If you've worked in a group living setting, there has probably been a time when you learned about a person we support moving to a new home, and perhaps you felt like you didn't have a full understanding about why. Earlier this week we hosted a new cohort for our manager pool training, where we explained all the puzzle pieces that fit into these kinds of decisions, and we were encouraged by the candidates to share more broadly. This post may be a little longer, and a bit more technical than usual, but it's in the interest of sharing and understanding.
Some values pieces to clarify:
People have the right to choose where they live. No one moves without their say-so.
It is our desire that people are able to choose to live independently, if they wish.
Where people do live in group settings, it is our desire that we help make the best possible matches. In the best case scenarios, people who are friends would choose each other.
In cases where people want something different, we try to facilitate that.
We have a legislated requirement to ensure people's safety who are under our care.
Why do people move internally (if not for friendship)?
It's complicated. We all know that the population is aging, and with aging comes health and mobility-related issues. On paper, when a person's needs change, we update Developmental Services Ontario ("The DSO"), they re-assess a person's needs, and that person gets connected with the additional resources they need. The only problem is that there are over 20,000 people in Ontario on the waitlist for developmental services, so the funding to provide critical support increases for people does not actually exist. The DSO, the Ministry, the agency, and everyone else may agree that a person needs more support/funding, but they won't rise to the top of the priority list because they already have support, whereas others have none.
So what....
So... We are a not-for-profit agency that is required to have a balanced budget. If the person's needs have changed in a critical way, and we can't get more funding, and we can't fund it ourselves, and our values are strongly opposed to doing things like moving people to hospital or long term care, what do we do? We play the hand we've got: we support folks in the best way we can, and we do everything in our power to provide the safety, support hours, and quality care that the person needs.
How?
This is where some of the disconnect happens in terms of leadership decisions and communication that happens in a sequence. In the group living part of the organization, we are generally provided a set amount of money to provide support to a set number of people (that funding doesn't increase with inflation, or when we reach collective agreements, but that's another conversation). Each person's needs are unique and some require far more support than others. When someone leaves group living support or passes away, we are required to post a "funded vacancy" to the DSO, who then provides name(s) of people on the priority list who they think should take that vacancy. However, we have an opportunity because we can actually post a "funded vacancy" at any of the support locations we manage, it doesn't have to be at the one where a person left or passed away. This is critical because it's the only way we have to increase the level of support for a person who needs it and who is already supported in a group living home. This is why you will rarely see a vacancy filled at a home where there are many staff hours, enhanced environmental features, or at homes that are accessible: we need those resources for the people we already support, and this is why you will see the option to move offered to people whose needs aren't being met (or who appear to be headed that way). The end result is that we take this opportunities to offer internal moves before declaring the required funded vacancy, which is typically at a home with fewer support hours in place (which will only allow a person with fewer needs to be matched). By doing this, we shift the "higher value" support to the person who needs it internally, and declare something that is less complex.
What about other people on the waitlist who needed the more complex vacancy?
Exactly! Ontario does not have an entitlement model for the developmental services sector (which is truly unfortunate). You're entitled to healthcare, you're entitled to schooling, but if you're a person with an intellectual disability you are NOT entitled to support from the DS sector. People who are no longer transitional age youth (TAY) have a very difficult time getting placements in group living homes because the supports aren't there. This is likely a contributing factor to why a new class action lawsuit was recently certified in Ontario. Unfortunately, here at CLW we have no choice but to contribute to this issue because we need to prioritize safety and properly supporting the people we already serve internally with their increasing needs (which, again, are not otherwise funded).
There are new locations being renovated and new apartments being occupied. How does CLW get money for supports that get provided there?
The Ministry has a funding strategy called MYSLP, which does indeed introduce new money to communities on an annual basis. These funds are NOT provided to augment existing supports. Generally speaking, MYSLP is aimed at assisting transitional age youth (TAYs) who are turning 18 and changing over to the adult service system. In this community, that has typically focused on TAYs who are connected with the Children's Aid Society, and TAYs who are connected with Hotel Dieu Grace Healthcare through their Complex Special Needs (CSN) program. When we do develop new plans with new funding, it typically involves these groups in specific, with almost no one else being eligible.
Some take-aways
We're all people who work in social services and each of us brings a ton of heart to what we do on a daily basis. If you see moves happening, or if you glean that there are some plans in the background, please know that it's all in support of people and that we are in a constant uphill battle to get people connected with the level of support they need. You'll appreciate that conversations with people and families need to happen before we make larger announcements, and that sometimes (usually) the moves are very complex and involve multiple people. Sometimes people don't want the moves we suggest and we need to go back to the drawing board, because we always respect people's choice to say: "no, thank you."
If you ever have questions about a move, whether people were consulted and what role they had in planning for a move, or even if you are simply curious, please feel free to speak with a manager. We always share the information we can, provided that people and families are settled first in the decision-making process.
If you're interested in learning more, please feel free to reach out any time to any member of the leadership team. Also, if you made it this far- thanks for reading (sorry for the long post).
