Hope on the horizon for seniors

May 02, 2008
Carol Goar

Paul Williams calls himself "a professional cynic" who is savouring a rare burst of hope.

Williams, a health policy professor at the University of Toronto, has spent the past 20 years trying to convince politicians, bureaucrats and medical authorities that most seniors don't belong in nursing homes. Few listened. Even when he did get a sympathetic hearing, nothing changed.

Then eight months ago, to his surprise – and nearly everyone else's – Health Minister George Smitherman announced a $700-million Aging at Home Strategy.

This spring, funds started flowing to Ontario's 14 regional health units. They'll soon be able to ramp up home care and offer seniors an array of services, from housekeeping to snow removal, to allow them to live independently for as long as possible.

What Williams finds particularly encouraging is that 20 per cent of the provincial money has been earmarked for innovative projects. Local providers are brainstorming, experimenting, listening to their clients.

"You really do have some choices," he told a roomful of active pensioners this week. "For the first time in my career, I see the possibility of real change in Ontario."

He is still cautious. He wonders if results-obsessed provincial officials will take into account intangibles such as dignity and quality of life. And he warns that without public support, Smitherman may have to back off or slow down.

"But we can try things we could never do before."

He gave a poignant example. He once watched an elderly gentleman's life spiral out of control because he could no longer buy cat food. No public program deals with that. The cat slowly died and the senior fell into a deep depression. He ended up in a nursing home.

"Should we provide pet care?" Williams asked. "No, not across-the-board. But it would have been a cheap solution in this case."

Under the old rules, there was no room for cheap solutions, no matter how sensible or humane. Under the new system, there will be flexibility to offer seniors the help they need, rather than slotting them into one-size-fits-all programs.

The federal government has tested this approach on a limited basis. Twenty-seven years ago, aging veterans were pressing for more nursing home beds. Instead, Ottawa offered them a choice: more beds or more support in their homes.

The vast majority opted to stay in their homes, drawing on the services they needed. There were nurses to treat medical conditions, personal care workers to help with bathing and dressing, housekeepers to assist with cleaning and laundry and yard workers to cut the lawn and clear the snow. Each client was assessed individually. As his or her needs changed, the arrangements were modified.

"Which of the services do you think was used most?" Williams asked. To most listeners' surprise, it was groundskeeping.

"Why not fix the eavestrough or shovel the sidewalk?" he asked. "It costs far less than long-term care."

A nursing home bed in Ontario costs $130 a day. The government pays $80 and the resident pays $50 (or whatever they can afford).

For that same $80 public expenditure, community agencies could provide most seniors with all the services they need. They'd be healthier. And hospitals would be able to release them back into their homes, rather than waiting for a nursing home bed to become available (at a cost of $1,500 to $3,000 a day).

Funding has begun to shift and mindsets have started to change, Williams says, but there is still a long way to go. Doctors will have to make house calls. Teamwork will have to replace patchwork. And taxpayers will have to understand that unconventional solutions – from buying cat food to building wheelchair ramps – are often the best solutions.

Most seniors don't want to end up in a nursing home, Williams said, to emphatic nods throughout the room.

But many expect they will. This time, the nods were grudging.

Williams used to offer such audiences moral support. Now he can offer them hope.

Carol Goar's column appears Monday, Wednesday and Friday.

Men, what are you doing to protect the women you know?

ONE REASON to get educated about violence against women -- if you are a man -- is because you have a mom. I happen to be a brother with a sister. That's another great reason. Or maybe you're a father with a daughter. Too often we men are bystanders to abusive, controlling, or violent behavior. We don't even recognize what we are seeing, how to interrupt it, or how to stop it. We need to begin to learn to use our personal power and our constructive collective power.

Here is what we can do if we are good-hearted men. We can make the world a safer place for women with our actions, words and deeds. We can commit ourselves today to take an active role in protecting the emotional and physical well-being of someone who brought us into the world, someone we love and care for, or someone we brought into the world. It's important to pay attention to the way men treat women in our society. We may have to learn how.

It is OK if it doesn't come naturally. Other good-hearted men can help each other learn. It is important that we do. Violence against women may seem like a "woman's problem" until it happens to someone you love. When it affects you directly that way, violence becomes a problem for you too. Violence is a human problem. I hope you learn about violence against women from your own free will. I hope, for the sake of you and your family, that you are not forced to learn about it when something bad happens.

If you are a good-hearted man, it is very hard to get bad news about what some men do to hurt women. Yet men are responsible for 95 percent of violence against women. If you are a good-hearted man, that news may feel like an affront to your dignity or an insult to your integrity -- and you haven't even been a victim of violence.

One in four women and one in six men will have unwanted sexual contact by the time they are 18. That runs the gamut from sexual harassment and unwanted touching to aggravated felonious sexual assault. That's a lot of human beings affected. Play this little game with statistics: look around. Maybe that's two people on your softball team, or the woman in your carpool, perhaps a half dozen people in the class you're taking at school, a dozen people at your work or congregation or coffee shop.

There's no shame in being a survivor. That's what it looks like, human faces, human beings, working on healing and mending their lives, perhaps looking or working for justice. That's what I want for you to do as a good-hearted man. Join others who are working for healing and justice. Be an ally. Use your voice, your knowledge, your clear thinking and calm action to help stop sexual and domestic violence in our society.

I'll be joining the celebration of White Ribbon Day this year and inviting my male friends to join me. Men from around the state will join Gov. John Lynch and me at the State House to use our voices against violence tomorrow at noon. We know and love women who have been subjected to violence and we want it to stop. Please come join us or call the New Hampshire Coalition Against Domestic and Sexual Violence and tell them you would like to get involved.

As one good-hearted man to another, I hope you'll come along. We can make New Hampshire a better, safer place for all people and we can start today.

Rick Agran is a former New Hampshire Coaltion Against Domestic and Sexual Violence board member. He also worked as an outreach coordinator at the Sexual Harassment and Rape Prevention Program at UNH.

Determining a deprivation index

Daily Bread Food Bank using survey to develop 'economic strain' guide for poverty in Ontario

April 19, 2008
LAURIE MONSEBRAATEN
STAFF REPORTER

Opal Sparks dreams of the day she doesn't have to walk in somebody else's shoes.

Second-hand clothes are second nature for the 56-year-old former office administrator whose mobility problems forced her out of work four years ago.

And for her, a constant reminder that she is poor.

"Everything I'm wearing today, except my coat and my underwear, are used," she says. "Even my shoes."

If you can't afford new clothes, are you poor?

It's a question a group of low-income Torontonians debated recently as part of a focus group to help determine what it means — in real life — to be poor in Ontario.

Their answers, along with the views of about 2,000 others living on low incomes, are being collected by the Daily Bread Food Bank to help the provincial government design a made-in-Ontario definition it can use to set goals and track progress in its promised poverty reduction strategy due by year's end.

"One of the big jobs is going to be how we measure our success," Children and Youth Minister Deb Matthews, chair of the provincial cabinet committee drafting the plan, said this week.

"We're looking at different measures that really reflect the complexity of poverty."

The Daily Bread process involves coming up with a list of between eight and 10 necessities of life — things poor people feel they need, but are unlikely to have.

Those who are missing two or more of these items because they can’t afford them would be considered poor. The poverty rate would be calculated by counting those people.

Kyle Vose doesn't believe clothes make the man.

The 35-year-old, HIV-positive activist struggles to survive on Ontario's $999 monthly disability support program, prefers second-hand clothes.

"I would rather wear used," he says. "It's better for the environment. But I guess I'd like to have a choice."

"What about socks?" asks Charles Jergl, 37, who has lived on just $560 in welfare payments since he lost his hotel job in January. "I'd love to have a new pair of socks."

The food bank's efforts mirror work pioneered by Ireland in the late 1980s and now underway in Europe, the UK and Australia, to develop so-called "deprivation" or "economic strain" indexes to help policy makers define poverty in a way that is more meaningful and accurate than looking at income alone.

But some social justice advocates believe this new way of looking at poverty will divert the province's attention from actually doing anything about the problem.

And since fewer people in Ontario may be considered poor under this measure, they worry it could be hijacked by right-wing groups to argue against the need for any government action to fight poverty.

But Michael Mendelson still believes passionately this is the way to go.

"Every country looking at poverty reduction is looking at this concept," says the senior scholar for the socially progressive Caledon Institute of Social Policy, and one of the country's leading experts on measuring poverty.

"Other provinces like Nova Scotia and Manitoba are also very interested in this idea. There really is a consensus building around it," he says.

Mendelson and others believe a deprivation index will resonate with the general public more than arbitrary income measures because it is concrete.

Items in the index are things the average person can see and feel and when taken together describe a quality of life most would agree is substandard or poor.

"One of our objectives is for 95 per cent of the general public to accept our definition," he says. "It means we will very likely under-count. But that's a trade-off we are willing to accept to get public buy-in."

No country expects this kind of index to tell the whole story when it comes to something as complex as poverty, he says. But when used in conjunction with income and other measures, it helps to provide a fuller picture.

Ireland developed what it calls a "consistent poverty" measure in 1987. The eight-item list was updated last year to 11 items.

It includes such things as being able to afford two pairs of sturdy shoes; meals with meat, chicken, fish or vegetarian equivalent every two days; and sharing a meal or drinks with family or friends every two weeks.

In Ireland, those who live on less than 60 per cent of the median income and who don't have two or more items on the index are considered to be living in "consistent poverty."

Ireland's "consistent poverty" rate of 6.5 per cent in 2006 is significantly lower than its "at-risk-of-poverty" rate of 17 per cent, which is derived solely from the number of people living below 60 per cent of the median income.

Back at the Daily Bread Food Bank, research director Michael Oliphant and survey co-ordinator Richard Matern take their focus group participants through a list of 29 possible necessities of life in Ontario.

It's not easy to pare it to 10.

"It would be nice to get my hair cut," says Thomas Canning, 46, grabbing a strand of his shoulder-length blond hair as the group debates the importance of being able to get a professional haircut every couple of months.

"When it gets too long, it gets unmanageable," says Canning whose undiagnosed learning and speech disabilities as a child, combined with partial hearing loss, has left him illiterate and reliant on provincial disability supports.

"It's a part of your self-esteem," agrees Jergl, the unemployed hotel worker who'd also like new socks. "If you don't feel good about how you look, how are you going to go out there and get a job?"

Some items, like owning a food processor, seem like an easy frill to eliminate — at first.

"I don't have one and I don't think it's necessary," says single mom Monica Mendoza, 29, who hopes her training in Daily Bread's industrial kitchen will help her leave welfare for a job in the food industry.

But what if you have arthritis and you can't chop your food, asks Vose, the HIV-positive activist.

So far, the food bank has analyzed 1,000 surveys and has come up with a list of 10 items that most respondents said were necessary but didn't have because they couldn't afford them.

Topping the list was regular savings of at least $20 a month for a rainy day followed by fresh fruits and vegetables every day and a small amount of money to spend each week on yourself.

"These are just preliminary results, but I think they are very interesting because they show what people in low-income feel are important," says Oliphant.

Next, the food bank plans to distribute the survey to social service agencies across the city to ensure a broad range of ethnic and cultural groups are also tapped for their thoughts, he says.

And it will conduct another 15 focus groups, including five in cities outside Toronto, to determine if they have left anything out, if the questions are clear and if any items reflect an unintended cultural or geographic bias.

From those results, Daily Bread hopes to partner with pollster Ipsos Reid to produce a refined list of between 15 and 20 items to test on the general public next September.

"We don't want to include any items that middle-income people say they can't afford," says Oliphant who hopes to have a final deprivation index ready for release by October for the province to consider.

But a deprivation index isn’t a proxy for poverty, Mendelson warns.

"You don't pull these people out of poverty by giving them the items they lack,' he says. "It's just a set of symptoms of a poverty-level standard of living."

So, poverty in Ontario won't be eliminated by giving Opal Sparks a new pair of shoes or Charles Jergl new socks, or Thomas Canning a haircut.

But at least the government will have a way to measure how many are like them in Ontario, Mendelson says. And the public will have a way to keep track of society's efforts to help.


Take the Daily Bread Food Bank's poverty survey at www.dailybread.ca.

The Obese Feel More Discrimination

Friday, Apr. 11, 2008

Alice Park

As obesity rates continue to rise in the U.S., so might our acceptance of those who are overweight. But a new study from Yale University suggests the converse trend: rather than feeling tolerance in our society, the overweight and obese say they feel more heavily discriminated against now than they did a decade ago.

Led by Tatiana Andreyeva, a postdoctoral research associate at Yale's Rudd Center for Food Policy and Obesity, a team of researchers questioned 1,100 subjects, aged 35 to 74, twice over a 10-year span (once between 1995 and 1996, and again between 2004 and 2006). The respondents answered 11 questions about whether they had been discriminated against in the context of common life experiences — including applying to college or for a scholarship, renting or buying a home in a neighborhood they desired, applying for a bank loan or dealing with police. Participants answered nine additional questions about everyday experiences, such as how they were treated in restaurants, and whether they had encountered name-calling, harassment or threats. The subjects were asked to indicate the reasons they felt they had been discriminated against (facing police harassment, for example, or being denied bank loans), whether it was because of age, gender, race, height or weight, physical disability, sexual orientation or religion. Between the two survey periods, the rate of discrimination due to height or weight increased from 7% of respondents to 12% of respondents. (The scientists determined separately that the people who reported discrimination due to height or weight were also more likely than other participants to be overweight or obese.)

The study is one of the first to track patterns of discrimination based on weight. It's worth noting, however, that the survey relied on people's own perception of discrimination — the authors did not require the subjects to document bias in any way. In addition, the authors found that rates of discrimination by age and gender also increased in the same time period, suggesting that several forms of bias — or perhaps sensitivity to perceived bias — is on the rise overall, not just against the overweight. Nevertheless, the study did track the same population over time, and Andreyeva says that an increase even in people's perceived sense of maltreatment is an important measure of our society's attitudes. In this report, weight ranked third behind age and race as the most common form of prejudice. "If a person perceives he is being discriminated against," Andreyeva says, "it might have significant consequences for his or her health and mental health. Even the perception of discrimination can be important because it is self-perpetuating." And if rates of weight discrimination are indeed on the rise, say the authors, then it's up to society to mandate legal protections for those who are overweight, just as laws protect people from discrimination by race, gender, disability and age.

Expert: Bystanders who don't speak up about bullies are enablers

By Dan Berrett
Pocono Record Writer
April 10, 2008 6:00 AM

STROUDSBURG — Wiping out bullying in schools depends on changing the image of the snitch into that of the Good Samaritan, a speaker said at a session on the subject Wednesday night.

"Whether we like it or not, we all have a role in bullying," said Tom McHugh of the Penn State Cooperative Extension, which sponsored the event at Stroudsburg Junior High School.

There are three roles in bullying, he said: bully, victim and bystander.

"My objective is to turn bystanders into reporters," he told the group of about three dozen child-care providers, teachers and parents.

McHugh, who regularly speaks to schools on the subject, said he often asks groups of students if they think snitching, tattling or ratting out others is wrong. Typically, nearly all will raise their hands.

Then he asks them how many think it is wrong not to report when someone is being harmed or injured. Nearly all will raise their hands again.

"The biggest step is to get beyond the point where kids think reporting is tattling," he said. "In order to reduce incidents of bullying, you have to report it.

"Who tells you not to tattle? The bully!"

According to the National Center for Education Statistics, nearly half of all middle schools across the country reported problems with student bullying, while a quarter of elementary and high schools had similar problems.

McHugh presented even starker statistics: 74 percent of 8- to 12-year-olds reported that other kids their age had been teased or bullied; 86 percent of 12- to 15-year-olds said the same.

Bullying can take a physical, verbal, mental, psychological, or increasingly, cyber form. It can range from a shove in the school hallway, if done repeatedly, to intimidation and threats of future violence, to emotional manipulation and alienation.

"If it happens to the same person over and over again for a long period of time," McHugh said, "if it causes harm or embarrassment, you have the right to say, 'I'm pretty sure I'm being bullied.'"

When a parent tells a child who is being bullied that he or she should stand up for themselves, the parent needs to specify what that means. McHugh thinks reporting it to an adult as the best step. Speaking firmly and clearly, and telling the bully to stop, is another route, as is finding allies, so that a target is not an easy mark.

Standing up does not mean resorting to violence, especially in the zero-tolerance world of schools. "If you bully the bully, you'll get in trouble," he said.

Left unaddressed, the toll can grow more onerous to both the bully and the victim, for whom McHugh used the term "target."

The feelings of powerlessness among victims should not be left to fester. Students who had been bullied and marginalized for years had carried out horrific massacres, including Columbine High School and Virginia Tech, he said.

On the other hand, bullies, if never corrected, can wind up with their own set of problems. They will not have developed interpersonal skills, or may have trouble with drugs and alcohol, or the law.

"There aren't bullies," he said. "There are kids who have bullying behavior."


Block the bully

Tips for kids:

Talk to a trusted adult
Support others who report problems
Project strong self-esteem; don't make yourself a target
Don't resort to violence yourself

Tips for parents:

Foster good communication skills
Model respectful behavior
Discuss retaliation and consequences, and the importance of standing up for what's right
Watch for changes in behavior in your child: withdrawal, desire to get to school late (often to avoid bullies), plummeting grades, anxiety and low self-esteem
Be observant, responsive, supportive and interested