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Category "Politics"

12Jan

‘The poverty children face is often hidden from us,’ say agencies helping the 20 per cent of B.C. kids who are poor

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As she bounces nine-month-old Delilah on her knee, Amber Hawse pauses reflectively before answering a question about what she thinks she and her baby will be doing in five years.

Hawse, 20, hopes by then to have graduated from college and to have a job as a special-needs support worker. Delilah will be in kindergarten. And they will live together in their own place with enough money for food, basic expenses and peace of mind.

Her goals may seem modest, but the reality is that 20 per cent of children in B.C. live in poverty and their families struggle to provide the necessities of life, especially in Metro Vancouver with its sky-high cost of living.

Hawse knows this well, as a foster child who lurched from home to home, some of them abusive. At age 16, she was living on her own in an apartment run by a social service agency, learning to budget her meagre government payments while attending high school.

The well-spoken, thoughtful young woman hopes Delilah will not be trapped in a similar cycle. She wants to provide her daughter with financial and emotional stability — which starts with them remaining together.

“I grew up with no dad and no mom, so I don’t want to let her grow up with (being) in care and getting her abused. I want her to know she is always loved,” Hawse said, fighting back tears.


Amber Hawse, 20, with nine-month-old daughter Delilah at Aunt Leah’s in New Westminster.

Poverty and other challenges facing youth, particularly in Metro Vancouver’s inner cities, were the focus of a recent brainstorming session during which dozens of service agencies and community members came together to discuss the root causes and possible solutions to these often multi-generational crises.

“People can easily become immune to seeing homeless people on the streets, but the poverty that children face is often hidden from us,” said Jennifer Johnstone, president of Central City Foundation, which organized the Hope Dialogue Series session. “And that makes (the depth of) child poverty a surprise to people sometimes.”

The Downtown Eastside has become the focal point, with many drawn there by its plethora of low-rent buildings and free food services. But poverty exists in many other pockets of Metro Vancouver, and affects the children of struggling parents as well as children without parents.

172,550 poor kids in B.C.

The statistics, say Central City, are stark:

• One in five of all B.C. children — 172,550 kids — lives in poverty, and that jumps to one in three for off-reserve Indigenous children.

• Nearly half of recent child immigrants are impoverished.

• Half of children in poverty are raised by single parents, mostly by mothers.

• Youth aging out of foster care are 200 times more likely to become homeless before the age of 25.

And research shows that disadvantaged children can be delayed mentally and physically due to a lack of nutrition, are more likely to struggle in school and end up unemployed, and are more prone to suffer from addictions and mental illness.

The trend is improving, though, as a quarter of all B.C. youth were impoverished a decade ago, compared to 20 per cent now, according to First Call’s annual Child Poverty Report Card. B.C.’s child poverty rate has been higher than the Canadian average for at least two decades, although that gap is narrowing.

Some of B.C.’s recent improvements can be credited to the new Child Tax Benefit introduced by Ottawa in 2016, and also promising are recent commitments by provincial and federal governments to adopt poverty-reduction plans, increase affordable housing, boost the minimum wage and introduce affordable daycare.

But there is more work to do to try to overcome the systemic marginalization that has led to this poverty — such as colonialism and residential schools that have brought a disproportionate number of Indigenous people into the Downtown Eastside, Johnstone said.


Jennifer Johnstone, president and CEO of Central City Foundation.

Arlen Redekop

The October brainstorming session, which included groups such as the Urban Native Youth Association and the Aboriginal Mother Centre, was just the beginning of a very important conversation, she added.

“When we come together and see possibilities, that is the hope for change,” Johnstone said. “The children are the stewards of our future.”

Schools are more than education

Schools increasingly provide more than education to impoverished youth, especially in inner cities. But during long school breaks, at-risk children can be left without enough food, fun activities or emotional support to keep them safe during the day while their parents are working.

To bridge this gap, a unique organization called KidSafe runs full-day camps during Christmas holidays, March break and the summer at six east Vancouver schools, so 450 vulnerable children have a safe place to go each day for three healthy meals, fun activities and continued access to important services.


Children at a KidSafe camp.

“The (camps) provide continuity for things like nutrition, healthy adult relationships, just somebody having eyes on a child,” said KidSafe executive director Quincey Kirschner, who attended the Hope Dialogue session.

“The demand is ever-increasing, and it is so awful to not have enough resources to be able to provide service to all the kids and families who need it.”

Poverty is one of the reasons some children are referred by teachers and others to KidSafe, but there are other factors as well, such as emotional vulnerability, she added.

For six years, Krista Ericson has relied on the three seasonal camps to help with her four children, who are in Grades 1 through 6 at Grandview/¿uuqinak’uuh Elementary in east Vancouver. The camps provide much-needed respite for the single mother, who fostered and then adopted the four Indigenous siblings who have a range of diagnoses that include fetal alcohol syndrome and attention deficit hyperactivity disorder.


Krista Ericson at Grandview school in Vancouver. (Arlen Redekop / PNG staff photo)

“The support during the (school) breaks is life-saving to me,” said Ericson, who added it is difficult to keep the active, high-needs children at home all day. “To think of trying to find out-of-school care for four children, I couldn’t afford it. I couldn’t afford full-time camps in the summer.”

She does not work outside the home, mainly because her days are consumed with hospital appointments and other commitments for the children.

Ericson lives in subsidized housing, shops for food that is on sale and in bulk, and is grateful for a myriad of programs — ranging from Backpack Buddies, which provides food to families for the weekends, to charity hampers and donated gifts at Christmas — that help her make ends meet.

When her children see other people with cellphones or trendy clothing, Ericson has her oft-repeated line: “I tell my kids, ‘That’s their family, and we do it differently in our family.’” She also uses the opportunity to teach her children that, although they live a modest life, they are better off than other students who don’t have enough food to eat or a safe place to sleep at night.

One of her top priorities is to include a lot of Indigenous culture in their home lives.

Indigenous culture creates ‘doorway into wellness’

After the brainstorming session in October, Central City compiled a summary of what they heard from the 100 people in attendance, and found that programs with cultural components, such as connections with elders and Indigenous languages, have been successful because they create “a doorway into wellness and community building.”

Other initiatives that are making a positive difference, the attendees said, were those that connect youth with relatives and meaningful people in their lives, as well as programs in which non-profits and service agencies work together to provide more comprehensive support to children.

The Central City summary also determined what isn’t working: Governments too often fund programs that treat problems once they start, rather than preventing them; a lack of affordable housing can lead to poverty and families losing their children; and there isn’t enough transition planning for youth aging out of care, who experience disproportionately high levels of mental illness, substance use and unemployment.

Aunt Leah’s Place, a New Westminster charity, has been helping children who age out of care for three decades, but 10 years ago it added a new element: soliciting financial support from foundations, corporations, governments and others to obtain specialized housing.


Aunt Leah’s executive director Sarah Stewart in New Westminster.

“That was done based on trends we saw around more and more young people who are aging out becoming homeless,” said president and CEO Sarah Stewart. “What we didn’t plan for is the opioid crisis — that’s been a double whammy for these young people. … They are dealing with daily grief connected to people they know who have died.”

Aunt Leah’s provided services to 345 youth last year — 41 foster children under age 19, 208 who had aged out, and 96 of their babies and children.

“The reality for youth aging out of foster care today is a lot of hardship,” said Stewart, who also attended the Hope Dialogue session.

There has been positive change in the last few years, such as free tuition and financial support for foster children to attend post-secondary schools. The provincial government has also expanded a program that will fund more life-skills training for these youth.

But, Stewart said, more subsidized housing is needed, along with better co-ordination between government agencies — such as education, health and child welfare — to look out for this population.

‘Just do what parents do’

The key to supporting youth coming out of care is simple, she argues — just do what parents do.

“Aunt Leah’s tries to replicate what families are doing for their kids,” Stewart said. “Parents are providing tuition, transportation, food, housing well into their 20s, so that is what we are doing. And that is what government should be doing.”

Hawse, though, was cast adrift. After being asked to leave her last foster home, the then-16-year-old moved into an apartment run by Aunt Leah’s, where teenage foster children live on their own but have access to support and training programs.


Amber Hawse, 20, with daughter Delilah at Aunt Leah’s in New Westminster.

“For the first couple of nights that I was by myself, I cried because I wasn’t used to being in a house alone,” she said. “It’s very lonely.”

She received government funding of $70 a week for groceries, and learned to buy food on sale and collect grocery store points to get items for free. She also worked part-time while completing high school — a remarkable accomplishment, as less than half of foster children in B.C. graduate from Grade 12.

When she turned 19, Hawse was newly pregnant but had to leave her Aunt Leah’s apartment funded specifically for foster kids. She moved into emergency housing for several months before Aunt Leah’s could offer her a room in a building for new mothers.

She is getting by, for now, able to buy food, diapers and other necessities with the employment insurance and federal child tax she is collecting while off work with her baby. She hopes to return to her job at a local daycare, and to attend college next year to become a community and classroom support worker.

“I’ve been through a lot,” Hawse says. “But there is light at the end of the tunnel.”

Some solutions for the future

Central City’s Johnstone says there are reasons to be optimistic. For example, her organization, which is a major sponsor of Aunt Leah’s, is also backing a unique new youth initiative in Surrey that will have a school program and government social workers located in the same place as a sort of one-stop shop for vulnerable kids.

And there are other organizations, such as Vancouver Native Health, launching innovative programs in the Downtown Eastside designed to keep families together, she said.

The summary from the brainstorming session came up with some solutions to work toward, although nearly everyone interviewed for this story admits there is no obvious quick fix to the deep-rooted problem of child poverty.

The goals for the agencies include expanding programs to support the family as a whole, not just the child alone; enlisting graduates of youth programs to return as mentors; and creating more hubs where multiple services can be offered in one place to at-risk families.

At Family Services of Greater Vancouver, many clients in the family preservation program are parents trying to keep their kids after the children’s ministry documented some type of child protection concern. Staff help them with a myriad of things, ranging from housing, daycare and community resources, to help with trauma, domestic violence or addictions.

“For many of our families, poverty is an issue and that becomes a barrier for everything. They don’t have money for housing, food or your basic needs,” said Susan Walker, a family preservation manager, adding that stress affects everything from going to school to having a healthy family relationship. “Poverty stops people from moving forward.”


Karen Dickenson Smith (right), director of specialized family supports for Family Services of Greater Vancouver and Susan Walker, manager of clinic services for family preservation.

The agency, which also attended the Hope Dialogue session, has joined with others to advocate for major changes. Karen Dickenson Smith, director of specialized family supports, said these include embedding support workers into more “creative” types of housing, larger subsidized homes to allow extended families to live together, better compensation for foster parents, and higher wages in the social services sector to reduce turnover and ensure continuity of care for youth.

“System change takes time. We’ve seen some really encouraging developments, but we are a ways off and there is a lot of work to do,” said Dickenson Smith.

Added her colleague, Walker: “Poverty is not going to end overnight, but if you have subsidized housing and people are given the opportunity to get the work they need to do in life to get a job, that can allow children stability.”

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9Jan

B.C. nurses against tentative deal want more staff, not more money

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There are hundreds of nursing vacancies posted on the HealthMatch B.C. website, but not even the union knows how many more jobs need to be filled.


There are hundreds of nursing vacancies posted on the HealthMatch B.C. website, but not even the union knows how many more jobs need to be filled.


Christopher Furlong / Getty Images files

A vocal group of frustrated nurses is threatening to reject a three-year tentative contract with the provincial government because it doesn’t come with written guarantees that more nurses will be hired for short-staffed hospital units.

The voting deadline for the tentative deal is Jan. 21 and, as Postmedia stories have been documenting contract details this week, nurses have been voicing their concerns in emails and on social media that the deal doesn’t go far enough to hold employers to account.

This, even though the Health Employers Association of B.C., which negotiates on behalf of the government, agreed to a provision in the $3.99-billion contract in which nurses working on short-staffed units will be given an hourly bonus ranging from $3 to $5 an hour. The “working short” premiums could cost taxpayer-funded health facilities as much as $100 million a year, according to the union bargaining team which insists that it is putative and is, therefore, a huge incentive for hospitals to fill vacancies.

The cost of the premiums is considered an “unfunded liability” to health employers so amounts owing to nurses would come out of hospital and other budgets already allocated by the provincial government. It remains to be seen whether the ministry of health would hand over more money to health authorities to cover the premiums.

Naysayers are skeptical that the premiums will achieve their purpose; some say it will still be cheaper to pay the premiums than to hire new nurses. Nearly $200 million was paid in overtime to nurses last year.

Health Employers spokesman Roy Thorpe-Dorward said in an interview that the agreement “requires employers to take all reasonable efforts to fill shifts, including going to full overtime rates.

“The working short premium is intended to compensate nurses who are required to work short if a shift can’t be filled. The goal of employers is to minimize the number of times this premium would be paid.”

Related

There are hundreds of nursing vacancies posted on the HealthMatch B.C. website but not even the union knows how many more jobs need to be filled, so the contract provides for a workload assessment process over the next year meant to show what “safe staffing” levels are for each hospital unit. The union can also press for more hirings in other ways, as it did at St. Paul’s Hospital last year.

The “working short premium” as it is called, will kick in on April 1, 2020 and B.C. Nurses Union CEO Umar Sheikh has said that many of the 6,000 casual nurses should be converted to regular, permanent positions to help plug the “four million hours” when hospitals are short staffed.

B.C. Nurses Union CEO Umar Sheikh.


B.C. Nurses Union CEO Umar Sheikh.

PNG

Sheikh acknowledged it may be difficult to find and hire enough registered nurses, registered psychiatric nurses and licensed practical nurses. Recent reports by the Canadian Nurses Association and the Canadian Institute of Health Information show that nationally, there is an alarming slowdown in the growth of employed nurses.

The annual growth rate fell to 0.7 per cent from 2016 to 2017, the slowest in a decade. In 2017 (the last year for which data is available), a total of 4,271 nurses were registered for the first time in B.C., but in the same year 3,135 retired, so there was a net gain of only 1,136 nurses. By comparison, Ontario had net gains of 1,941 nurses and Alberta had 1,183.

Nurses say they can’t speak on the record during the ratification process but they have been reaching out in droves — off the record — to articulate their worries.

B.C. Nurses Union president Christine Sorensen.


B.C. Nurses Union president Christine Sorensen.

Wayne Leidenfrost /

PNG

In a comment posted under a news story, Teresa Johnson-Fortune said:

“We have been working short staffed for years and the government has not lived up to their previous contract negotiations. The current health care system is run based on nurses doing crazy amounts of overtime. We are tired, but most of us do overtime because we feel bad for our co-workers and don’t want to leave them working short.”

Sheikh told his union members the working short premiums are high enough that hospitals will be compelled to hire extra staff rather than pay it. For example, the $5 per hour premium represents an 11.38-per-cent wage increase on top of the 7.75-per-cent increase nurses will get over three years. (Although the contract calls for a two-per-cent increase each year, an extra 1.75 is due to nurses this year as a carryover from the last contract.)

“The working short premium represents a commitment by the employers — (one) we haven’t seen before.”

Nurses union president Christine Sorensen told members in the same teleconference that the understaffing in hospitals is “simply unsustainable.” The contract addresses priorities nurses identified before bargaining, she said, including compensation for all time worked, wage increases, benefits protection, workloads and safe staffing levels, and a premium “for those times when you did not have staff (on leaves) replaced.”

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8Jan

‘Abuse is possible’ with B.C. nurses’ unlimited massage benefits

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Unlike most other public and private employees, nurses do not have a limit on the number of massages they and their family members can get each year and there are no co-pays.


Unlike most other public and private employees, nurses do not have a limit on the number of massages they and their family members can get each year and there are no co-pays.


David De Lossy / Getty Images files

The B.C. Nurses Union is investigating how one nurse’s family managed to use $174,000 in massage therapy benefits over the course of a year through the taxpayer-funded extended benefits plan.

This amid a raging controversy triggered by news that public health care employers spent $31 million in nurses’ massage therapy costs in 2017, a 900-per-cent increase from 2008.

Unlike most other public and private employees, nurses do not have a limit on the number of massages they and their family members can get each year and there are no co-pays; massages are 100 per cent employer paid at rates up to $110 per hour.

According to BCNU contract bargaining documents, a disproportionate number of nurses are using most of the massage benefits. Twenty-one per cent ate up 82 per cent of the expenditure on massage therapy.  The vast majority — 80 per cent — of union members used less than $1,000 per year in such benefits.

But there are cases of apparent abuse, according to nurses union CEO Umar Sheikh.

In a town hall question and answer teleconference for nurses soon after the tentative contract was reached last month, he told union members that under the system of unlimited massages “abuse is possible.”

He cited the $174,000 case and said at that rate, the nurse and his or her dependents would have had 1.8 massages per day. There is a provision in the nurses union benefits package to curb such egregious spending but the language is vague, with reference to “reasonable and customary limits” on such perks.

 

Sheikh said there is no proposal to revoke massage therapy for “vulnerable” nurses who need them for medical and preventive purposes, but the proposed review to take place over the next year would consider whether to introduce a cap to curb the exponential growth in costs to publicly funded hospitals and other health care facilities.

Massage therapy is a popular health and wellness treatment approach and many have said it can help nurses reduce stress and its associated symptoms, not to mention relieve muscle and joint pain. B.C. has eight schools for massage therapy training and there are about 400 new registrants each year. In 2015, there were 4,183 active registrants, up from 3,653 just two years earlier.

The Registered Massage Therapists Association of B.C. said the “significant rise” in massage therapy use is attributable to studies showing evidence of benefits, an increase in the public’s interest in non-surgical and drug-free treatments and higher educational standards among therapists.

According to companies that specialize in health benefits, private companies and public employee plans typically have limits on the dollar value or number of massages that are covered per year. A recent survey showed that the upper limit of coverage in the most elite plans is $400 per person. The B.C. Public Service Benefits Guide shows that employees can claim up to $750 a year per person for massage therapy.

Sanofi Canada Healthcare Surveys have shown that massage therapy is one of the fastest growing benefits and that nearly half of those who have extended health care benefits filed at least one claim for massage therapy. The steady growth in the use of employer-sponsored massage therapy has caused much consternation and navel-gazing in the insurance industry. Green Shield Canada, which calls itself Canada’s only national not-for-profit health and dental benefits company, recently posted this commentary: We Spend More on Massage than Mental Health Services…Time For A Change?


B.C. Nurses Union CEO Umar Sheikh.

PNG

Green Shield Canada has initiated a rethink on massage benefits, removing it as a core benefit in its new SMARTspend plans, as they are called, “in order to reinvest significant funds in more serious health challenges.”

Under siege Tuesday from angry nurses who read the first Postmedia story about the tentative contract, Sheikh declined to be interviewed. On social media channels, some nurses were vociferous in their protests over some elements of the agreement, including the plan to consider capping massage benefits.

Nurses are also angry that Sheikh said the average annual wage for nurses is about $45 an hour. For the 36,420 registered nurses in the B.C. Nurses Union, it is currently $42.35, according to a union factsheet. For 9,229 licensed practical nurses, the average in 2018 was $29.42. If nurses approve the tentative agreement by the Jan. 21 deadline, licensed practical nurses’ wages on April 1 would range from $27.87 per hour to $32.46 per hour, depending on job descriptions and experience. Registered nurses and registered psychiatric nurses would be paid anywhere from $34.83 to $55.18 per hour.

While nurses’ benefits are part of their collective agreements, in other health care unions there are joint benefit trusts that are co-managed by union and employer-appointed trustees who get funding from employers that is fixed to a percentage of the payroll.

Roy Thorpe-Dorward, spokesman for the Health Employers Association of B.C., said “no benefit costs are unlimited.”

“Working together, both parties (unions and employers) are motivated to operate efficient and sustainable benefits plans that provide the best possible benefits for employees,” he said, adding that historically health sector agreements have included caps on “paramedical” expenses such as massage therapy.

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7Jan

B.C. nurses negotiate pricey premium designed to force additional hiring

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A tentative contract negotiated by the B.C. Nurses’ Union for over 50,000 nurses is rich with bonuses that could far exceed the contract’s $3.99 billion in base costs paid by taxpayer-funded hospitals and other health facilities.

Details of the tentative agreement obtained by Postmedia show significant gains made by the BCNU. The deadline for ratification of the 2019–2022 contract by registered, psychiatric and licensed practical nurses is Jan. 21.

While the base wages stick to the government-framework of two per cent wage increases each year for public sector workers, the new contract compels health authorities to beef up staffing by filling hundreds of nursing positions that have been left vacant.

On average, nurses make about $45 an hour, but there are wide variations depending on experience and training.

If heath authorities do not hire more staff, nurses who are shouldering the burden of working in short-staffed units will be entitled to premiums ranging from $3 to $5 an hour. The premiums could cost taxpayers as much as $100 million a year, according to the union.

The amount is not included in the costs of the contract. It is considered an “unfunded liability” to health employers, so costs would come out of hospital and other budgets allocated by the provincial government.

The “working short premium” as it is called, will kick in on April 1, 2020 and is meant to force health authorities to get their staffing up to “safe patient care” levels and convert many of the 6,000 casual nurses into permanent positions, according to BCNU CEO Umar Sheikh.

“We think we are four million hours short of the proper level of patient care across the province. Health employers will now be the masters of their own fate,” Sheikh said.

While some nurses prefer to have casual positions for their flexibility, Sheikh said 13 per cent of the workforce are casuals, a proportion he maintains is far too high.

Nearly $200 million was paid in overtime to nurses last year and that, according to Sheikh, is a reflection of staffing shortfalls.

HealthMatch B.C., the government-funded agency that recruits health professionals from around the world, lists about 250 nursing vacancies in B.C. this week but that figure does not reflect the entire complement of vacancies since not all positions are posted. HealthMatch said it recruited 79 nurses from outside B.C. last year.

Sheikh acknowledged it may be difficult to find and hire enough nurses. But he said an assessment process will take place in the next year to help determine optimum staffing levels in various settings, based on patient needs. That means that staffing should be higher on units where patient illnesses are more severe.

Management in hospitals and other facilities should be keen to fill vacancies sooner than later if they want to avoid the “unsustainable” hit their budgets could take because of the working short premiums.

Under the tentative agreement, nurses will also be paid for every minute they work. Since nurses say they often do administrative work after their shift ends, a paid end-of-shift bonus will stop the “normalization” of unpaid work. For the first 15 minutes of such work (usually done as nurses are handing off patients to the next shift), nurses will be paid at their straight time rate of pay. When they work more than 15 minutes, they will be paid at an overtime rate.

Michael McMillan, president-CEO of the Health Employers Association of B.C., which negotiated the contract with the BCNU, could not be reached for comment. But Roy Thorpe-Dorward, a spokesman for the association, said no one there would comment until the contract is ratified.

Sheikh said there was more trust and goodwill in this round of  bargaining.

“I wouldn’t call this a scare tactic at all, I would say it’s more of a leap of faith,” he said, referring to the premiums which he said McMillan and health employers agreed to “because they are the right thing to do.”

“I applaud their courage.”

While the new contract mostly rewards those in the nursing profession, there is one nurses’ job benefit that may not be as lucrative in the future — massage therapy.

According to BCNU figures, massage therapy costs have jumped by over 900 per cent in the past 10 years. Nurses and their family members are entitled to unlimited massages and the benefit now accounts for 1.2 per cent of all payroll costs.

Sheikh said the annual cost of taxpayer-funded massages increased from $3 million to $31 million in the past decade. In the past three rounds of bargaining, the government and health employers have raised the issue of skyrocketing massage therapy costs and now the union has agreed to consider a cap or some other formula to bring such costs down.

Nurses will be consulted over the next year on possible changes to their extended health benefit plans. Under one option, they would have a flex benefit plan that would limit how much nurses and their family members spend on massage services while using cost savings there to improve vision, dental and drug benefits.

While nursing is known to be physically and emotionally draining, it is not clear why health employers and the government, many years ago, agreed to fund unlimited massages for nurses’ family members as well.

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4Jan

BC reduces or eliminates deductibles for many Fair Pharmacare clients

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Health Minister Adrian Dix announced that as of Jan. 1, B.C. households earning up to $30,000 in net income annually no longer have to pay a Fair PharmaCare deductible.


Nick Procaylo / PNG

B.C. has eliminated Fair Pharmacare deductibles for families earning less than $30,000 and reduced deductibles for families earning between $30,000 and $45,000.

Low-income seniors and individuals will see co-payments eliminated, meaning their prescriptions will be fully covered by the plan, if they qualify, said Health Minister Adrian Dix.

Before the new rules kicked in Jan. 1, families that qualified for Fair Pharmacare would have to pay some of their prescription costs out of pocket before receiving coverage.

A family with an annual income of just $11,250 would have paid $200 before Pharmacare would begin to pay. Households with a net annual income between $15,000 and $30,000 were paying $300 to $600 out-of-pocket before coverage assistance began.

Ministry data show that people in income bands affected by the deductibles were skipping their prescriptions, possibly to pay for other living expenses, said Dix.

“No one should have to make the difficult decision between their family’s health and putting food on the table,” said Dix. “We know that for many working households, needed prescriptions were going unfilled too often because Fair PharmaCare deductibles were too high.”

A 2014 study by the Institute for Research on Public Policy found that seniors were particularly poorly served by income-based pharmacare coverage. B.C. switched from age-based coverage in 2003 to contain rising program costs.

Faced with paying the full price of prescriptions until the minimum threshold of $1,000, B.C. seniors have been less likely to fill prescriptions, said lead author Steve Morgan, director of the Centre for Heath Services and Policy Research at the University of B.C.

Several Canadian studies have found that British Columbians were twice as likely to report skipping medications for financial reasons (7.1 per cent, according to one study) compared seniors in Ontario, where their drug costs are minimal.

When people skip medications for chronic conditions, the costs tend to turn up in other parts of the health care system, such as more frequent hospitalization.

Fair Pharmacare serves about 240,000 families in B.C., including people in long-term residential care and income assistance clients. The average drug expenditure per patient is about $1,600 a year.

The provincial government has budgeted $105 million to pay for coverage improvements.

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4Dec

Impasse between Fraser Health and hospice continues

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A year after Fraser Health told hospices and other care facilities to stop transferring clients for medically assisted deaths, the Delta Hospice Society continues to openly defy the edict.

Operators of many palliative care hospices — even those that are non-denominational — refuse to provide medical assistance in dying (MAiD) because they contend it conflicts with their principles that death shouldn’t be hastened.

Freedom of information documents (FOI) obtained by Dying With Dignity show there appears to be ongoing confusion about the process when it comes to patients seeking MAiD in facilities like the Irene Thomas Hospice in Ladner (operated by the society) that don’t want to provide it.

Each month, patients in pain are being moved from hospices to places like Queen’s Park Care Centre in order to get their dying wishes respected, the documents requested by Dying With Dignity reveal. The problem with transfers is that they’re uncomfortable and distressing for patients and their families.

“The documents speak to why Fraser Health made its decision late last year (to compel MAiD to be provided where patients reside), and they also complicate the Delta Hospice’s narrative that forced transfers for MAiD are not harmful and not a significant problem,” said Dying With Dignity’s spokesman Cory Ruf.

“I would say that the conflict between the health authority and the hospice is unique and potentially nationally significant. I’m not aware of any instances of a hospice battling a regional health authority over the provision of assisted dying,” he said, referring to the fact that Delta Hospice Society leaders have repeatedly stated they will not provide MAiD. The society’s leaders couldn’t be reached for comment Tuesday but in previous interviews Delta Hospice society operators complained they were victims of Fraser Health bullying and MAiD activists who want the service provided in all hospice palliative care facilities.

The FOI documents show that just over 20 per cent of MAiD deaths in the region between June 2016 (when MAiD became legal) and December 2017 (when Fraser Health told facilities to stop making transfers) involved a transfer from a hospice. During that 18-month period, 107 people reportedly used MAiD in the Fraser region. And of those, 27 involved transfers to homes, hospitals and other facilities so the service could take place. 

“This number is astounding,” said Ruf, adding that while transfers are occurring across the country since many faith-based facilities are opting out of MAiD, hospices haven’t been given an exemption since they’re usually non-denominational.

“As an organization, we find it extremely problematic that people at end of life are being discouraged from getting, or are being denied access to, hospice palliative care simply because they’re considering a request for MAiD.”

Hospices are places where individuals go to receive palliative care for pain and symptom management of their life-limiting illnesses. Average stays are usually about two weeks. The goal is to offer physical comfort and emotional support at the end of life when dying is a “normal” process.

Fraser Health didn’t respond to questions about the controversy Tuesday, nor did the Ministry of Health.

The Ladner hospice has a contract with Fraser Health to supply 10 beds; it derives a sliver under half its income from the health authority while the rest comes from charitable donations and fees.

Ruf said transfers aren’t unique to Fraser Health. Dr. Ellen Wiebe, a Vancouver MAiD provider, said her patients are being transferred from hospices “on the last day of their lives.”

“People are in hospice because they are at the end of life and cannot manage at home. In hospice, they have comfortable private rooms with staff to help them. To be forced to transfer into a wheelchair or stretcher, travel by van to another facility, and then transfer to another bed can be exhausting and excruciatingly painful for someone at the end of life. In the last hour of his life, one of my transferred patients had to wait for an elevator beside three men using jackhammers. Another was so weak and exhausted after the trip that, although he had transferred himself at the hospice, he could not do so at the other facility and fell. This kind of suffering is preventable and unacceptable.”

On Vancouver Island, Dr. Tanja Daws said there are no non-denominational, non-Catholic hospital or hospices in Comox to deliver MAiD to her patients and in one case recently an individual had MAiD in the lobby of a funeral home while another had to be transferred from a hospice to a conference room where the board table and other furniture had to be moved around. “The janitor was just outside, in the hallway, and we had no choice but to try to keep him away.” 

The FOI documents Ruff obtained show that there have been complaints over various matters, including one family being told in error that paying for the transfer was their responsibility when in fact that facility doing the transfer is obliged to pay.

“One social worker with the FHA’s MAiD program wrote that a transfer involved moving mountains and expressed concern that these policies don’t represent a patient-centred approach to care,” he said.

The federal legislation states that no individual can be compelled to provide medical assistance in dying. But it doesn’t define where assisted dying should be provided. It’s up to provinces and health authorities to figure out how to deliver services and to create policies.

The federal governments latest report on MAiD shows that across Canada there were 3,714 MAiD deaths from December 2015 to the end of 2017. Hospitals and homes are the preferred setting, each accounting for about 42 per cent of MAiD cases while hospices account for only three per cent of cases in Canada (five per cent in B.C.) B.C. and Ontario led the country in MAiD cases. There were 365 cases in the last half of 2017 in B.C. and about 100 more than that in Ontario.

Alex Muir, a Dying with Dignity volunteer in Vancouver, has sent a letter to the premier, health minister and other B.C. officials, describing procedures that are limiting access to MAiD. Patient transfers are a big problem, he says, because if a frail person nearing the end of life needs hospitalization and paramedics take them to St. Paul’s, a Catholic-based Providence Health facility, then they won’t get MAiD there since the hospital has been given a religious-based exemption by the province.

Patients must then be transferred to Vancouver General Hospital or some other facility. 

“The transfer itself can be physically brutal for the patient and emotionally draining to that person and their loved ones,” he said.

As well, since patients awaiting subsidized residential-care beds can’t always choose the facility where they will be admitted, they may end up in one that doesn’t allow MAiD, “again resulting in a forced transfer if they choose this path.”  

The forced transfers should end, Muir says.

“While the government has allowed clinicians who oppose MAiD to opt out of directly participating in it, this right should not be afforded to facilities. An individual has a conscience. Bricks and mortar do not,” Muir said.

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23Nov

Deadline to return referendum ballots to Elections B.C. extended

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13Nov

ICBC says concussions and mental health injuries fall under new claims cap

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VICTORIA — Concussions and mental health problems caused by an automobile crash will be considered a “minor injury” and fall under the new $5,500 cap on pain and suffering, according to new rules set by the provincial government.

Attorney General David Eby signed a cabinet order that declared sprains, strains, aches, cuts, bruises, minor whiplash (including forms called TMJ and WAD), concussions and mental health issues caused by vehicle crashes to be designated minor injuries under new caps that begin April 1, 2019.

The inclusion of concussions and mental health has worried some lawyers and health care practitioners opposed to the cap, who say it can take a long time for symptoms of brain damage, depression or post-traumatic stress to show  and that the long-lasting effects are not minor for those suffering.

In response, the Insurance Corp. of B.C. said it has set special rules for concussions and mental health injuries. ICBC will consider them to become major injuries not limited to the $5,500 pain and suffering cap if they persist for more than four months, said the president and CEO, Nicolas Jimenez.

“The advice we got from the medical community is they are trickier to diagnose and trickier to, quite frankly, treat, so we are better to proceed cautiously and put them on a short time frame,” Jimenez said.

Other minor injuries — whiplash, sprains, etc. — will only be considered major if they are still problems after 2 months.

ICBC cites medical research that indicates approximately 85 per cent of people with mild concussions fully recover within three months.

Doctors of B.C., which represents physicians, was consulted on the timeline and agrees with ICBC, said president Dr. Eric Cadesky.

“When we look at things like concussions, pain and the emotional consequences of a car accident, four months is a good indicator of whether those conditions are going to improve or not,” he said.

The NDP government passed legislation to set the insurance caps earlier this year in an attempt to save more than $1 billion annually from the cash-strapped public auto insurer, reduce the rising costs of claims and prevent ICBC rate hikes. Broken bones and other more serious injuries do not fall under the $5,500 pain and suffering cap.

B.C. was the last province in Canada to have a fully tort-based insurance claims system, frequently leading to lengthy and costly court cases. Disputes over the new caps on pain and suffering claims will first go to a new civil resolution tribunal process that’s mainly been used for strata disputes. People can still sue for such things as the cost of future care and loss of wages.

To compensate for the cap, the government has raised significantly raised the fees ICBC pays for medical treatment, and added kinesiology, acupuncture, massage therapy and counselling to the list of approved services. Drivers at fault in a crash will also get full medical care costs, instead of lesser benefits outlined in the old rules.

But B.C.’s Trial Lawyers Association, which has opposed the cap, said the latest details remain troubling. Even with a four-month time frame for concussions and mental health, the new regulations set a steep definition of “incapacity” that a person will need to suffer to be considered as having a major injury, said lawyer Ron Nairne, the incoming president of the association.

That incapacity definition includes being unable to work, go to school or complete the “activities of daily living” defined in the rules as preparing your own meals, managing finances, shopping, using public transportation, cleaning your home and managing your medication.

“That is so narrowly defined that it will be very difficult for people to escape the definition of minor injury based on that particular provision,” said Nairne.

He said it appears government is trying to set rules that “capture the majority of claims” as minor, and concussions along with mental health should be excluded.

“There’s no such thing as a minor concussion because concussions are a form of brain injury,” said Nairne. “The government is doing the exact opposite, and deeming these to minor injuries.”

Other reaction was mixed.

The Physiotherapy Association of B.C. said Tuesday the changes are a positive step because ICBC is expanding the list of treatment providers and fees to enhance psychotherapy recovery.

But ROAD B.C., an organization that represents some other types of health care providers, said the new definition of minor injury is beyond what most British Columbians would consider fair.

One other change in the new rules set by Eby is that government has dropped a proposal to allow motorists to spend an extra $1,300 a year for additional insurance to get a cap of $75,000 on minor injuries.

“It was an idea,” said Jimenez. “But it’s not something that was embraced and put into our policy framework.

“These are really complicated changes, and I think quite frankly we are proceeding on the basis of get the system change in, and we’ll monitor and evaluate as we go.”

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9Nov

Remembrance Day 2018 | Vancouver Sun

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Worn by everyone from young children to aging veterans, the poppy has been a symbol of respect and gratitude for the last century. But when you see all the poppies on lapels today, you may also want to consider: Who sells the poppies and why, who benefits from the proceeds, and what more can be done in Canada to support veterans and their families.

1. Poppy sales and programs they support

Thick rows of poppies grew over soldiers’ graves in Flanders, France, and were the inspiration for the now famous poem that Canadian medic Lieutenant-Colonel John McCrae wrote on a scrap of paper in 1915 during the First World War. Today, most schoolchildren can recite the first two lines of McCrae’s poem: In Flanders fields the poppies blow, Between the crosses, row on row. The poem was also the inspiration for wearing poppies on lapels every November as a sign of remembrance.

Thousands of volunteers with the Royal Canadian Legion sell these poppies across Canada each year. In the 2016 Poppy Campaign, more than 21.5 million poppies were distributed, and $16.7 million in donations were used to support veterans and their families between October 2016 to October 2017.

The poppy sale proceeds provide financial assistance to veterans in need in many ways, including:

  • Grants for food, living expenses, medication, emergency shelter.
  • Housing and care facilities.
  • Programs that help veterans transition from military to civilian life.
  • Accessibility modifications to help veterans with disabilities.
  • Educational bursaries for children, grandchildren and great-grandchildren of veterans.
  • Community drop-in centres, meals-on-wheels, and seniors services in areas with many veterans.
  • Administering Remembrance Day activities.


Annual Remembrance Day ceremony at the Victory Square Cenotaph in Vancouver, BC Saturday, November 11, 2017.

Jason Payne /

PNG

2. Veterans by the numbers

There are 649,300 veterans in Canada:

  • 48,300 served in the Second World War or Korean War.
  • 601,000 are Canadian Armed Forces (CAF) veterans, from regular and primary reserves.
  • B.C. has the third-highest number of veterans with 91,700, behind Quebec (120,600) and Ontario (235,700).
  • 10 per cent of veterans are women.

Average age

  • 93 — Second World War
  • 86 — Korean War
  • 60 — Regular CAF
  • 55 — Primary Reserves

Changing demographics

  • Veterans Affairs Canada provides services to about 18 per cent of Canadian vets for issues such as disability pensions or rehabilitation services. Since 2010, it has assisted more modern-day CAF veterans than traditional war service veterans.
  • In 2017/18, services were provided to 20,139 war vets and 96,644 CAF vets.
  • By 2022/23, that difference is expected to increase as war vets continue to age, when Ottawa anticipates serving only 5,500 of them, but 119,700 modern-day CAF vets.

Afghanistan

More than 40,000 Canadian Armed Forces personnel were sent to Afghanistan, the largest deployment since the Second World War. The mission ended in 2014.

  • There are 16,500 Afghanistan veterans, and 10,550 of those receive disability benefits.
  • Mental health conditions were the most common reason for disability benefits, followed closely by PTSD (post-traumatic stress disorder).


FILE PHOTO: A Canadian Armed Forces soldier fires an M72 light anti-tank weapon at the Kabul Military Training Centre range in Kabul, Afghanistan on November 4, 2013.

Sgt Norm McLean /

Sgt Norm McLean

3. Royal Canadian Legions: then and now

Legions organize poppy sales and support for veterans, but as the veteran population declines so, too, do legion memberships. Across Canada, the number of members peaked in 1984 with 602,500 but dropped to 550,000 by 1996, according to a Vancouver Sun story written at the time. Today, legions count just 270,000 members across Canada, but are trying to get that number back up to 300,000, said David Whittier, executive director of the B.C. Yukon Command.

The trend has been similar in the B.C.-Yukon region:

  • 2010 — 66,000 members and 152 branches
  • 2016 — 57,000 members and 149 branches
  • 2018 — 45,000 members and 147 branches

There are about 5,000 new members registered a year in B.C. and Yukon, Whittier said, but that’s not enough to offset the number who leave each year. The biggest growth has been in affiliate members — those joining the legion without a military background — who now represent more than 30 per cent of the local membership. The other members include veterans and active CAF (24 per cent) and their relatives (44 per cent).

To retain existing members and attract more, the B.C.-Yukon branches have explored changes to some locations to make them more popular with younger generations, such as a coffee shop model with lattés and free Wi-Fi.

“We really want to reach out to veterans of all ages and eras, and we really want to reach out to their families and the community,” Whittier said.

A slide show prepared for the legion’s 2017 convention, entitled New Era, New Legion, discusses new potential revenue streams such as bakeries, lunch-box delivery services, and community shuttle services. It said one branch makes $20,000 annually by holding farmer’s markets.

Suggestions also include trying to recruit new members through commercials, and transit advertising, and through new creative evening activities such as open-mike, trivia contests and dance lessons.

Whittier’s message is that people should consider joining the legion for all the good community work it does, such as those programs supported by poppy sales. “The legion does a lot of really tangible, useful things,” he said.

4. The War Amps turn 100

The War Amps, which began helping military amputees, now raises money to help a variety of people who have lost a limb, including children. Some of its history:

1918: On Sept. 23, 1918, the Amputation Club of British Columbia held its first meeting for war amputees, the start of many similar groups that would form across Canada and eventually amalgamate into a national organization.

1932: The War Amps and four other veteran groups lobbied the federal government for improved rights for war veterans, especially those with disabilities.

1946: The Key Tag Service began. It raises money and also provides jobs for amputees, who make the identification tags that Canadians attached to valued items. To date, 1.5 million sets of lost keys have been returned to their owners.

1962: The War Amps started to help all Canadian amputees, not only war veterans.

1975: The CHAMP program was started to offer support services to child amputees and their families, including financial assistance, regional seminars and connections with peers.

2016: In this year alone, there were 1,072 amputees enrolled with the War Amps, and it granted 3,355 requests for financial help to buy prosthetics.

2018: On its 100th birthday, the War Amps says it is serving an increasing number of amputees. “There is still much to do to ensure amputees have the artificial limbs they need to lead independent and active lives,” its website says.

5. How and where to celebrate Remembrance Day

The B.C.-Yukon Legion website lists the details of 150 Remembrance Day ceremonies happening across the province on Nov. 11.

There are seven events in Vancouver. One of the most popular is the ceremony and parade that begins at 9:45 a.m. at the Victory Square Cenotaph downtown, which has major historical significance. The tiny park was filled with recruiting tents for the First World War, and later soldiers returned there to re-enact the conditions in the trenches and to fire rockets into the air in an effort to raise money for charity. In 1922, the park was named Victory Square and the cenotaph was built two years later.

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4Nov

Pressure on B.C. government to recognize physician assistants

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On the other side of most B.C. borders — four U.S. states plus Alberta — patients can see a physician assistant for many health concerns.

But not in B.C., where the province does not recognize physician assistants as health professionals, even though they’re trained to do some of the same work that family doctors do.

Pressure is mounting, however, now that B.C. Green leader Andrew Weaver has become a vocal champion of physician assistants.

In a speech he gave recently to the annual conference of physician assistants in Victoria, he called them a “largely untapped resource” in B.C.

Weaver told Postmedia News that he’s a supporter because with hundreds of thousands of B.C. residents unable to find a family doctor, physician assistants “are a good way to provide highly skilled services in the medical system.”

Weaver said he’s using the agreement the Green party has with the NDP to press for recognition of physician assistants so they can practice in B.C. and be regulated by the College of Physicians and Surgeons of B.C.

The agreement calls for the expansion “of team-based health care, to ensure that people have better access to the type of care they need, including access to services from physiotherapists, nurse practitioners, midwives, dietitians, pharmacists and other health professionals.”

Physician assistants could be part of that team-based care, he said.

With family doctors in short supply in B.C., the College of Physicians and Surgeons of B.C. has said it is ready to regulate physician assistants as soon as the provincial government gives its OK.

Often called physician extenders because physicians delegate work to them, thus improving physician productivity, physician assistants have two years of training after undergraduate degrees. The program is offered in Canada by various institutions like the Universities of Toronto, McMaster University and the University of Manitoba.

Just over 600 physician assistants are working in clinics, communities and hospitals in a handful of provinces and territories, qualified to do physical examinations, take medical histories, order tests, prescribe certain medications, and assist surgeons before, during and after surgeries. Their taxpayer-funded salaries range from about $75,000 to $150,000, comparable to what nurse practitioners earn.

Physician assistants have been used extensively in the Canadian military for five decades, on military bases and missions abroad. Some companies, such as those in the energy and mining fields, employ them for occupational health, advanced first aid and other employee health care needs.

But because B.C. has not amended the Health Professions Act to recognize and regulate them, the Canadian-trained assistants can neither be used by companies here nor be hired by doctors here. (Some large medical practices use internationally trained doctors in a similar assistant role but they are not physician assistants who’ve passed the Canadian exams).

Eric Demers is one such physician assistant. He recently retired from the Canadian military after a 23-year career, the last seven as a physician assistant taking care of navy and army personnel.

He said that since he is too young to retire entirely at age 44, he wants to get back to work diagnosing, prescribing and treating under the supervision of physicians.

“I’ve had five deployments abroad to places like the Balkans, Afghanistan and Libya and I’ve served on various submarines. It’s disheartening to know that I can’t employ my skills and knowledge as a civilian.”

Demers said there are companies in B.C. that are interested in hiring physician assistants at no cost to taxpayers, so “designating or recognizing us doesn’t mean that there would be an expense to the government.”

In the military, Demers worked in hospitals in Vancouver and Nanaimo after agreements were struck between Canadian Forces and health authorities. And, when the military was called in to assist while B.C. forests were burning, “we weren’t limited to who we provided treatment to.

“So I don’t know why we are facing this challenge getting recognized by the B.C. government.


Physician assistant Kashif Mushtaq, left, speaks with patient Kyle Fiorini, at Hotel-Dieu Grace Hospital emergency department in Windsor, Ont. physician Assistant is a recognized profession in Ontario.

Janisse, Dan /

City

The Canadian Medical Association and Doctors of B.C. have been in favour of the physician assistants for years. At the recent annual conference of Stone’s group in Victoria, Dr. Kathleen Ross, president-elect of Doctors of B.C., said physician assistants would be “an important support for doctors and patients.”

Yet the B.C. Ministry of Health has for years put its focus on nurse practitioners as part of its team-based primary care strategy despite studies showing that a broader scope of health professionals are needed to improve access for patients.

Last year, a report from the Conference Board of Canada said physician assistants are “a largely untapped resource that can help governments continue to provide high levels of service while reducing overall system costs.”

Health minister Adrian Dix was not available for an interview. But Laura Heinze, a spokeswoman for the minister, said while the government will continue to review how physician assistants might be integrated into the health care system, “our current focus is to maximize the effectiveness of the (already regulated) professions that we have right now in B.C.”

In the legislative assembly recently, Dix repeated that nurse practitioners were the first priority but the government plans to revisit the use of the physician assistants at some point.

Trevor Stone, president of the Canadian Association of Physician Assistants, said it’s a disgrace that military veterans who served as physician assistants abroad and at Canadian Forces bases in B.C. cannot continue their careers when they return to civilian life.

“Putting physician assistants to work in British Columbia has been stalled for far too long,” he said. “We have members across the country who would come back to B.C. to work in a heartbeat. With better and faster access to care, it’s patients who would be the big winners.

“It’s time for British Columbia to catch up with Ontario, Alberta, Manitoba, New Brunswick and many other parts of the world,” said Stone, adding that using physician assistants, especially in rural communities, “is an obvious way to save money and improve the health of British Columbians, yet the government refuses to act.”

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