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Systemic Change in the ODSP Delivery Model

Prepared for:

Community Housing Research Alliance (CURA) on Mental Health and Housing

Dr. Cheryl Forchuk
Lawson Heath Research Institute
Room D227, Nurses Residence
375 South Street
London, Ontario
N6A 4G5

Prepared by:

Pro Bono Students Canada

Michael Hassell, Dave Vaillancourt, Morgan Crockett

Faculty of Law, The University of Western Ontario
London, Ontario
N6A 3K7

Pro Bono Students Canada at the University of Western Ontario, Faculty of Law regrets that it cannot provide legal advice. This document contains a general discussion of certain legal and related issues only. Please consult with a lawyer for assistance with specific legal problems.

Executive Summary

The Ontario Disability Support Program (ODSP) has an excellent objective of providing financial assistance to eligible people with disabilities. However, ODSP is not achieving its objective because ODSP is an overly complicated program that does not always consider the unique circumstances of people with disabilities. ODSP is designed to severely restrict the number of people able to receive income supports, rather than assist people with disabilities to gain access to income supports. Furthermore, successful applicants do not receive an adequate level of income support.

In response to these systemic problems, and in order to improve ODSP, this paper makes three major recommendations:

1. Every applicant should have a caseworker provided by ODSP to assist them with their application and on-going reporting requirements.

2. ODSP needs to change its attitude from an exclusionary program to a program that assists persons with disabilities get the support they need.

3. The level of income support should be increased and linked to the Consumer Price Index.

Table of Contents

Introduction

The goal of project two is to identify ways in which systemic changes can be implemented through amendments to the ODSP legislation, regulations, and policy directives as well as modification to the attitudes of ODSP service providers. For the sake of clarity, this project is broken down into three parts. Firstly, we looked at ways to reform the ODSP system from the current business-centered model to a client-centered model. Our position is that the ODSP would operate in a more efficient manner if each applicant (or "client") is assigned a caseworker to take them step by step through the application process. Secondly, we have investigated ways to change the attitudes of ODSP service providers. The ODSP legislation itself has exclusionary and possibly discriminatory provisions built into it, which can negatively affect applicants. The final area of focus in project two involves the current income level supports. Based on our analysis we have found that the ODSP Act does not guarantee a sufficient level of income support and as well, there are possibly negative implications to the fact that in the event of an overpayment, the ODSP can demand repayment which may lead to severe cash flow issues.

The analysis for each of the three parts was carried out as follows. A problem area in the current legislation, regulation or policy directive was identified and an amendment or addition proposed. The rationale behind the amendment is discussed to explain how the amendment will improve the service delivery of ODSP. In addition to the amendments, consideration is given to supporting policies that go beyond the amendments. The reason for the supporting policies is that not all problems with ODSP are amenable to change only by way of legislative enactment. As well, unresolved considerations relating to the issues identified are discussed. These are usually included due to difficulties in obtaining complete information that would assist in a decision to implement a particular recommendation. Internal information on ODSP is not always readily available, which is one constraint on the project.

The paper attempts to touch upon some of the main problem areas of ODSP. It does not discuss all problems and there are areas for further research. More changes than those outlined here are needed in order to strengthen the delivery of ODSP services. However, the areas covered by the paper have been identified as high priority areas by the Community-University Research Alliance.

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Part One:

Shift from business model to client-centered model

Issue: The ODSP would operate more efficiently if each applicant/recipient was assigned a caseworker

Clients will benefit greatly if the ODSP incorporates caseworkers into their delivery model. The caseworker will be there to provide assistance to the client at all stages of the application process, and beyond. Once an applicant is assigned a caseworker, this caseworker should be that applicant's main point of contact with ODSP throughout the application process. The same caseworker should also continue to be the main point of contact after the client has qualified for the program. This continuity will benefit both the applicant, and the system.

While there may be additional costs to implementing caseworkers there are numerous benefits to both the staff and the clients of ODSP to offset this expenditure. The implementation of a system of a client-caseworker relationship will ensure efficient and effective utilisation of ODSP resources. The use of a caseworker will increase efficiency in that, the caseworker will be familiar with their particular clients and they will be better able to serve them. It will increase effectiveness in that ODSP clients will not have to spend time re-explaining their situation and waiting for the ODSP staff to get caught up on their circumstances. The client-caseworker relationship will also serve to boost client's confidence in the system as a client will feel much more comfortable having a caseworker's support each time they contact the ODSP office. The present system is frustrating for the individual, and time consuming for the ODSP staff.

Outlined below are four aspects of the program that should be amended to reflect the role of caseworkers within the ODSP.

Sub-Issue 1: Financial Assessment

Current Policy Directive: ODSP Policy Directive 1.1

Intent of Policy: To provide a prompt and comprehensive response to requests for income support and to ensure the information and verification necessary to establish eligibility for income support is provided.

Proposed Amendment

Intent of Policy: To provide a prompt and comprehensive response to requests for income support, by assisting applicants through the application process, and by ensuring that all information and verification necessary to establish eligibility for income support has been provided.

Also, to be added as a new point under Application of Policy: Standards.

Page 2: An applicant will be assigned an OSDP caseworker. The caseworker will provide assistance, as required, during this stage of the application.

Rationale

Applicants who are not in need of immediate financial assistance apply for ODSP support directly through the ODSP office. The applicant must assemble a wide variety of information in order to undergo a financial assessment with a member of the ODSP staff. The current wording of both the intent, and the standards, of Policy Directive 1.1 portray the role of ODSP staff as a computer-like fact-checker. The caseworker should play a more hands-on role, offering assistance and guidance if the applicant so requires in procuring this information. The caseworker will be able to better advise the applicant on both the financial and the medical criteria that must be fulfilled to qualify for support. Having a caseworker assist the applicant in this manner will result in more properly screened applications, and will help speed up the review process.

Sub-Issue 2: Disability Adjudication Process

Current Policy Directive: ODSP Policy Directive 1.2: Disability Adjudication Process

Applications Made through ODSP Offices, page 2: Once financial eligibility has been established, a referral is made to the DAU and a DDP is provided to the client.

Note:
DAU = Disability Adjudication Unit
DPP = Disability Determination Package

Proposed amendment:

Once financial eligibility has been established, a referral is made to the DAU and a DDP is provided to the client. The applicant will have the option of discussing the DDP with their caseworker. The client's medical professional will be able to obtain clarification regarding the DDP from that applicant's caseworker.

Rationale

According to the Income Security Advocacy Centre, the Disability Determination Package (DDP) is the most significant challenge to ODSP applicants. "In the 2000/2001 fiscal year, almost 40% of applicants referred to the DAU did not, ultimately, submit a DDP package". ⁽¹⁾ These are individuals who have started an application process with the ODSP, and have been deemed to qualify financially for the program. This statistic is evidence of a very serious problem within the system. Presently, there is no support or assistance offered to applicants during this part of the process. ⁽²⁾ Caseworkers should be available for consultation during this period of time. Furthermore, there is evidence that the forms are even confusing for the medical practitioners, and as such are difficult for them to complete. ⁽³⁾ The applicant's caseworker should be available to answer general questions and provide general instructions to the medical practitioner in order to complete the required forms.

Current Policy Directive: ODSP Policy Directive 1.2

Applications Made through Ontario Works, page 3: Once financial eligibility has been established, a referral is made to the DAU and a DDP is provided to the client.

Proposed amendment

Page 3: Once financial eligibility has been established, a referral is made to the DAU and a DDP is provided to the client. At this point, the applicant will be assigned an ODSP caseworker. The applicant will have the option of discussing the DDP with their caseworker. The client's medical professional will be able to obtain clarification regarding the DPP from that applicant's caseworker.

Rationale

Since individuals applying through Ontario Works do not acquire an ODSP caseworker during the financial assessment stage, it is important that they be assigned one at this point. The main rationale for having a caseworker during this stage of the application is outlined above.

Current Regulation: Reg. 222/98 ss. 5(3), 5(4), 16(5)

S. 5(3): If a review date for a disability determination has been set under subsection (1), the information requested under paragraph 1 of section 47 must be provided within 90 days after the request is made unless an extension has been granted by the Director.

S. 5(4): If the information described under subsection (3) is not provided within the 90-day period or within the extended time period, the recipient or the spouse included in the benefit unit is not eligible for income support.

S. 16(5): An application referred to in subsection 14 (1) that has not been completed within 90 days after a request under paragraph 1 of section 47 has been made shall be deemed to be withdrawn unless the Director approves a greater period of time for its completion.

Proposed amendment

s. 5(3): If a review date for a disability determination has been set under subsection (1), the information requested under paragraph 1 of section 47 must be provided within 180 days after the request is made unless an extension has been granted by the Director.

s. 5(4): If the information described under subsection (3) is not provided within the 180-day period or within the extended time period, the recipient or the spouse included in the benefit unit is not eligible for income support.

s. 16(5): An application referred to in subsection 14 (1) that has not been completed within 180 days after a request under paragraph 1 of section 47 has been made shall be deemed to be withdrawn unless the Director approves a greater period of time for its completion.

Rationale

The current 90-day time limit places an unfair burden on the applicant. One particular concern is that applicants may have poor access to doctors, particularly in under-serviced parts of the province ⁽⁴⁾. This would further compound the already existing problems surrounding the complexity of the DDP. It stands to reason that the large number of applicants who don't submit a DDP are at least partially impacted by this short timeline. The ODSP receives no tangible benefit by imposing this short timeline on applicants. Since the ODSP double-checks the finances of an applicant after a successful disability determination, there is no institutional need to receive the DDP so soon after the original financial assessment. The timeframe should be expanded from 90 days to 180 days, in order to provide the applicant with more time to submit the DDP.

Current Policy Directive: ODSP Policy Directive 1.2

Summary of Legislation, page 1: The applicant must have a Disability Determination Package (DDP) completed and returned to the Disability Adjudication Unit (DAU) within 90 days.

Proposed Amendment

Summary of Legislation, page 1: The applicant must have a Disability Determination Package (DDP) completed and returned to the Disability Adjudication Unit (DAU) within 180 days.

Rationale

Same as above.

Supporting Policies

The legislative and policy changes noted above will have to be accompanied by a modification to current ODSP staff training practices. Training should be provided so as to prepare ODSP staff to be more responsive and involved in the applications of their clients. Increased disability awareness training should also be a part of this training regime.

Unresolved Considerations

The following questions and considerations focus on the additional costs associated with hiring extra caseworkers, as well as the training and education that these caseworkers would require. What percentage of applicants would require a caseworker? How much more time would ODSP staff have to spend with each applicant, and how many more staff would need to be hired to meet this demand? What qualifications and training do current staff have, and what (if any) enhanced qualifications and training would be required to do the job as a caseworker? Is it a matter of formal education (such as a Bachelor of Social Work or Masters of Social Work), or a matter of on the job training? Could current members of ODSP staff be integrated into a new delivery model? It is essential that a province-wide standard be met for ODSP caseworkers. These are essential logistical matters that must be taken into account.

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Part Two:

Changing attitudes of ODSP service providers

Issue: The ODSP Act has an exclusionary attitude

Current Legislation, Regulation, or Policy Directive

ODSP Act, section 5(1) - relating to eligibility for income support

"No person is eligible for income support unless,"

Proposed Amendment

Change the language quoted above to: "A person is eligible for income support when"

Rationale

This amendment is a minor adjustment, yet it would involve a shift from exclusionary language to language that supports the inclusion of people meeting the criteria set out in the act. It results in no substantive change to the requirements for a person to be eligible.

Supporting Policies

ODSP should actively advertise the availability of ODSP income supports to potential recipients. It is a right of all Ontario residents who are eligible for income supports to receive them. Many eligible people currently do not know about the ODSP program and should be made aware of it. As one anonymous front-line ODSP worker told us, if everyone eligible for ODSP applied, they would be overwhelmed and not be able to handle applications in a timely manner.

Unresolved Considerations

What is currently done in the way of advertising the availability of ODSP assistance? How well partnered is ODSP with disability organisations? What are the best methods for improving advertisement of ODSP supports? What other policies options are available to support a more welcoming attitude on the part of OSDP when taking in new clients?

Section 16 of the Ontarians with Disabilities Act, 2001 sets out an accessibility policy requirement for government agencies. It states the following:

S. 16(1)  Every agency shall prepare an accessibility policy.

S. 16(2)  The accessibility policy shall address the provision of services to persons with disabilities in the policies, programs and practices of the agency.

For 2005-2006, the former Minister of Community and Social Services, Sandra Pupatello, lays out such an accessibility plan. It discusses at one point awareness, access and accountability (AAA) training that over 300 employees received. All new employees receive this within 90 days of being hired. It would be useful to know exactly what this training involved, how standardised it is, and who has not yet received it.

Issue: The ODSP Act has a discriminatory approach to people dependent on or addicted to alcohol and drugs

Current Legislation, Regulation, or Policy Directive

ODSP Act, section 5(2) - relating to eligibility for income support

"A person is not eligible for income support if,

ODSP Act, section 5(3) - relating to eligibility for income support

"Subsection (2) does not apply with respect to a person who, in addition to being dependent on or addicted to alcohol, a drug or some other chemically active substance, has a substantial physical or mental impairment, whether or not that impairment is caused by the use of alcohol, a drug or some other chemically active substance."

Proposed Amendment

Remove section 5(2) and section 5(3) altogether.

Rationale

A dependence on alcohol or drugs has been associated with issues of mental health and disability, not as something entirely independent. This broad exclusion does recognise that alcohol and drug addition or dependence may be a disability in itself. Section 5(2) makes it clear that anyone addicted to drugs and alcohol is ineligible for income supports. Where an addiction or dependence is combined with a physical or mental impairment, a person then becomes eligible under s. 5(3).

These sections are most likely included to reflect a policy choice of excluding people addicted to drugs and alcohol from receiving supports. It essentially reinforces a societal stigma against such people, who comprise a group that may be in great need of support. Unless clear scientific evidence is brought forth demonstrating that alcohol and drug addiction/dependence are not forms of mental disability, there is no place for these exclusionary sections in the legislation.

Supporting Policies

When an individual applies for income supports and notes an addiction/dependence, ODSP should provide referral services to drug and alcohol rehab services.

Unresolved Considerations

How many applicants apply for income supports citing only alcohol and drug related challenges as their disability?

Issue: How to make the ODSP Act more welcoming

Current Legislation, Regulation, or Policy Directive

The ODSP Act outlines its purposes in section 1 which have welcoming elements. However, there is no preamble.

Proposed Amendment

The ODSP Act could be amended to include a preamble that makes the Act more welcoming. Alberta has a program called called Assured Income for the Severely Handicapped (AISH). Its preamble is excellent and could be modified to provide Ontario with a similar preamble as follows:

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Part Three:

Increasing the level of income support

Issue: The ODSP Act does not guarantee a sufficient level of income support

Current Legislation, Regulation, or Policy Directive

ODSP Act:

S. 1. The purpose of this Act is to establish a program that,

(a) provides income and employment supports to eligible persons with disabilities;

S. 11. The amount of income support to be provided and the time and manner of providing that support shall be determined in accordance with the regulations.

Ontario Regulation 222/98, part V - relates to the specific calculation and payment of income support

Proposed Amendment

Change the language of s. 1(a) to "provides income and employment supports to eligible persons with disabilities that allow the eligible person to maintain a sufficient standard of living".

A definition of a "sufficient standard of living" should be defined in the Act. Since s. 2 of the Act contains a list of definitions, this new definition could be included there.

Proposed definition for "sufficient standard of living": means that a person's basic needs, including shelter, food, and utilities, are met such that a person is able to participate in society.

Rationale

The level of income support is currently too low. In 2003, there was a 3% increase in social assistance benefits, the first increase in over a decade. Note that this increase was just slightly above the inflation level for that particular year.

This proposed amendment would ensure that at least a minimum standard of living is provided to eligible persons. The current income support levels for persons on ODSP are as follows:

Under the ODSP, the maximum amount a single person could receive is $959/month. The maximum amount given for a couple, where one spouse is disabled and the other is not, is $1460/month. (Source: ODSP Handbook)

In the ODSP policy directive, "basic needs" is calculated according to: family size, age of dependents, geographic location, and the individual circumstances of the benefit unit."

However, even if the maximum amount of income support is received, this amount may not be sufficient to ensure that a person can live at a sufficient standard of living and meet their "basic needs."

The following chart from Settlement.org (a website funded by Citizenship and Immigration Canada and the Government of Ontario) indicates the average monthly expenditures on basic needs for a person in Ontario:

The range of the maximum ODSP income supports available ($959-$1460/mo) clearly falls below average amount required to meet the basic needs required for a sufficient standard of living.

Compare for example, the maximum amount payable for shelter (table found in s. 31 (2) of the General Regulation to the ODSP Act) to persons on ODSP to the average cost of rent in various cities across Ontario:

S. 31(2) of the General Regulation to the ODSP Act (Ontario regulation 222/98). Determine the maximum amount payable for shelter in accordance with the following table:

The following chart from Settlement.org lists the average monthly cost of rent for select cities across the province:

The maximum amount of money given for shelter is insufficient to cover the average rental costs in the situation of a one person benefit unit. The $427/month is clearly not enough to enable a recipient of ODSP to meet the average rental rates. It is essential that the maximum amount of income support available to people on ODSP be enough to guarantee that they will be able to live at a sufficient standard of living. The current maximum amounts do not allow for this.

Supporting Policies

It is important to link the amount of income support to the Consumer Price Index and adjust for it at least annually. The maximum amount of income support should increase with inflation, which it historically has not. This amount should be reviewed in light of changing economic conditions.

Additionally, the amount required to meet the basic standards of living varies depending on what city or town the recipient resides in. This should be taken into account when assessing the amount of income support to be received.

Finally, an important policy consideration to include is to prevent the downward adjustment of the amount without good reason.

Bill 30 was introduced in the provincial legislature and it addresses many of these matters:

Bill 30, 2003

An Act to amend the Ontario Disability Support Program Act, 1997 to require annual cost-of-living adjustments to income support payments

Her Majesty, by and with the advice and consent of the Legislative Assembly of the Province of Ontario, enacts as follows:

1. (1) Subsection 55 (1) of the Ontario Disability Support Program Act, 1997 is amended by adding the following paragraph:

4.1 requiring that the amount of income support provided be indexed to the cost of living as described in subsection (3.1);

(2) Section 55 of the Act, as amended by the Statutes of Ontario, 2002, chapter 18, Schedule D, section 2, is amended by adding the following subsections:

Indexing amount of income support

(3.1) A regulation made under paragraph 4.1 of subsection (1) may provide that the amount of income support provided be adjusted on April 1 in each year by multiplying it by the indexing factor for that year.

Indexing factor

(3.2) The indexing factor for a year is the percentage change in the Consumer Price Index for Ontario for prices of all items between the month of January in that year and the same month in the previous year, as published by Statistics Canada.

Commencement

2. This Act comes into force on the day it receives Royal Assent.

Short title

3. The short title of this Act is the Ontario Disability Support Program Amendment Act (Fairness in Disability Income Support Payments), 2003.

Unresolved Issues

A huge consideration here is how much these changes will cost. As we do not have information as to the current funding of ODSP, it is not possible to assess how much the maximum amount of income support be realistically be increased. This increase in funding also begs the question of how to muster up the political will to improve funding.

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Conclusion

Taken all together, the OSDP Act, Regulation and Policy Directives represent a thick body of legislation and procedures. ODSP is a bureaucratic program and it is difficult to understand its true nature. However, from the information made available by the ODSP website, various OSDP working groups and affected individuals, it has become clear that the program is not functioning to the best of its potential, despite being an important program in Ontario's social assistance.

Systemic change of ODSP is important. This paper has outlined three important areas in which such change is possible: assisting the disabled when required in their dealings with ODSP, changing the attitudes of ODSP and increasing the levels of income support. For each area, legislative or policy change needs to be accompanied by supporting policies in order to give effect to the legislation and make it possible for the changes to have an impact.

Much of the work to be done in this area is not necessarily legal, but rather political. Political will is required in order for most of the changes proposed here to arise. For instance, only the provincial legislature can amend the ODSP Act, through the implementation of Bills such as Bill 30 noted in the income support section.

It is hoped that this paper will serve as a discussion piece to move the political discussions forward by raising important issues relating to ODSP service delivery. While the paper does not include all possible improvements that would make OSDP a better service to Ontarians, it raises significant issues that call for more research as well as immediate reform of the Ontario Disability Support Program.

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¹ Income Security Advocacy Centre, "Denial by Design. the Ontario Disability Support Program" (2003) 11. Return

² Ibid. Return

³ Ibid at 12. Return

⁴ Last year's memo, 11. Return

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