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Tuesday
Mar072017

Critics blast government long-term care reforms

 

“They cut hospital beds and lay off staff without having community health care services ready…”

“When the elderly… decide that facility-based care is the best option, they can’t get it…”

By David South

Today’s Seniors (Canada), October 1992

Seniors should keep a close eye on the Ontario government’s proposed long-term care reforms. According to critics, the plan has more than a few bugs. 

The term long-term care encompasses an often confusing web of services, from home-provided community services like meals on wheels to institutional care including homes for the aged, seniors’ apartments and chronic care hospitals. 

Like other provincial governments, the Rae government is trying to rein in escalating health care costs - and long-term care services aren’t immune. They hope that emphasizing prevention and healthy lifestyles, plus providing more services in the home and community, will reduce reliance and expensive health care services like high-cost drugs, surgery and high-tech equipment. According to health minister Frances Lankin, this will preserve medicare in the age of fiscal restraint. 

The government has outlined seven goals for its long-term care reforms: prepare for the coming surge in the over-65 population; cater services to better reflect the cultural, racial and linguistic make-up of Ontario; eliminate confusion over what services are available; involve the community in planning so that services reflect community needs; lessen reliance on institutions; provide support to family caregivers; tighten regulations governing government-run and private facilities; and improve working conditions for the largely female caregiving workforce. 

But many people are wary of the proposed reforms and worry that if they aren’t managed properly, some seniors will fall through the cracks. 

A report released in July by the Senior Citizens’ Consumer Alliance for Long-Term Care Reform blasts the government for being simplistic in its plans. The report compares the present reforms to the failed attempt in the 1970s to move psychiatric care out of the institutions and into communities by closing 1,000 beds. The tragic result in that case was homelessness for many psychiatric patients who found community services unable to help, or, more often than not, non-existent. The Alliance fears seniors - the biggest users of health services - could fall victim to reforms in a similar way. 

Emily Phillips, president of the Registered Nurses’ Association of Ontario, is blunt: “The NDP’s plans sound good on paper, but they can’t give a budget or direct plan on how they hope to carry out reforms. They are going about things backwards. They cut hospital beds and lay off staff without having community health care services ready.”

The Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS) - which operates charitable and municipal homes for the aged, non-profit seniors’ apartments. chronic care hospitals and community services serving over 100,000 seniors - says 4,300 seniors are on waiting lists for their member facilities right now, and things won’t improve if the government continues to reduce the number of long-term care beds. 

But Lankin insists that beds are available in homes and hospitals and it is funding formulas that prevent them from being filled. 

To help carry out its reforms, the NDP will reallocate $647 million by 1996-97. In bureaucratese, this funding is said to be “back-end loaded”, or mostly spent close to 1996-97. 

The problem with this, according to the Alliance, is that the government has already embarked on a radical “downsizing” of hospitals, closing beds and laying off health care workers. Lankin claims the worst case scenario for layoffs this year won’t exceed 2,000, but the Ontario Hospital Association claims 14,000 jobs are in jeopardy. Because of this, the Alliance wants money to be spent earlier to avoid gaps in services. 

Phillips believes it will be hard to pin down the extent of job losses. “For every full-time job cut many part-time and relief positions go with it,” she says. 

Dr. Rosanna Pellizzari, a member of the Medical Reform Group and chair of the Ontario Association of Health Centres, wants better community accountability for hospitals before they lay off staff and cut services. “Sometimes it makes sense to bring people to hospitals,” she says. “Planning must be at the community level, open and democractic. Health care workers, who are mostly women, should not be scapegoated for financial problems. Doctors and management should go first. Physicians experience very little unemployment.” 

Many nursing and charitable homes for the aged are facing financial crisis. According to OANHSS, six charitable homes for the aged have closed since 1987 due to deficits. In 30 homes, the total annual deficit has increased 125 per cent since 1987. The Ministry of Health recently allocated special funds of $8.1 million to ensure these facilities survive until January, when a new, needs-based funding formula will be introduced. It is intended to better match the actual care requirements of the 59,000 consumers living in long-term care facilities. 

Michael Klejman, executive director of OANHSS, agrees with helping seniors to stay in their homes. “But when the elderly and their care-givers in Ontario decide that facility-based care is the best option, they simply can’t get it,” he notes. “We know from experience that many of them remain in acute care hospital beds with a cost to the province of about four times what it would cost them to fund a long-term care bed. And many, unfortunately, remain in their own flats or apartments at considerable risk to themselves, isolated and dependent on a patchwork of services.” 

Beatrix Robinow, who worked on the Alliance’s report, was not impressed with the government’s initial plans, especially the proposed creation of 40 service coordination agencies whose mandate would be to control the delivery of home care services to seniors. Robinow thinks this would add to the confusion and just be another layer of bureaucracy. Many people who appeared at the Alliance’s public hearings expressed confusion over how the long-term care system worked. 

Robinow says that the government could save money by trimming the bureaucracy and using present organizations like the little-known District Health Councils. 

“District Health Councils have nothing to do with social services,” says Robinow. “But we want them to be expanded to include long-term care and general supervision of community services. We are waiting to hear if they are interested. I would urge the government to make sure that services are in place before pushing people out of institutions.” 

The health minister is cautious about the government’s next steps. “The Alliance’s report has been very helpful,” she says. “We are in the process of developing options. Two other ministers are involved and we also need to take this through Cabinet.

“Ontario is much larger and more complex (than other provinces). The range of services is more developed. We also have a mess in jurisdictions between municipalities and the province. And in Ontario there isn’t a concensus that this is the way to go. 

“We have been doing a lot of rationalization and streamlining for longer than other provinces. Most thinking people looking at the situation agree that doing nothing would hurt the system. It is not sustainable at present. You hear a lot of things about user fees. That would be the slippery slope for medicare. That would make people think they could buy better services.”

Ironically, user fees were recently endorsed by the Canadian Medical Association, suggesting the minister will have a fight on her hands with angry doctors. 

Amidst all the confusion, Dr. Perry Kendall was appointed on Aug. 24 as the provincial government’s special advisor on long-term care and population health. This veteran of both the City of Toronto as Medical Officer of Health - and the groundbreaking Victoria Health Project in British Columbia (often seen as the model for community services to seniors) seems well qualified. “One problem in the past has been the creation of smaller and smaller organizations every time somebody felt the system was not responsive to their needs,” he says. “This created organizational chaos. The challenge  now is to get all the organizations back together to share their expertise.”

Lankin says she hopes to have a conference on the reforms in the fall. 

Sunday
Feb122017

Changing health care careers a sign of the times

 

By David South

Hospital News (Canada), June 1992

Ontario’s health care system is in the midst of a big change. But where are the new jobs going to be and how can health care workers prepare for the coming crunch?

“Anybody who thought they could progress through the health care system until retirement is in for a shock,” said Ruth Robinson, a national health care consultant for Peat Marwick Stevenson and Kellogg management consultants. 

Radical changes are taking place in the health care system and it looks like traditionally safe occupations are in for a shake-up. 

“Hospitals are being pressured to change fundamentally,” said Ms. Robinson. “The net effect is fewer jobs. A lot of people will have to think about new careers.”

In the Ministry of Health working document entitled Goals and Strategic Priorities, released in January, the fundamental shift from treatment to disease prevention and health promotion is laid out in generalities. 

The goals range from health equity for aboriginals, women, children and AIDS patients to better management of costs to development of a stronger health care industry that will jump start the economy. And they range from the reorganization of professional responsibilities to promotion of services outside institutions with the goal of keeping people out of hospitals. 

One thing is clear, the talk is about big changes. But talk is cheap to laid-off health care workers looking for new jobs. 

The provincial government’s recently passed, but yet to be proclaimed, Regulated Health Professions Act will have serious repercusions for all health care providers. 

“Traditionally, doctors have an exclusive domain over a wide area,” said Charlie Bigenwald, executive director of health human resources planning at the Ministry of Health. “Even though other people could do things, they had to be delegated by a doctor. With the legislation, we have pushed back what doctors can do. This means there will be more opportunity for a wider variety of health care workers to get into those areas.”

Midwifery is one of the benefactors of changes in regulations. The Ministry of Health is looking into having a university-based program for midwives. 

Ms. Robinson predicted nurses and middle management will suffer the most in the change to community-based health care. 

“Nurses will need to get a bachelor degree if they hope to compete for jobs,” she said. 

As for middle managers, who often have clinical skills, they will have to reconsider staying in health care, she said. “They will disappear significantly. They can advance themselves by getting back to clinical skills or consider management positions in non-health care areas.

“There is nothing to be ashamed of about career changes these days,” she added. 

In the shift towards community-based care, opportunities will arise for health care workers who can offer creative solutions to improve service delivery. 

“For nurses, we currently have something called the Nursing Innovation Fund where individuals can apply for a wide variety of developmental things like attending workshops, conferences and training programs. We process 2,500 applications a year,” said Mr. Bigenwald. 

The Ministry of Health hopes the future sees a health care system that adds to the province’s economy rather than drains it. 

“We spend $17 billion a year on health care. We never looked a the health care system as an economic motor in the past. The question we are asking right now is ‘why can’t an Ontario firm make the carpets, beds, sutures etc?’, said Mr. Bigenwald. 

Ms. Robinson said “Governments are running out of money and can’t increase funding. They will be looking for more partnerships in the private sector. In this climate, creative solutions to health care delivery have a great opportunity.” 

Sunday
Jan312016

Magazine Stories | Toronto 1992

 

By David South

Flare Magazine (Toronto, Canada) 1992

Time Machines

While many designers are telling us to don platform shoes and love beads, the man behind London-based Hi-Tek watches is looking even further back in time - drawing his inspiration from classic visions of the future.

Hi-Tek’s stainless steel timepieces bring to mind early futuristic films such as Lang’s Metropolis and Chaplin’s Modern Times with their grotesque exaggerations of modern machinery. That era’s confusion, fear, or simple wonderment at new technology influenced everything from toasters to steam trains.

For the equally economically and technologically turbulent ‘90s, Hi-Tek designer Alexander has captured this sense of techno-wonder with watches, sunglasses, and other hip accessories. One watch looks as if a Cuisinart hit it, leaving gears strewn across the face. Another has a retractable lid like an astronomer’s observatory. Yet another tells time with the blinker of a radar screen. Despite their made-exclusively-for-James-Bond appearance, all cost less than $190. Available at Possessions in Montreal, Body Body in Toronto, and D and R in Vancouver.


By David South

The Financial Post Magazine (Toronto, Canada), May 1992

Too Black

They’ve sold their hip clothing designs out of their basement and out of the back of their car. Now the young designers and marketers behind Toronto’s Too Black Guys can boast that their wares are being sold out of film-maker Spike Lee’s shop in Brooklyn, as well as five other funky U.S. stores from Washington to L.A.

Neither of the co-owners studied fashion - Adrian, 24, holds a BA in economics and Robert, 23, studied marketing at community college. Still, they have designed their own T-shirts, jeans, baseball caps and sweatshirts, and the message is at least as important as the medium.

“They forgot to ask my name and called me negro,” reads a typical shirt. Earl Smith, the manager at Lee’s Brooklyn shop, says he loves the clothes but adds that customers often ask his staff to explain what the thought-provoking garments mean.

Other stories from the 1990s:

An Abuse of Privilege?

Aid Organization Gives Overseas Hungry Diet Food

Artists Fear Indifference From Megacity

The Big Dump: CP's New Operational Plan Leaves Critics with Questions Aplenty

Casino Calamity: One Gambling Guru Thinks The Province Is Going Too Far

Counter Accusations Split Bathurst Quay Complex: Issues of Sexual Assault, Racism at Centre of Local Dispute

Do TV Porn Channels Degrade and Humiliate?

The Ethics of Soup: Grading Supermarket Shelves - For Profit

False Data Makes Border Screening Corruptible

Freaky - The 70s Meant Something

Health Care in Danger

Is the UK Rushing to Watch TV Porn? 

Lamas Against AIDS

Land of the Free, Home of the Bored

Man Out Of Time: The World Once Turned On the Ideas of this Guelph Grad, But Does the Economist John Kenneth Galbraith Know the Way Forward?

New Student Group Seeks 30 Percent Tuition Hike

Oasis Has Arrogance, A Pile of Attitude and the Best Album of 1994

Peaceniks Questioning Air-raid Strategy in Bosnia

Philippine Conference Tackles Asia's AIDS Crisis

Playboy ‘is not for sad and lonely single men’

Porn Again: More Ways to Get Off, But Should We Regulate the Sex Industry?

Safety at Stake

Somali Killings Reveal Ugly Side of Elite Regiment

Starting from Scratch: The Challenge of Transition

State of Decay: Haiti Turns to Free-market Economics and the UN to Save Itself

Study Says Jetliner Air Quality Poses Health Risks

Swing Shift: Sexual Liberation is Back in Style

Take Two Big Doses of Humanity and Call Me in the Morning

Taking Medicine to the People: Four Innovators In Community Health

Top Reporters Offer Military Media Handling Tips

Traffic Signs Bring Safety to the Streets

TV's Moral Guide in Question - Again

UK Laws on Satellite Porn Among Toughest in Europe

Undercurrents: A Cancellation at CBC TV Raises a Host of Issues for the Future

US Health Care Businesses Chasing Profits into Canada

Will the Megacity Mean Mega-privatization?

Will Niagara Falls Become the Northern Vegas?

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Saturday
Jun132015

False data makes border screening corruptible

 

“Big Brother” system could violate rights of Canada’s visitors

By David South

Now Magazine (Toronto, Canada), May 21-27, 1992

New technology that can spew out a person’s life history in less than six seconds is now available to Canada’s customs and immigration officials.

And while Canada customs and immigration officers say this toy is a boon – replacing the need to memorize names of so-called undesirables – civil rights workers and refugee activists point out that the gizmo could have serious consequences, with little recourse.

The technology is called PALS, or primary automated look out system, and is already in operation at airports in Toronto, Montreal, Calgary, Winnipeg, Ottawa and Vancouver.

PALS’ operation is based on the use of computer-readable passports. Canada is one of several countries that have started including computer strips on passports and identity cards. Officers use PALS by either keying in a special number printed on the passport or identity card or using a scanning machine to read the strip.

The system went into effect at Toronto’s Pearson airport on January 20, after a three-year pilot project in Vancouver, adding Canada to the 11 countries that have machine readers for passports. Under the old system, customs officers combined judgement, questioning and the most-wanted list to decide if a passenger required further interrogation and search.

During a demonstration of the system, customs officials at Pearson airport boast about the system’s role in apprehending a drug smuggler in PALS’ first week of operation.

Sinister sign

But to civil libertarians with experience of such systems in other countries, PALS has a sinister implication. Many say that PALS spews out what is fed into it. And depending on the country involved, what is fed into it may not necessarily be true.

While customs emphasizes PALS’ role in apprehending popular targets like drug smugglers, terrorists and child kidnappers, its reach also includes people who have smuggled in too many cigarettes or bottles of alcohol, convicted criminals who have finished serving their time, immigrants, refugees and a range of petty offenders.

All of these face a second interrogation and detention based on what their governments have decided to incorporate into the computer strip. And it is this that worries civil libertarians and refugee workers.

Consider the case of a legally sponsored Portuguese immigrant who arrived at Pearson just after PALS had been introduced. He was detained based on information stored in PALS. His immigration lawyer Ali Mohideen recalls how the man was held because of a cheque that he bounced in his native Portugal about eight years ago.

Ed Lam, director of research for the Canadian Ethnocultural Council, feels customs and immigration already have “too many powers.” He regularly receives complaints from visible minorities and immigrants who feel they are singled out for harassment at the airport.

“This is big brother. Legal protection is not enough,” he argues. “It leads to costly court battles with the government. I would like to see an ombudsperson or complaints bureau set up. As for refugees turned back at the border, we will never hear from them.”

False data

Other critics, especially those in the US, where a PALS-type system has been in operation for more than a decade, worry that the system will simply accept information given by tyrannical governments.

“It is hard to trace false information to a foreign government,” says Jeanne Woods, legislative counsel to the American Civil Liberties Union, which monitors abuse under the United States system.

“People have been accused of being communists or terrorists who have denied it. The El Salvadoran government is one example of a regime which has called prominent human rights activists and lawyers terrorists.”

She would like the Canadian Parliament to pass a law similar to one passed last November in the US requiring the state department to report to Congress when somebody is denied access because they have been called a terrorist, so that the origin of the information can be tracked.

The Canadian database draws its information from several sources, according to customs spokesperson Suzanne Bray. The sources include immigration records and the Police Information Retrieval System, which is a database shared between customs and the RCMP.

Bray refuses to divulge any other sources, citing security, but both RCMP and customs operate their own intelligence services, sharing information with their counterparts all over the world, especially the US. Information is also drawn from the Canadian Security Intelligence Service (CSIS) and its sister organizations such as the CIA. However, CSIS spokesperson Ray Boisvert says they have adequate safeguards against false information provided by countries known to be human rights abusers.

“CSIS does look at bias in intelligence reports,” he says.

The US equivalent of PALS has been criticized after several cases of abuse were detected. Gara LaMarche, executive director of the Fund for Free Expression, a project of US-based Human Rights Watch, has documented abuse on political and ideological grounds.

“The US public has a right to hear dissenting views under the first amendment of the Constitution,” he says. “I don’t think improving the technology of border control violates civil liberties, but keeping a massive database of information which includes people’s political associations is bad.”

Similar concerns are expressed by John Tackaberry of Amnesty International in Ottawa, which is only now beginning its own analysis of PALS. “We have concerns over data input, who controls information and basic civil liberties.”

Even as Canadian civil rights activists take stock of PALS, Canada customs is planning to use it to check cross-border shopping by expanding the system to all land entry points.

As for those visitors who feel wronged by PALS, they may have a problem seeking redress from such organizations as the Canadian Human Rights Commission. A spokesperson says the CHRC can only help those who have been admitted to Canada. And visitors turned back at the border are not considered admitted.

Sherry Gerstl, a customs superintendent responsible for the implementation of PALS at Pearson, says that people can also appeal to the Privacy Act to see information that is kept on them. But two fact sheets explaining how this can be done are located in a corner, pretty much out of public view.

Bray acknowledges that “honest” passengers could face the prospect of a search with PALS, but given its positive attributes, she says, passengers involved in such delays should simply “grin and bear it.”

"False data makes border screening corruptible": Now Magazine 1992

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Saturday
Jun132015

Top reporters offer military media handling tips

 

Ryerson’s course on handling media has raised eyebrows

By David South

Now Magazine (Toronto, Canada), November 12-18, 1992

The whimsical Certificate of Military Achievement hanging in the offices of the Ryersonian newspaper at Ryerson journalism school is testament to the warm relationship between the armed forces and one of Canada’s top journalism schools.

But a two-month crash course in journalism for military public affairs officers hosted by Ryerson this summer has left a bad taste in the mouths of some participants and critics.

The course, which involved 18 soldiers, included two weeks of classes in each of print, radio and TV journalism, wrapping up with two weeks of “crisis management” training. The 60 instructures included such prominent journalists as Ann Medina and Pamela Wallin.

According to an administration newsletter, the course netted Ryerson more than $350,000. Organizers say the course was merely an exercise in familiarizing soldiers with the needs of working journalists. But given the often conflicting roles of the military and the media, some fear journalistic ethics may have taken some collateral damage.

“The course had nothing to do with national defence or the armed forces,” says course teacher and organizer Shelley Robertson. “They just wanted to understand the roles of journalists from the other side. The military didn’t ask us to teach what we teach our students.”

Robertson says the course also benefited the participating journalists by giving them contacts in the military.

But according to media critic Barrie Zwicker, the exercise blurs what should be the distinctly different interests of journalists and the military. “It’s similar to press and politicians. By getting close to the politician, journalists can get information they couldn’t normally obtain. The negative side is that the media can get sucked in and lose a larger perspective. The same tensions exist with covering the military.

Managing media

“It’s up to the media to break the rules and try and get the story. The military always wants to hide its victims. If a Ryerson journalist strikes up a friendship with a public affairs officer, will the reporter be true to their journalistic tradition?”

Colloquially known as spin doctors, hype-meisters and flak catchers, public affairs officers perform much the same tasks in the military as their civilian counterparts in industry and government – including managing information that gets to the public or media.

In the past, Canadian soldiers had to go to the US for special training at the Defense Information School at Fort Benjamin Harrison. But, according to Robertson, the armed forces were looking for a Canadian spin.

With 4,600 Canadian peacekeepers now stationed around the world, including a contingent in the dangerous and volatile former Yugoslav republics, the chances for conflict – and casualties – have increased.

Lieutenant-commander Glen Chamberlain, who helped coordinate the course, says the military’s increased profile means that the forces have to become more adept at media relations. “There is a great desire among Canadians to know what troops on peacekeeping duties are up to. We have a wonderful story to tell.”

Chamberlain says he works on journalists’ behalf with stubborn military commanders. “The armed forces are finding there is a real benefit to having specialized PA officers. We want to help journalists to tell our story well.”

The crisis management section of the course offered participants a hands-on approach to managing journalists. The officers were presented with two scenarios – a murder at Moss Park armoury and a highway helicopter crash – and then practised handling a group of journalists investigating the events.

Course lecturer Kevin Donovan, who covered the Gulf war for the Toronto Star, remembers the effectiveness and sophistication of PA officers in the field.

“When I was in Riyadh, Saudi Arabia, I walked into a hotel and on the wall were pool reports – news briefs written by US military public affairs officers – that journalists were encouraged to use for stories. There were some journalists going out into the field to cover stories, but a huge number just sat in this beautiful hotel.”

Stop information

Donovan feels uncomfortable about teaching on the course.

“I was asked by Ryerson to give a talk on my experiences in Saudi Arabia, Kuwait and Iraq,” he says. “My initial reaction was no. I hate the existance of public affairs people with a passion. Their job is to stop information.

“I’m uncomfortable with Ryerson being hired by the department of national defence. One officer in the course got very upset when I told them to make contacts with the media and leak stories.”

Course organizer Clive Vanderburgh admits organizers had concerns about conflicts between the role of journalists and military officers. “There was a lot of discussion concerning the potential for conflict – especially that the people hired to teach might think they were there to help the department of national defence to avoid the media

“But we were trying to give a general understanding of the media’s needs. We didn’t sell the country down the drain.”

Another teacher was Robert Fulford, the well-known writer and lecturer on journalistic ethics. “I don’t have a problem with Ryerson teaching the military,”says Fulford. “It’s a way of spreading journalistic technique to people in the DND. It seems to be a natural extension of the work of Ryerson.

“Canadian journalists are ignorant of the military and could do with getting closer. You almost never find a full-time journalist in Canada who knows anything about them. The more you know about the military, the less you will be manipulated.”

But Gideon Forman, coordinator of the Canadian Peace Alliance, fears Ryerson may be helping the military mislead the public.

“Why do these guys practise handling the media so much of there’s nothing to hide? This is just better packaging for the military so they can get what they want from the public.

“I have problems with public money being spent teaching the military to be more effective with the media, while other organizations have their budgets cut or eliminated.

“Is there a similar program for food banks or women’s shelters?”

"Top reporters offer military media handling tips": Now Magazine, November 1992

Note on story context: This story was researched and written after two key events involving Canada's military: the first Gulf War from 1990-1991; and the Oka Crisis in 1990, where the Canadian Armed Forces confronted an armed group of Mohawk "Warriors" in Oka, Quebec.  

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