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Aging in place

Take it with a grain of salt, but this is your future

According to the Chronicle-Herald, there are 7,821 Long Term Care beds in the province and 2,551 on the waitlist. That's 10,372.

Health and Wellness budgets $566,971,000 for its Long Term Care Program, a daily rate of $198.61 for the 7,821. That's quite a lot more than the $135 Ontario claims, so it probably includes a mix of Nursing Homes and Residential Care services. It's probably even more per bed, as some of the 7821 are self-pay

If there is a need for 2,551 more beds, that represents a further $184,930,702 or 32%

As a wheelchair user and Practical Pig, I'm very conscious of what will happen to me at the end of my life. I'm very lucky to have already considered accessibility issues. I have level access, wide doors, a roll-in shower and feel pretty confident that I can spend most of my remaining days here.

Both Health and Wellness and I are excited about this, as we won't be spending the $198.61 on me every day. In order to avoid that expense, Health and Wellness will provide in-home services at $12.65/hr, with some income-based subsidy available. For the $198.61, you'd get more than 15 hours of home care. This will work for me, hopefully for a while.  I'll need some help with the Activities of Daily Living, as they are called, but can easily see getting by on 4 hours/day or less.

  • The Province can save money if homes are retrofitted.  
  • Homeowners would prefer to stay home
  • Homebuilders can make money
Sounds like an opportunity.......

Suppose the province would subsidize your renovations (or new construction) up to, say, $6000 (30 days @ $200) on the certain bet that they will save money.  Capital and operating.  Your renovation would need to include a level entrance, a ground floor bath and bedroom, and 36" doors in between.  You'd have a good shot at doing that for $6000, and any extra would serve you well for nursing-home avoidance.

Some similar incentive can be imagined for landlords.

The Province would need to develop some minimum standards, but this is a no-brainer that will benefit the province, the construction industry, but most of all people who just want to stay at home.

An employee at CHI Franciscan Health's telemedicine center monitors far-flung patients' vital signs in Tacoma, Wash. The New York Times
By 2015, a short 10 years, the internet will become an important, if not the dominant way of delivering primary health care.  The next generation of activity trackers like Fitbits will morph into health trackers.  Home video monitoring will become ubiquitous.   Here's a recent New York Times Article.

In their accessible homes, elders avoiding institutionalization will access a range of services, from simple check-in all the way to remote physician visits and diagnosis.  Your wrist-worn health tracker will call 911 when your heart rate is out of control, and your GPS will be aware of our location if you go wandering.

Cost pressures, wider availability of broadband, increased patient loads and the uneven distribution of specialists all make this inevitable.  There will be arguments back and forth about cost and outcomes, but the horse has already left the stable.

Rather than playing catch-up-ball, Health and Wellness, Doctors Nova Scotia and The College of Physicians and Surgeons should be ahead of this trend.  It'll save money and lives.

Getting on with Business

The best medicine for any disability is self-esteem, and the best thing for self-esteem is self-reliance.

A Complicated Problem
Should we focus on jobs creation or workforce optimization?
How to deal with a growing population of people with disabilities?
Is Social Assistance a trap for some people?
How do we pay for modern accessibility standards?

I'm not in tune with provincial arithmetic, nor do I have access to all the numbers. But it strikes me there is a sensible and thrifty solution that serves Nova Scotians and not Bay Street:

In a nutshell
For every 1000 people with disabilities moving from Social Assistance to Minimum Wage or better
Savings in Social Assistance$9,840,000
New tax revenue$1,452,000
Worker Incentives-$2,000,000
Accessibility Incentives-$5,000,000
Net annual savings$4,292,000

The Details

Disability keeps a lot of Nova Scotians from working. What's seldom recognized is the fact that many are prevented from working by arbitrary barriers and rules. Examples abound - every retail business with steps and no ramp represents a place no wheelchair user can work or shop. Some businesses that want to be more accessible run afoul of counterproductive regulations. Up until 2013, people with some disabilities couldn't even get in to MLA constituency offices, let alone work. We should find a way to remove barriers to employment without causing hardship to employers. We need to get creative.

Although the following math works for anyone on social assistance, it is especially appropriate for people with disabilities, who are eagerly awaiting new legislation, but fear it will be derailed by the perception of cost. It can pay for itself and then some.

The current focus

Igate and RBC are recent out-of-province beneficiaries of taxpayer largesse. In exchange for committing to bringing jobs to Nova Scotia, the income tax revenue from those jobs is more or less refunded to the company. Details below. The notion that RBC (2014 profit $9 billion) needs the people of Nova Scotia to cough up $22 million over 10 years reflects poorly on RBC's corporate citizenship.

There is some truth that the new employees have a multiplier effect due to spending, but that's a subject of much speculation. Any multiplier effect is considerably diminished by the fact that rebates will end up on Bay Street Toronto, not Bay Street Antigonish.

Last week I wrote about the RBC deal, which nets the taxpayers of Nova Scotia $1,020,000 over ten years. I pointed out that Laurel Broten, CEO of NSBI, will earn $2.1 million over those same 10 years, leaving taxpayers $1,080,000 in the hole.

An alternative: saving more by spending less

The present NSBI strategy is just to give in to corporate demands, and the error is compounded by the neglect of opportunities to save real money by spending less. This doesn't have to be Greek-style austerity, just common sense.  Moving people from social assistance to work is an excellent investment. At the same time, making Nova Scotia businesses accessible gives them a greater selection of customers and employees. We should support our own entrepreneurs, not ones in New Jersey.

The Department of Community services budgets $387 million for Employment Support and Income Assistance. How many people are helped and at what level seems to be an Official Secret, but a rough guess is that a typical recipient is eligible for these monthly amounts:

Personal (includes food)$255
Rent - up to$535

or $9840/year.

Using that amount, how does hiring just 10 Nova Scotians with disabilities who are currently receiving social assistance compare with the NSBI deals? 

Keeping incentives local

This isn't a jobs plan, it's a people plan. We should recognize that people with disabilities have been excluded from the workforce.  For everyone's sake, we need to make better use of our human capital. The important question is the net benefit to taxpayers. Moving one person from social assistance to work can save taxpayers $11,292 a year, while subsidizing a "new" RBC job is worth just $208. In the former case, this is because every job means a savings of $9,840 (plus some administrative savings) in social assistance instead of an expense in the form of a rebate.

I'm proposing that some of the savings realized by moving people from social assistance to work be used as an incentive to home-grown employers and reward to participants. A person going from $9840/year to full-time minimum-wage employment has more use for a reward than the Royal Bank. And by encouraging local employers to make accommodations for disabled workers, we can make a permanent dent in the chronic underemployment of people with disabilities, only 47.9% of whom are employed (68.7% for everyone else).

Incentives should be well-integrated with existing training efforts and follow the principle that the money is tied to individuals, not government.  And those incentives will be spent in-province, of course, instead of vanishing and reappearing on Bay Street balance sheets.

Making it happen

Just as accessible constituency offices are a symbol of democracy, removing barriers to productive work is a symbol of equality. Figuring the cost of social assistance for disabled Nova Scotians and devising useful work incentives ought to be a priority at least as important to government as enticing some company from New Jersey to bring a few jobs to Dartmouth. We can take pride in fairness. 

Getting people from social assistance to work is complicated. Few people would choose to live in the poverty imposed by the basic allowances of the Department of Community Services. On the other hand, inconvenience, inertia and low expectations mitigate against risking a change. The nightmare stories are legion.

Consider getting to work in the first place: not all bus routes in HRM are accessible, in rural areas transportation can be nonexistent, Access-a-Bus is inflexible to the point of being useless. Or job accommodation: Employers are fearful of expenses like accessible washrooms or special tools like accessible workstations. Or the daunting 103 page rulebook controlling every aspect of your life. Independence and change can be scary, particularly when your self-reliance is untested.

Currently, a social assistance recipient trying work as an experiment is allowed to keep the first $300 earned plus 30% of anything over. A minimum wage job is worth $1767/month. A half time experiment would be worth $883 gross, or $300 + (30% of $583 = $175). Working 80 hours/month would be worth $475 or $5.90/hour. Not much incentive, and I doubt many are tempted.

In the US, those receiving Social Security Disability Benefits may keep their entire benefit while working full-time for up to 9 months.

An even more attractive alternative would be to spend some of the $11,292 savings per job on incentives, as I suggested above. $500 to workers for transitional expenses, $1500 to the worker at the end of a year of full-time employment, $2000 or more to any Nova Scotia employer for workplace accommodations, $2000 to the employer for public accessibility. Still leaving $4292 for the taxpayer - more than 5 times better than the Igate deal. We should be generous to our own employers and to ourselves.

Worth Remembering
Hiring just 10 workers currently receiving social assistance, taxpayers receive more than the direct benefit of the RBC deal.  

There are 12,641 people in the demographic: Nova Scotians of working age, with mild or moderate physical disabilities, not currently employed. They will have a variety of income sources - Canada Pension Plan, Provincial income assistance, private insurance. It's difficult to say how many have income primarily from the province, but someone knows the answer.

It will be hard work, but sustainable, predictable and in keeping with our ideals. There should be no disincentives to work.

The payoff

The accessibility legislation promised by this government will be a source of apprehension for many Nova Scotia businesses. Consequently, there are tremendous benefits to linking accessibility with employment. It's an incentive for employers, taxpayers and job-seekers alike. It has immediate and tangible rewards. It has lasting implications for the general public. It's transparent, voluntary and incremental. It strengthens the case against counterproductive by-laws. It makes accessible transportation a necessity. It saves a ton of money. Most of all, we help ourselves.

It will be a sign of progress; that Nova Scotia can be self-reliant, won't heed the siren call of corporate welfare and is intent on making the most of its human capital. That's the kind of responsible message Bay Street respects.

Wheelchair Pride, Same-Sex Rights

This is Halifax Pride week.  Coincidentally, it's the 25th anniversary of the Americans with Disabilities Act.  I've long admired the speed with which the LGBTQ+ community has reached its goals.  I'm jealous.

It's interesting to consider the mirrored trajectory of these superficially similar social movements in Canada and the US:

  • In the US, same-sex marriage just became universally available last month
  • In Canada, it's been around since July 20, 2005
  • In the US, the UN Convention on the Rights of Persons with Disabilities has not been ratified, even though it is clearly modeled after the ADA
  • In Canada, the UN Convention on the Rights of Persons with Disabilities has been ratified but not implemented
  • In the US, Josh Cassidy, a Canadian, set the world's record in the wheelchair division of the Boston Marathon
  • In Canada, there is no wheelchair division in the Scotiabank Blue Nose Marathon
  • In Canada,  the federal government uses a shredding facility that pays people with intellectual disabilities $1.15/hour
  • In the US, President Obama signed an executive order mandating minimum wage for any federal contract, including sheltered workshops 
I'm not enough of a social scientist to make complete sense of these incongruities, but this paragraph from the Canadian Index of Wellbeing webpage hints at something:
From (a) cornerstone principle of shared destiny and collective action, a number of core consensus values informed the development of the CIW: fairness, diversity, equity, inclusion, health, safety, economic security, democracy, and sustainability.
and here are 9 core American Values identified by Robin Williams (not that one) in 1970 that hint at something else:
  1. Equal Opportunity
  2. Achievement and Success
  3. Material Comfort
  4. Activity and Work
  5. Practicality and Efficiency
  6. Progress
  7. Science
  8. Democracy and Enterprise
  9. Freedom
Two competing ideals seem to be at work:

  • Independence vs Inclusion
  • Equal opportunity vs Equal Outcome

You can see how the Canadian values might favor Pride and American values might favor Rights.

Please share your thoughts by commenting.