Category: **ESPC Documents: Publications

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A review by Shawna Ladouceur

The ongoing pandemic has brought to the fore the abysmal state of institutional long-term care (LTC) in Canada. As evidenced by the devastation, the existing system will not suffice and will certainly not hold against the advancing wave of aging Canadians. While a complete overhaul of institutional care is necessary, increasing support for both formal homecare and informal caregiving could facilitate the preference for aging-in-place at home. At present, however, with limited access to a fragmented and often confusing home care system, insufficient alternatives can lead to inappropriate institutionalization. The report Assessing Cash-for-Care Benefits to Support Aging at Home in Canada, based on a study conducted by the Institute for Public Policy as a part of their Faces of Aging research program, examines popular cash-for-care benefit programs in Germany and the Netherlands as a possible solution for expanding care options to better support aging at home in Canada.

While several Canadian provinces have self-managed home care programs, most restrict choice by precluding informal caregiving arrangements. This negates important advantages of cash-for-care benefit programs like those currently operating in both Germany and the Netherlands. Cash benefits can increase autonomy by allowing financial compensation to informal caregivers, decreasing cost by substituting for institutional care, and redistributing the burden on informal caregivers by affording the means to engage supplemental care. Though an appealing option with demonstrable successes, a deeper examination also reveals shortcomings to consider.

Lessons from both Germany and the Netherlands must be contemplated if a Canadian cash-for-care program is meant to alleviate cost of the more expensive formal and institutional systems. Flexibility of programs in both Germany and the Netherlands have resulted in higher uptake and hence greater public spending as a result of payment to informal caregivers, such as family members, for the same previously uncompensated work. Since this mounting financial cost has not significantly increased quality or provision of care, both countries have instituted more restrictive measures, including significantly lower payment amounts offered for informal care than formal care.

At the same time, establishing a Canadian cash-benefits policy would require acknowledgement of persistent societal norms regarding gender and caregiving, which continue to disadvantage women. Unpaid informal caregiving responsibilities exhibit a detrimental effect on work hours and earning capacity. Cash-benefit considerations must include financial support such as vacation time and pension contributions to properly alleviate the long-term, and often life-long consequences that still disproportionately affect female caregivers.

The German program has given rise to a large, unregulated, and untrained “grey market”—with families using cash benefits to hire migrant workers to provide 24-hour care that would not otherwise be possible or affordable. Ungoverned by social or labour regulations, studies have revealed exploitative practices and intolerable working conditions (p. 17). In the Netherlands, on the other hand, program constraints and well-funded formal home care services paid for with universal, mandatory LTC insurance plans have instead led to a highly regulated care market. Canada’s own Live-In Caregiver Program (LCP) would likely become more popular if cash benefits were introduced. Already having required changes to combat similar issues, the LCP program would necessitate further restructuring to protect vulnerable workers.

With a rising reliance on informal care, quality is at issue. Monitoring is difficult and enforcing standards, disciplining, or terminating informal caregivers—especially relatives—is nearly impossible. Instead, to prevent the potential for senior abuse and ensure quality and safety, cash benefits must be tied to a minimum level of training, with clear delineation of tasks appropriate to informal caregivers or to care professionals.

With an estimated 120% increase of older adults requiring LTC supports by 2050 (p. 7), in addition to an immediate overhaul of the current system, capacity building strategies to enable older adults to remain in the home must be urgently pursued. While some success has been recognized with cash-for-care benefit programs in Germany and the Netherlands, Canada can learn from both. The failure of either program to reduce costs, alongside difficulties ensuring quality of care and struggles to overcome long-term consequences for women and exploitation of grey market caregivers, demonstrate the need for a strong, formal caregiving system and proper supports for informal caregivers. Especially when considering a Canadian version of a cash-for-benefits program.

Publication Source:

Flood, C. M., DeJean, D., Frisina Doetter, L., Quesnel-Vallée, A., & Schut, E. (2021). Assessing

cash-for-care benefits to support aging at home in Canada, (No. 83). Institute for Research on Public Policy. https://irpp.org/research-studies/assessing-cash-for-care-benefits-to-support-aging-at-home-in-canada/

About the volunteer:

Shawna Ladouceur is a Registered Nurse who sees the impacts of the social determinants of health in ways that demand action. She has extensive experience working directly with vulnerable populations in the inner city. Her personal interests include skiing, hiking, biking, running, reading, and travelling

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A review by Rebecca Jansen

Calls to change how the non-profit community functions have existed at the fringes of the sector for decades. However, COVID-19 has rapidly revealed historical injustices within the sector, bringing calls for change to the forefront. In response, many leaders have answered these emerging needs by spearheading transformative initiatives. One such example is this report, taken on by the Edmonton Chamber of Voluntary Organizations (ECVO). The report, Transforming the Non-Profit Community in Edmonton, is described by the ECVO as the first phase on a long road to bring to life “a reimagining of non-profits” within a local Edmonton context (p. 1). The report captures historical injustices magnified by COVID-19 while harnessing their impacts to imagine a desired future that transcends the current status quo. The report opens with a review of the non-profit sector—past and present, includes surveys, myths, and trends, and introduces a model for change. The information is based on 24 individual and five group conversations held with 82 Edmonton-based knowledge holders (p. 13).  The collaborative approach aimed to increase critical reflection, system-wide connectivity, and community accountability by creating opportunities for engagement and generous critique for/by those working first-hand in the sector.

Three main categories were brought to the forefront during the reporting process: myths, trends, and a model for change. As seen by sector insiders, myths are widely held yet largely inaccurate beliefs that often create barriers in practice and policy. Myths highlighted include:

• The non-profit sector is truly voluntary,
• Non-profit organizations are flexible and responsive,
• Non-profit organizations operate as representatives of the community,
• The non-profit sector is apolitical,
• non-profit programs are fully data-driven and evidence-based, and
• The non-profit sector is truly altruistic. (p. 14)

In tandem with myths, trends—or general patterns—often emerge from neoliberalism and have also marked how the sector operates. Trends emphasized in the report include:

• Short-term, contract-based funding,
• Venture philanthropy,
• “Business-like” practices,
• The organization as the primary unit of analysis,
• Outdated board structures, and
• Individualized programming of subsectors. (p. 20)

Using these myths and trends as guideposts, ECVO present a model for change that encapsulates a more socially just future for the non-profit sector. Inspired by the Miami Workers Center, ECVO’s model for change offers four pillars of action: service, power, consciousness, and policy (p. 24). At first glance, the pillars appear ambiguous and broad. However, each pillar is broken down to address explicit concerns. Some examples include:

• Switching from a 3- to 5-year planning cycle to a 50- to 100-year vision,
• De-centring organization,
• Hiring those directly impacted by systemic harms,
• Building social justice competencies,
• Building new knowledge systems into decision-making processes, and
• Funding more significant advocacy efforts. (p. 25–37)

While each pillar is thorough and specific in its mandates, as a whole, the model begs questions of infrastructure. In any such work, how does one “devise methods of participation and decision-making, build and sustain leadership, create shared political analysis, and generate and manage resources to feed the work”? (p. 38)

ECVO preface their work by stating it is not prescriptive, nor complete. They emphasize that they do not support or oppose political parties but instead focus on how past practices and policies have shaped current operations. This non-partisan approach, along with the ECVO’s innovative, collective, and collaborative process, seems to be both reflective and flexible. As stressed in the report, this is merely phase one. As the process unfolds, more insight is gleaned and new learnings emerge and so priorities may shift. But for now, the ECVO report appears to be a comprehensive and critical step for a more socially just future for the sector. As such, they encourage readers to take their report and “use it to build new forms and methods of participation, decision making, leadership, and resource distribution. It is by altering our everyday processes that we can build new infrastructure and in doing so, construct alternative futures” (p. 38).

Publication Source:

Tink, L. N., & Kingsley, B. C. (2021). Transforming the non-profit community in Edmonton: Phase 1—identifying myths, trends, and areas for change. Edmonton Chamber of Voluntary Organizations. https://ecvo.ca/wp-content/uploads/2021/05/ECVO-Transformation-FINAL-highres.pdf

About the volunteer:

Rebecca Jansen is currently a graduate student at the University of Alberta studying educational policy specializing in Adult, Community and Higher Education. With over ten years of experience as an adult and community educator, her primary research focus is on embodied learning, indigenization, and policy reform to realign power imbalances within social institutions that impact local communities.

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A review by Jayme Wong

The Royal Society of Canada established its Task Force on COVID-19 in April 2020 to “provide evidence-informed perspectives on major scientific challenges in response to and recovery from COVID-19” (p. 2). The result of the task force’s findings is Impacts of COVID-19 in Racialized Communities, a collection of eleven essays published in May 2021.

Racism existed before COVID-19. The pandemic simply created conditions in which racism became more apparent. The attitudes, policies, and practices created and reinforced by individual, systemic, and cultural racism resulted in disparities that could no longer be ignored by mainstream society. In the anthology’s introductory essay, “The Background to Racism in Canadian Society,” author Frances Henry explains: “It is the racism that existed in settler societies, the racism that led to the subjugation of people through colonialism and the expansion of Europeans into far off places in the world, which created the conditions that exist today” (p. 14). COVID-19 became a racial issue when the historical roots of racism, colonialism, and imperialism created unequal conditions among people living in Canada.

Canada has never really collected race-based data related to the COVID-19 pandemic. Certain provinces, such as Manitoba and Ontario, started to collect this data recently—though only in clusters (p. 25). The result is that Canadians cannot accurately determine the impact that COVID-19 has had on different racial communities. However, just because we cannot determine how people of colour were affected does not negate the irrefutable fact that visible minorities were far more affected by the virus than white communities.

Take, for example, the data that the City of Toronto gathered throughout the pandemic: “In the Greater Toronto Area, whites account for 48 per cent of the population and 17 per cent of COVID-19 cases. This is in contrast to the situation with Black people who account for 9 per cent of the population and 21 per cent of cases” (p. 19). This data supports emerging statistics from the United States, which project that 1 in 1,125 Black Americans have died from COVID-19 compared to 1 in 2,450 White Americans (p. 25). Similar numbers collected from the United Kingdom also highlight the stark differences between rates for people of colour who are affected and dying from COVID-19 in comparison to white populations in the same areas.

The virus does not discriminate. Poor conditions grounded in centuries of systemic racism have worsened the impact of COVID-19 on certain groups. In addition to sickness, racialized communities have also had to deal with economic and social factors that cause uncertainty and instability in an already turbulent time. In the essay “Racial Inequality, COVID-19 and the Education of Black and Other Marginalized Students,” Carl E. James identifies the factors that contribute to inequality as access—or lack thereof—to nutrition, academic supports, mental health, and online learning (p. 30). People who face multiple barriers when accessing these resources are more likely impacted by the long-term health and social effects of COVID-19.

Health care experts have criticized the federal government’s decision not to collect race-based data during COVID-19. Many consider this decision a failure to provide support for marginalized communities and indicative of a flawed system built upon colonialism. In the essay “Race and Ethnicity Collection During COVID-19 in Canada: If You Are Not Counted You Cannot Count on the Pandemic Response,” Kwame McKenzie goes so far as to say that “seeing significant disparities and doing nothing active to deal with them is a form of systemic racism” (p. 67). The federal government’s silence on the issue does not hide the obvious harm that has already been inflicted by centuries of colonial policies that have prevented visible minorities from accessing necessary health and education resources or inhabiting clean, socially distanced spaces that increase quality of life.

Overall, the report’s primary recommendation is to begin collecting race-based data and to involve racialized communities in the collection and dissemination of the information. While this solution does not amend all of the damage that COVID-19, and other health crises, have already done, it is a step forward into a post-COVID and, more importantly, post-colonial nation. Having diverse voices at the table means that government decisions would no longer be made based on archaic legislation that—either intentionally or unintentionally—excluded and discriminated against minorities.

Although rebuilding in a post-COVID landscape is uncertain, it is also an opportunity to lay a new foundation that is informed by the mistakes made in the past. Re-examining the systems, institutions, and attitudes that have created unequal access to health care and other resources means people living in Canada can prevent history from repeating and begin a precedent for neighbouring nations.

Publication Source:

Henry, F., James, C., Allen, U., Collins, T., Dei, G. J. S., Ibrahim, A., Jean-Pierre, J., Kobayashi, A., Lewis, K., Mawani, R., McKenzie, K., Owusu-Bempah, A., Walcott, R., & Wane, N. N. (2021). Impacts of COVID-19 in racialized communities. Royal Society of Canada. https://rsc-src.ca/en/research-and-reports/end-life-decision-making-policy-and-statutory-progress/covid-19-policy-briefing?mc_cid=41ac70285f&mc_eid=4a6bf13a01

About the volunteer:

Jayme Wong graduated from the University of Lethbridge in 2014 with a BA in English and Philosophy, and more recently graduated from the University of Alberta in 2020 with an MA in English and Film Studies. She currently works at a local non-profit, the Learning Centre Literacy Association.

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The Edmonton Social Planning Council, in collaboration with our volunteers, strives to provide stakeholders and community members with up-to-date reviews on recently published social research reports and publications.

In this issue, we have the following reviews:

• Low-income persistence in Alberta – Reviewed by Besindone Dumi-Leslie
• The Future of Non-Profits in Edmonton – Reviewed by Rebecca Jansen
• Welfare in Canada – Reviewed by Sung Min (Amy) Jo
• “She-cession” or Parental Problems: Disparities in the Alberta Labour Market from COVID-19 – Reviewed by Dharma Johnston
• Show Me the Money? Cash-for-Care Benefits to Support Aging at Home in Canada – Reviewed by Shawna Ladouceur
• It’s More than Just Training – Reviewed by Lexia Simmons
• Changing Canada’s Social Safety Net – Reviewed by Jennifer Smyth
• “Oh Kanata!” Indigenous and non-Indigenous views on national identity, leadership, and reconciliation in Canada – Reviewed by Laurel Van De Keere
• The Numbers Game: How Lack of Race-Based Data Collection During COVID-19 in Canada has Highlighted Systemic Racism – Reviewed by Jayme Wong

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