2. domiciliary
hostels services and standards services
et normes relatifs aux centres d’accueil |
That Council:
1.
Approve the Domiciliary Hostel Standards for
incorporation into contracts with Domiciliary Hostel Operators, and;
2.
Request the Minister of Community and Social Services
and the Minister of Health and Long Term Care to review recommendations of the
2002 report of the Mental Health Implementation Task Force and make a final
decision as to the disposition of the Domiciliary Hostels and related funding
issues.
RECOMMANDATIONS
DU COMITÉ
Que le Conseil :
1.
approuve
l’inclusion des normes relatives aux centres d’accueil proposées dans les
contrats des exploitants de centres d’accueil.
2.
demande
au ministre des Services sociaux et communautaires et au ministre de la Santé
et des Soins de longue durée d’examiner les recommandations du rapport de 2002
du Groupe de travail sur la santé mentale et de prendre une décision finale au
sujet des centres d’accueil et des problèmes de financement connexes.
DOCUMENTATION
1.
Deputy City Manager, Community and Protective
Services report dated 8 February 2006 (ACS2006-CPS-HOU-0002).
2.
Extract
of Minutes, 16 February 2006.
Report to/Rapport au :
Health, Recreation and Social Services Committee
Comité de la santé, des loisirs et
des services sociaux
and Council / et au Conseil
8 February 2006/le 8 février 2006
Submitted
by/Soumis par: Steve Kanellakos, Deputy City Manager/Directeur
municipal adjoint,
Community and Protective Services/Services communautaires et de
protection
Contact
Person/Personne-ressource : Russell Mawby, Director/directeur,
Housing/Logement
(613) 580-2424 x/poste 44162,
russell.mawby@ottawa.ca
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SUBJECT: |
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OBJET : |
SERVICES ET NORMES
RELATIFS AUX CENTRES D’ACCUEIL
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That Health, Recreation and
Social Services Committee recommend that Council:
1. Approve the Domiciliary Hostel Standards
for incorporation into contracts with Domiciliary Hostel Operators, and
2. Request the Minister of Community and
Social Services and the Minister of Health and Long Term Care to review
recommendations of the 2002 report of the Mental Health Implementation Task
Force and make a final decision as to the disposition of the Domiciliary
Hostels and related funding issues.
Le Comité de la santé, des loisirs
et des services sociaux recommande au Conseil :
1. d’approuver
l’inclusion des normes relatives aux centres d’accueil proposées dans les
contrats des exploitants de centres d’accueil.
2. de
demander au ministre des Services sociaux et communautaires et au ministre de
la Santé et des Soins de longue durée d’examiner les recommandations du rapport
de 2002 du Groupe de travail sur la santé mentale et de prendre une décision
finale au sujet des centres d’accueil et des problèmes de financement
connexes.
Domiciliary Hostels, also known as Residential Care Facilities, provide permanent housing and supports to vulnerable individuals who are not able to live independently in the community. The majority of residents of domiciliary hostels have mental health issues; a smaller group are considered frail elderly.
The City of Ottawa, through the Housing Branch, provides subsidies for approximately 850 clients who reside in 25 facilities.
The subsidies are provided to the
operators through a per diem contract.
The program funding is 80/20 cost shared with the Provincial Ministry of
Community and Social Services (MCSS).
The total 2006 budget for the program is $6.6 million; the City’s
portion is approximately $1.5 million.
The operators provide the following services in accordance with a contract with the City:
The Housing Branch negotiates and monitors the contracts, including regular and complaint-driven site visits to ensure compliance with basic standards in providing the above-mentioned services.
The funding envelope also covers services from Employment and Financial Assistance (EFA) staff who:
This report responds to Council direction to:
BACKGROUND
At its meeting of October 7, 2004, during consideration of a report from the Health and Social Services Advisory Committee respecting Mental Health in Ottawa, HRSS approved direction to staff to:
1. Develop policies and procedures for domiciliary housing that ensure quality of life standards for residents
2. support better coordination between domiciliary houses and the City’s programs and agencies;
3. Better assist people to move from Ontario Works to Ontario Disability Support Program
And, in the longer term,
4. Lobby
the provincial government for sustained programs and associated funding and
resources to provide sufficient supportive housing for those living with
chronic mental illness as well as to establish better systems of coordination,
improved funding and long-term strategic planning for community mental health
services in Ontario.
On January 20, 2005 HRSS Committee and subsequently Council received for information an interim report, Mental Health in Ottawa: Domiciliary Hostel Services. This document is the final report outlining the work done in response to Council’s direction.
In response to the Council direction of October 7, 2004, the Housing Branch initiated extensive consultation with domiciliary hostel operators, community stakeholders and other City Staff that has resulted in the following:
1. Development of Domiciliary Hostel Standards
In late 2004, the Housing Branch convened a work group in order to develop client-focused standards for the operation of a domiciliary hostel service. Members of this group included domiciliary hostel operators, City staff (Housing and EFA) as well as representatives from the Royal Ottawa Hospital, Canadian Mental Health Association, and Carlington Community Health Services Assertive Community Treatment Team. They reviewed practices in other communities, the minimum standards in the current service agreements, and concerns expressed by community stakeholders in order to develop formal standards of service. In addition, at various times throughout the past year, City staff received feedback from subsidized residents that informed the development of the Standards.
The Standards were then presented and accepted at a meeting of all domiciliary hostel operators held on October 7, 2005.
The Standards comprehensively articulate an acceptable standard of service delivery across domiciliary hostels covering the following areas:
Compliance with the Standards will improve the quality of life for residents by ensuring greater consistency in service delivery, increased accountability and improved collaboration among operators, City staff and the community stakeholders.
New service agreements with operators incorporating the Standards were prepared for signing in January 2006. Procedures to govern implementation of the Standards will be completed by the end of February 2006. The Standards will then be implemented and used to monitor service delivery across the sector. Implementation will include site visits and the creation of remedial action plans. As the Standards are implemented, work will begin on developing internal policies and procedures for program administration. This work should be completed by December 2006.
2. Improved coordination between domiciliary hostels the City and community agencies
In addition to producing the Domiciliary Hostel Standards, the work group meetings mentioned above have resulted in increasing understanding and collaboration among the community stakeholders and operators. While scanning the services provided across the sector, the work group was able to identify systemic client service issues and critical service gaps. Issues that could not be addressed in the Standards document were tabled for action through an alternative process. Stakeholders and operators were then asked to commit to developing this process by forming a Domiciliary Hostel Resource Network to begin meeting in February 2006.
This Network will review the critical service gaps identified during the standards development process, such as access to community services for residents with mental illness. The Network will then examine options for addressing those gaps by sharing best practices and resources. The overall goal is to improve and maximize community services for domiciliary hostel residents within current resource limits, while building sector capacity by engaging key stakeholders, including residents.
In the interim, some key actions have already taken place, such as:
o resource information sharing at the operator’s meeting in October 2005, where presentations were provided by ODSP and OW staff;
o free training offered by City staff specifically for front line domiciliary hostel staff in food handling (held in December 2005), and in infectious disease control (scheduled for February 2006);
o customized training in mental health issues, provided by a community assertive treatment team to a domiciliary hostel (June and July 2005); and
o access to Homelessness Community Capacity Building training sessions for staff and volunteers of agencies that work with homeless and at-risk populations (e.g. sessions on medication administration, HIV and diversity in the workplace).
The Network will build on these key actions. It is anticipated that Housing Branch with EFA staff will initiate the Network’s meetings in February 2006 and that meetings will take place at least quarterly.
3. Better access to Ontario Disability Support Program and benefits.
Although EFA does not administer the Ontario Disability Support
Program (ODSP) in Ottawa, EFA staff
does facilitate the transfer from Ontario Works (OW) to ODSP. In
2005, EFA saw a 50% increase in successful transfers of domiciliary hostel
residents to ODSP and a 50% improvement overall in the length of time it takes
to process transfers, compared to 2004.
EFA will continue to monitor this process.
In addition, EFA continues to work with ODSP to improve access to benefits in general.
For instance, in March 2005, after meetings with EFA and Housing Branch staff,
ODSP agreed to extend the provision of special diet benefits to ODSP recipients
resident in domiciliary hostels.
4. Domiciliary Hostel Sustainability Issues
Despite the provincially initiated 3% increase to the domiciliary hostel per diem in 2004, operators continue to report to City staff that the per diem funding alone is still inadequate for anything except minimal service. Although operators worked in good faith with City Staff and community stakeholders to create the new Standards, they raised serious concerns about:
While funding for domiciliary hostel services is provided through the Ministry of Community and Social Services, the funding and delivery of mental health services continues to be in the purview of the Ministry of Health and Long Term Care (MOHLTC). Since 2002, operators have been waiting for the MOHLTC to release the Mental Health Implementation Task Force report, which would have contained clear guidelines and recommendations for a revised funding structure for services such as domiciliary hostels.
Lack of resolution of this issue has created uncertainty and increased pressure at both the administrative and operational level and according to operators, threatens the long-term viability of this valuable supportive housing sector.
On September 22, 2005, Housing Branch staff met with the Ontario Homes for Special Needs Association representing domiciliary hostel operators from across the province. At that meeting local operators repeated their concerns and specifically requested that City Staff ask Council to advocate on their behalf with the MOHLTC and the MCSS. Such a response on the part of Council will reinforce similar requests submitted to the Ministry by other jurisdictions, such as the City of Windsor, advocating for domiciliary hostels in their communities.
As highlighted in this report, City staff together with both domiciliary hostel operators and community stakeholders are taking concrete actions to improve the quality of life for domiciliary hostel residents. As a next step, it is proposed that Committee and Council approve the Domiciliary Hostel Standards for implementation.
Furthermore, as a good faith response to the request from domiciliary hostel operators, it is requested that Council petition the Minister of Community and Social Services and the Minister of Health and Long Term Care to review recommendations of the 2002 report of the Mental Health Implementation Task Force and make a final decision about which Ministry is responsible for domiciliary hostel services and their funding issues.
There has been consultation around the proposed Domiciliary Hostel Standards with all domiciliary hostel operators, interested community mental health advocates and the City’s Employment and Financial Assistance, Fire, By-Law and Public Health Branches.
The information in this report was taken to the HSSAC on January 31, 2006 for discussion. HSSAC is supportive in principle of the process, report and recommendations. The HSSAC sub committee will review the report in detail on February 14, 2006 and prepare comments for HRSS.
Document 1- Domiciliary Hostel Standards (previously
distributed and on file with the City Clerk)
There are no financial implications for the recommendations in this report.
The Community and
Protective Services Department will implement the directions of Council.
Domiciliary hostelS
services and standards
SERVICES ET NORMES RELATIFS AUX CENTRES D’ACCUEIL
ACS2006-CPS-HOU-0002 CITY WIDE / À L'ÉCHELLE DE LA VILLE
Connie Woloschuk, Manager of Residential Services, provided committee with a brief overview of the report, the more salient points of which are as follows:
· domiciliary hostels provide permanent housing and supports to vulnerable individuals who are not able to live independently in the community, but which do not require the kind of health care that requires a nursing home and is cost-shared 80/20 between the Ministry of Community and Social Services (MCSS) and the City
· funding is provided by the MCSS but it was believed this funding would move to the Ministry of Health and Long Term care as a result of recommendations from the Mental Health Implementation Task Force report in 2002
· there are approximately 850 subsidized residents at any time in 25 facilities in both urban and rural areas of Ottawa ranging in size from 7 to 124 beds; there is a budget for domiciliary hostels of over $6M with 20% contributed by the City.
She further identified four deliverables, which resulted from Council direction in October 2004:
Development of the domiciliary hostel standards - the standards were developed (and endorsed) in consultation with the operators, a community reference group and input from residents. This consultation resulted in a much better understanding and sense of collaboration among all stakeholders. This year, there will be a formal review of hostel operations in the areas of administration, resident services and the environment in the facilities. Staff will work with operators for any remediation plans that should be put in place.
Improved coordination between domiciliary hostels, the City and community agencies - a community resource network has been formed to allow stakeholders to work more closely.
Better access to the Ontario Disability Support Program and benefits - the Employment and Financial Assistance Branch facilitates the transfer of clients from Ontario Works to ODSP; there has been a 50% improvement in the transfer rate in 2005.
An identification of all the sustainability issues around the domiciliary hostel services – in spite of funding concerns, domiciliary hostel operators have been extremely supportive and collaborative in developing the standards. They will provide consistency across the board, drawing attention to the actual funding issues. Funding issues are the result of an increase in the level of supervision that is needed because of mental health issues. In order to offer an increased level of service, operators need a different kind of staffing model with more adequate wages, training for appropriate staff, etc. Staff expects that funding issues will become more evident through the standard review.
Ms. Woloschuk concluded her presentation by emphasizing the frustration of stakeholders stemming from the lack of resolution regarding which Ministry will assume responsibility of domiciliary hostels.
Bill Bijl, Vice President of Ontario Home for Special Needs Association (OHSNA) spoke in support of the domiciliary hostel standards; he believed these standards were similar to those in Windsor which are part of a by-law and include enforcement provisions. He spoke to funding for domiciliary hostels with specific reference to the per diem, which has increased from $34.10 in 1994 to $41.20 in 2005. He indicated that the services offered by domiciliary hostels include 24-hour care, three meals per day and snacks throughout the day, distribution of medication, housekeeping, personal laundry, recreational activities and crisis and prevention. He strongly supported the approval of the report and its recommendations, as well as an urgent request to the Province to increase the per diem to $51.
Responding to Mr. Bijl’s recommendation to increase the per diem, Russell Mawby, Director of Housing clarified that part of staff’s task of implementing the standards outlined in the report is to identify the necessary funding for domiciliary hostels. He felt that the notice forthcoming from the Province would recognize the appropriate level of funding.
Phil Brown, Chair, Health and Social Services Advisory Committee reinforced their support for the standards included in the report. They had one concern and that was with respect to a brochure that could be developed for residents of domiciliary hostels to help them better understand their rights. He added that while the standards will enable providers, families and residents to put forth complaints more effectively, residents may not be fully aware of all the details in the standards or they may feel disempowered due to a sense of vulnerability. He suggested the possibility of a pamphlet offered to residents of boarding homes, which was developed by the Resource Development Committee at the Carlington Community Health and Resource Centre or suggested the City could develop a brochure with the members of the community resource network. A copy of the Advisory Committee’s submission is held on file.
In response to these comments, Mr. Mawby agreed there was a need for a brochure and other kinds of information and he advised that this would be part of the agenda of the community resource network. In response to the suggestion made by the first delegation, he confirmed that staff would bring a report to Committee with respect to their findings on the appropriate level of funding for domiciliary hostels within the next year.
That Health, Recreation and Social Services Committee recommend that
Council:
1. Approve the
Domiciliary Hostel Standards for incorporation into contracts with Domiciliary
Hostel Operators, and;
2. Request the Minister
of Community and Social Services and the Minister of Health and Long Term Care
to review recommendations of the 2002 report of the Mental Health
Implementation Task Force and make a final decision as to the disposition of
the Domiciliary Hostels and related funding issues.
CARRIED