SWLF 1005 - Week 11 This week

1
SWLF 1005 - Week 11This weeks key concept in
social welfare people with disabilities

• Two important thoughts as we begin
• To provide equal opportunities for all
  Canadians, what must be done for people with
  disabilities?
• Is the way we deliver government services
  important?

2
Agenda for this week

• A word about course participation, and my
  assessment of it
• Paper 2 review of last weeks discussion,
  questions and concerns to be reviewed
• Quiz 2 this Thursday, same format as Quiz 1.
  Any questions?
• Review of key themes for discussion from last
  weeks key concept in social welfare health and
  social work
• Todays readings Hick, 2002 217-233.

3
Recall The Origins of Canadian Medicare

• Saskatchewan is the first province to implement a
  public insurance plan for hospital services in
  1947.
• But why, we asked last week, did Saskatchewan
  take the lead in doing this?

4
Prarie populism Tommy Douglas and the CCF/NDP

• In order to understand why Saskatchewan took the
  lead in implementing health care policy, one
  needs to grasp the politics of Tommy Douglas and
  the CCF/NDP.
• The story of Mouseland (often told by Douglas)
  helps shed light on the ideas espoused by the
  CCF/NDP.

5
The CCF/NDPs compromise in Health Policy

• In 1961, Saskatchewan was paralyzed by a doctors
  strike across the province. This was supported
  at the time by the Canadian and American Medical
  Associations
• The CCF wins the struggle, but doctors maintain
  fee-for-service system, and the right to practice
  in both the public and private system.

6
The Origins of Canadian Medicare

• Prior to the events of 1961, the federal
  government implements the Hospital Insurance and
  Diagnostic Services Act in 1957, agreeing to
  finance 50 of the cost of acute and chronic
  hospital care. (121-122)
• There were serious gaps in this federal
  legislation however, and the Saskatchewan
  experience was crucial in pushing for broader
  access to physician services.
• The release of the federal Hall Report (1964),
  was the precursor to the Medical Care Act
  enacted in 1966 (note that Hick gets this date
  wrong).

7
Implications of the Saskatchewan compromise in
1961

• Tommy Douglas reflects on the 1961 compromise
• when we began to plan Medicare, we pointed out
  that it would be in two phases. The first phase
  would be to remove the financial barrier between
  those giving the service and those receiving it.
  The second phase would be to reorganize and
  revamp the delivery system, and of course, thats
  the big thing we havent done yet.

8
The Canada Health Act (1984)

• 1979 Hall Commission (same Hall as in 1964)
  warns of privatization trends in extra-billing by
  doctors and user fees assessed by institutions
• The Canada Health Act was the next major
  innovation in Canadian medicare to respond to
  this challenge
• The CHA enshrined five major principles 1)
  public administration 2) comprehensiveness 3)
  universality 4) portability 5) accessibility.

9
Funding Canadian MedicareFederal programs in
perspective

• Taxes from Canadian citizens
• ?
• Federal (18) / provincial (80) / municipal
  spending (2)
• ?
• Hospitals/ practicioner billing/health services

10
Subsequent developments in Canadian Medicare

• 1999 Social Union agreement re-affirms the
  principles of the Canada Health Act
• The 2002 Romanow report called for 15 billion
  in increased federal funding for Medicare
• The recent First Ministers Conference (Sept 2004)
  restated commitment to the CHA, commits to 18
  billion in new federalfunding for Medicare over
  the next 10 years.
• But someone was curiously absent

11
Medicare and privatization

• Ralph Klein left after the first day of the First
  Ministers talks on Canadian Medicare.
• Alberta, under Bill 11, has allowed its hospitals
  to hire for-profit providers of core health
  services
• In Ontario, public-private partnership hospitals
  (P3) have emerged in Ottawa and Brampton, and at
  least 11 others are in the planning stages across
  Canada
• A recent report finds that the Brampton hospital
  will cost 175 million more than a comparable
  hospital built through public funding.

12
People with disabilities

• About 4.2 million Canadians today (about 1 in 6
  or 16) are classified as being disabled.
• Disabling conditions can include sensory
  disabilities, developmental disabilities,
  intellectual disabilities from trauma, and
  learning disabilities.

13
People with disabilities

• More details from Hick
• Only 6 of the disabled population has been
  disabled since birth
• 92 live in communities, while 8 live in group
  homes, nursing homes, or chronic care facilities.
• Age also defines the population of Canadas
  disabled age 15-24 4 report a disability age
  44-65 40 report disability 72.5 of those
  older than 85 report a disability.

14
People with disabilities

• More details from Hick
• Disabled Canadians stand a far likelier chance of
  being unemployed and poor
• Disabled Canadians have a lower level of
  education than most Canadians.
• There is a remarkable difference in the status of
  unemployed disabled Canadians on the basis of
  gender.

15
Servicing the needs of disabled Canadians

• The very word disability comes from a legal
  distinction used to separate deserving and
  undeserving poor in early social welfare
  programs
• Deserving poor were given the right to beg,
  others were required to work.
• Out-of-door relief (a common service for the
  disabled deemed deserving poor) grew steadily
  unpopular. This dramatically changed the
  treatment of the disabled in Europe and North
  America

16
The institutionalization movement

• The foreclosing of out-of-door relief programs
  created gave way to the institutionalization
  movement in servicing the needs of the disabled.
• The social distinctions were so severe, in cases
  the disabled were forbidden residence in the
  streets of towns and cities.
• By World War II, the segregation of the disabled
  is common, and regarded as a normal practice.

17
Scientific Charity and the disabled

• Attitudes slowly began to change before the WW2
  era, however, even despite the laissez-faire
  design of Canadian social welfare.
• Charitable organizations took the lead in
  providing services to the disabled, based on what
  were deemed to be scientific principles. Most
  of these principles involved measuring the
  deserving nature of disability claimants.
• Period is a mixed blessing for disabled
  Canadians. Leads to new programs and services,
  but also to sterilization laws and the eugenics
  movement modelled on Nazi Germany

18
The impact of WW2 on rights for the disabled

• Seeing soldiers returning from the war had a
  profound impact on social perceptions of the
  disabled
• A medical approach to disabled Canadians becomes
  more common, with rehabilitation teams assigned
  to a given client
• Specific hospitals, schools and training programs
  for the disabled are established.

19
Disability rights movement

• Emerges in North America around the same time
  that feminism and gay liberation movements come
  to the fore (late 1960s early 1970s)
• This approach challenges an exclusively medical
  definition of disability, and questions social
  assumptions towards the disabled. Disability
  rights movement gains legislative recognition in
  the U.S., and constitutional recognition in
  Canada.
• This movement begins to challenge the problems of
  ableism the notion that able-bodied people
  are superior.

20
Disability Theories

• Personal tradegy theory disability is an
  unfortunate life event, requiring medical
  treatment for the individual client.
• Social oppression theory of disability problems
  for the disabled are not theirs alone, but the
  result of social inequality and prejudicial
  behaviour by decision-makers.

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Am I my sister or brothers keeper?

• Your task
• Think about the two disability theories
  discussed in the last slide, and our previous
  discussions around negative and positive
  liberty.
• In your groups opinion, how well is Canada
  doing in providing positive liberty to people
  with disabilities?
• What must happen in Canada to maintain or
  improve existing practices towards the disabled?

22
Income security for disabled Canadians

• Publicly-funded programs Canada Pension Plan
  (federal), Family Benefits (provincial), General
  Welfare Assistance (municipal).
• Privately-funded programs private insurance
  plans, voluntary/charitable organizations.

23
Details of Canadian income security programs for
the disabled

• General welfare assistance and family benefits
  (provincial funding)
• Eligibility determined by a physician
  examination
• Social assistance review of financial assets
  follows medical examination (226)
• In Ontario, an individuals savings are not to
  exceed 3500 per month.

24
Details of Canadian income security programs for
the disabled

• Canada Pension Plan (federal)
• Eligibility determined by a physician
  examination
• Claimant must have contributed to CPP during 2 of
  the last 3 years or 5 of the last 10 years
• Pension benefit amount is limited at flat rate of
  75 of pension to which the claimant would
  normally be entitled.
• Financial need is not calculated.

25
Independent Living Movement

• The Independent Living Movement has emerged out
  the of Disability Rights Movement
• Students in California began to challenge the
  bureaucratic control of their lives by university
  officials
• This movement since the early 1970s has
  encouraged the self-direction of disability
  services and full participation in community life
  through Independent Living Resource Centres
  (ILRCs).
• Key concepts empowerment in organizational
  values and principles, alternative program
  delivery.

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Next class

• Quiz 2 Ladies and gentlemen, start your
  engines!
• Remember the QAC factor still applies. Most
  importantly, organize your time, and answer the
  question. For an even better result, demonstrate
  independent analysis, and grasp of content in
  course materials.