The PADDLE Program; ATCO Structures; Town of Kapuskasing
Ms. Megan Johnson
My name is Megan Johnson. I’m the executive director of the PADDLE Program in North Bay, Ontario. The PADDLE Program in North Bay, an [inaudible] learning and wellness hub serving adults with complex disabilities, is going to be forced to close, without immediate government intervention. The consequences of that decision, in our opinion, are fiscally irrational and morally indefensible. It represents, basically, a failure of basic fiscal stewardship and cross-ministerial governance. We support adults whose developmental disabilities are almost always coupled with a mental illness as well as significant physical disabilities. So it’s a very high-needs, very niche, complex population; many require one-to-one support to stay alive. We were not originally designed as a crisis response program, but over 18 years, it has become one, because we can’t watch people walk into crisis in real time and do nothing. The reason it’s so critical to keep programs functioning right now is because they provide consistent weekday structure and respite that adults and caregivers rely on to prevent crisis. There are 20 caregivers supporting adults in our community who have stated clearly that if our program shuts down they cannot sustain their current caregiving arrangements over the next year. The impending closure of this program is therefore the destabilizing event. The closure of this program will directly precipitate emergency room use, prolonged hospitalization, and involuntary institutionalization. As the Ombudsmen have found, adults with developmental disabilities are being inappropriately housed in hospitals because there are insufficient community supports and services available to meet their needs. These adults and caregivers understand what happens when structure disappears: emergency room presentation, and prolonged hospitalization. At the same time, the adults we support are watching a peer be confined to an institutional setting going on over 3,000 days. In their view, that person has been irreparably harmed. They reasonably understand that this is the pathway they are placed on if this program collapses. This program serves 36 adults; 20 are at the breaking point in their caregiver relationships right now, and that is not a failure of their families or them. This is a system that told them there is literally nowhere else to turn. The Ombudsmen have found these problems—it’s long-standing, it’s systematic, decades-long, and similar concerns have been identified for a very long time. When supports like this don’t exist, people don’t manage; they’re involuntarily contained in emergency rooms, psychiatric units, police cells and hospitals. They don’t require medical treatment, but because there’s nowhere else to go, that’s where they are. This is the pathway: community stability collapses; prices escalate; and individuals are held in systems never designed for them, at an extraordinarily high public cost. Ontario is currently paying millions of dollars to contain people it could support in the community for a fraction of that cost. The resulting harm is foreseeable, and it is preventable. From a fiscal perspective, the contrast is stark. The PADDLE Program was seeking approximately $400,000 in operational funding to stabilize these adults and to prevent the crisis that is oncoming. By comparison, Ontario’s own data—including the Ontario Auditor General, Ontario Health, and the Canadian Institute for Health Information—shows that prolonged hospital and alternative-level-of-care stays cost hundreds to thousands of dollars per day. One individual—like we said, if we’re looking at 3,000 days at the minimum, we’re looking at millions of dollars just for that person. So if even a portion of the adults whose caregivers are approaching crisis end up on this same pathway, that cost will escalate into tens of millions of dollars, and then it becomes absorbed across health, justice and emergency systems. The funding being requested represents a fraction of what is already being spent to harm people. The cost does not disappear, either; it’s absorbed across health, justice and social services, and it fragments itself in a way that makes it very difficult for the public to see, but no less real for the taxpayer. The Ombudsmen have found that people often receive services only after a crisis occurs, rather than through timely preventive supports. Ontario’s current administration’s approach requires people to enter crisis before supports are unlocked. That design directly drives higher cost in emergency and institutional spending. In North Bay, it’s not a temporary shortage; it’s a documented deficit—we do not have any homes; we do not have short stay; we do not have crisis. If you wake up and your caregiver has passed, there is nowhere to go. So the pathway for people who require care to live is the hospital. And at 3,000 days and having to pay $55 an hour to leave—it is very expensive. In North Bay, again, we’re not overwhelmed—it is misaligned. If we look at the findings and we look at Lost in Transition and we look at the number of expert panels, advisory tables, commissioned specialty groups convened over the years, a conclusion is unavoidable, and that’s that cross-sector change has long been identified as necessary to prevent harm. We’ve been here before. At Huronia Regional Centre, people were confined and buried. To this day, the identities of many of the remains found there have not been established. That work is unfinished. Proceeding to create new forms of forcible containment at extraordinary public expense is not responsible governance.