but I understand the reason for doing this was the number of people who were claiming this allowance didn't actually deserve it. How do you counter that?
Nancy: It was up to doctors, or registered dieticians, or health professionals, to prescribe what their patients needed. Their doctors know what they need. You know -- what they're doing here is far more than closing a loophole here, what they see as a loophole. They're going to create intense suffering for many, many people this winter. There are going to be more people going hungry. More children who don't have vitamins and adequate nutrition. And that's going to cost more for the health ministry in the years to come, no question.
Alan: Were you aware, though, of a lot of people claiming an allowance who didn't deserve it?
Nancy: I usually dealt with people here who actually had gone to their own family doctors and had prescribed amounts. There were some clinics around the city where some people had forms filled out, because in some cases they didn't have a family doctor. And I understand the Ministry is responding to that. But they have taken such a draconian measure that is going to create suffering far beyond the amount of people who had so-called "loopholes".
Alan: OK Nancy, thanks for your time today.
Nancy: OK you're welcome.
Alan: Bye bye. Nancy Vander Plaats is the chair of the Ontario Disability Support Program Action Coalition. Sandra Pupatello is the Minister of Community and Social Services, the ministry that administers these funds, and she joins us now on the line from her constituency office in Windsor. Hi, Sandra?
Sandra Pupatello: How are you?
Alan: I'm fine. Why did the government make this change?
Sandra: Well, it really was very specifically to deal with what this organization OCAP was doing, which was encouraging them to access the special diet allowance -- even individuals who are on social assistance that did not have a listed medical condition -- and that really was concerning to us. And it was obviously becoming more and more prevalent, and they were gaining a lot of momentum in doing this...
Alan: How prevalent? Like how many people...?
Sandra: There was, you know, hundreds more coming in. We started hearing from municipalities right across the province where they were saying, "wait a minute, these are people without medical conditions who are suddenly coming with these forms". And I have to say first off, that I listen to Nancy carefully, and I listen to her advice on a regular basis, and certainly appreciate it -- I will tell you that the largest growth in the special diet allowance over the years, and it's been doubling since the year 2000 at least, has been people who are on disability. It stands to reason that people come on to the disability program because they qualify, and they often will have the same very medical conditions that have always been listed for additional support, via money, for special diet. That will not change. People who are on welfare who also have a requirement because of these medical conditions will still access this. That will not change. So I really am concerned to hear Nancy to suggest xxx that people in through her ODSP Action Committee may be harder pressed -- that is certainly not the case. What we've done is ensure that the use of this special diet allowance is truly related to people who have a special diet requirement. We've gone through with the medical professionals to say, in this review that we've done recently, are there any missing medical conditions on our list which is three pages long in small type that needs to be added, they said no...we've got all of them there---
Alan: So, sorry, so who said "no"?
Sandra: Those are the medical professionals, and we're working with the Ontario Medical Association, they are the ones that go through the appropriate form that ought to be used, and that's what we have done again in this case. And we've got to be sure. We've also changed our process internally, so that should a medical condition become known to us that requires a special diet, I will be able to now through regulation to make that change in 48 hours. So we really are tightening up the process, but not [for] those who will always be able to get it. What we are saying that, for this group, OCAP, who were frankly counselling people and managing them, to go through the process to get it without having a medical condition. We can't afford to have the integrity of the system questioned by the general public. They have a cause which is related to the rates on welfare or on ODSP; on social assistance generally. I welcome that conversation because I agree. We as a government have done more since we became the government in offering that 3-per-cent increase which was double the inflationary rate at the time. We know that we need to do more. But that has to be more for everyone on the system, not just the---
Alan: But Nancy's point about, for instance, the people can't afford a healthy diet on existing welfare payments...
Sandra: And that's right. And that's for everyone on welfare, not just those who may manage, because of a medical condition, to access an additional allowance. So we can't have an unfairness in the system, because some people get through via a loophole, because OCAP may counsel them in such a way, and those who don't have a medical condition and therefore don't get it. So when we talk about the need in our next budget process which we're engaging in right now, because we are already halfway through the year, to say look, we need to do more for people who are on social assistance. We're doing that work now. And people like Nancy should be and are making discussions with us about where those rates should be, but unfortunately...uh---
Alan: When you're saying "those rates", for instance, the 10-dollars for a Lou Gehrig's disease, the 10-dollars for---
Sandra: No, not on the medical conditions, but on the rates generally, because we have an assigned amount for the shelter allowance -- which for people living in downtown Toronto we know how difficult that is -- where would you find a place if you're single individual on welfare for 380 a month? It's virtually impossible, and it's made life extremely difficult on housing. And, likewise, the amount that's assigned for basic living, is extremely difficult to live on, especially if you are in a larger urban centre. So we know that discussion is ongoing with us. That is a general social policy discussion that needs to happen. I believe that we need to take care of our most vulnerable---
Alan: Yes, but what about---
Sandra: We just can't go through a special diet allowance that is meant to be for certain medical conditions, and then find people who don't have those conditions accessing that allowance.
Alan: But what about the dollar value that has actually been attached to some of those conditions that Nancy is talking about, do you find for instance that that is a fair amount?
Sandra: And again, that's a whole different conversation that is separate from what changes were just made because what we did, was that a physician who may sign a form requiring a special diet, now would indicate which of those medical conditions it relates to. That in fact is the change that we've made. It doesn't address what has happened in terms of how much for what condition. That is a discussion that I'm most prepared to have. And one that has not changed based on these regulatory changes that we have just made with the form. But I just want to keep it clear---
Alan: So the amount has not changed.
Sandra: That's right. We are happy to have conversations about what isn't sufficient. But I have to say that the general public expects our system to have integrity, and that people accessing these funds do so for it's intended purpose. And in this case, a special diet is related to a particular medical condition. And that is what that's there for---
Alan: When we hear about the humiliation that some people feel about having to prove how much sick -- how sick they actually are to get the money -- in the case of Crohn's disease we were talking about getting a certain amount, if you lose a certain amount of weight -- what do you say to those people?
Sandra: Well I say that that is the state is how people go through now to get on disabilty it is extremely difficult -- and I have to say we've made some improvements in the two years that we've been in government. But generally, when people come to the doors at the Ontario Disability Office, they have to present all kinds of information just to get on disability in the first place. And over time -- and now I know this is a throwback and the last government did it -- but we are now dealing with this, and trying to improve that. What level is the appropriate level of information for a government to have to know that people are due the disability pension. So there has to be accountability. But I do agree, that we have to do what we can, to make it reasonable: a reasonable amount of questioning, a reasonable amount of accountability. And what I did find, is, that it has changed in the last two years. We are getting better. We are eliminating some rules. In the end, we have to balance, on accountability for a system because people are getting government funding.
Alan: OK. Sandra Pupatello, thanks for your time today.
Sandra: You bet. Thank you.
Alan: Bye bye. Sandra Pupatello, the Minister of Community and Social Services, we reached her at her constituency office in Windsor. What do you have to say on this? ontariotoday@cbc.ca is our email address. Maybe you're someone who is experiencing this change yourself in your own life. ontariotoday@cbc.ca, or you can drop us a line at 1-888-591-4111.
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