Sunday, October 16, 2016

THE AFFORDABLE HOUSING CRISIS RECONSTRUCTED

We are hearing from more and more news reports that certain cities that young, upwardly mobile professionals are increasingly getting locked out of the housing market, without help from parents or winning a lottery of sorts.  This is particularly true of Vancouver and Toronto..  We are learning that political authorities have been trying various measures to "cool" the hot housing markets where there is this difficulty, such as imposing a tax on foreign investors or a vacancy tax.  Younger people are still buying, but further afield from their workplaces, thus amounting to a longer commute for them to go to work each day (and thus contributing to the congestion problem).

At the other end of the market, we are talking to people who have purchased homes perhaps in the last few years, but can no longer afford to stay in them.  This is particularly true of seniors, as pensions are diminishing and forcing more and more elders into poverty, or due to health issues that such seniors cannot afford to cover the costs for (e.g. home care, accessibility renovations).  Low income persons in their own homes are also impacted by higher costs and stagnant benefits.  With the removal of the Home Repair Benefit that used to assist at least on ODSP to perform necessary repairs in their home has been cut, leaving only loans and discretionary programs that rely on geography and even then, on the whims of the region or county one lives in.  There has been a substantial hike in the number of low income persons, including assistance recipients and seniors, who cannot afford to repair leaky roofs, heating systems, electrical system, etc.  In my own practice, I've represented such persons who were essentially threatened with an unsafe building order when it was learned that these people were living in such states of disrepair.  Unfortunately, my region thinks the only solution is for these folks to live in shelters, where their health will decline quickly.

At the very lower end of the spectrum, people are only seeking rental housing at a reasonable cost.  For those on social assistance, there is nowhere in Ontario they can live and stay within their allotted shelter allowance without having to take the majority of their "basic needs" benefit to cover their shelter costs.  Average rents across Canada and Ontario have been rising, not falling.  Yet social assistance rates have been falling further and further behind the costs of everyday items.  The only other options for such folks is to get on the wait list for social housing, which hardly seems worth it as lists are very long and there is little turnover in available units within the respective municipalities. Even if we can manage to build 171,360 units overnight, the wait list will be refilled by others who see movement on this eternal wait list and want to join up too.  The cost of building all the new units we need would be way too expensive - in the multi-billions! However, the wait lists are not getting shorter, nor is the wait times getting reduced.  Even people with so-called "priority listing" can wait at least a couple of years before they get a unit.  Others can wait between six years in some regions to twenty-one years in others.  It is obvious the social housing system we have adopted is not working.

Even when people do obtain a unit, the municipally owned ones are often in a state of disrepair.  In my opinion, the municipalities do not have the money to keep them up.  The larger their owned housing stock, the worse the problem appears to be.  In Toronto, TCHC units have a $2.6 billion repair backlog, while Niagara Region (a smaller region with a lower proportional housing stock) has a $120 million backlog.  In its report, entitled Neighbourhoods First, the Smarter Niagara Steering Committee has presented a number of problems with social housing itself, particularly how those in social housing are segregated and are made to know their place in society (as being less valued and sought after).  Their suggestions have been interesting, to say the least:

1.  The Cost:

In this report, it stated  What is not measured is the public tax benefit (much less the human benefit) of diverting children to better outcomes compared to the cost of providing subsidized housing to subsequent generations. This approach to addressing housing affordability costs all of us in lost productivity, continued social assistance, and in the physical upkeep of the properties. Much of the current affordable housing stock is in disrepair, largely due to the failure to adequately invest sufficient initial capital funds. Many buildings were cheaply built with low “maximum unit prices” and other methods of capital cost limitations. Insufficient reserve funding also meant that these projects suffer from budgetary deficits and are now forced to refinance for capital improvements well beyond what private market units would require.  Children who have grown up in public housing often end up living in public housing themselves as they grow up.  People in one part of my husband's family have all lived in public housing as children, only to grow up and have children living in public housing themselves.

Repair backlogs are expensive.  I've been inside units in my region that have had serious issues, such as mould, rotting ceilings and nonworking appliances.  When taken to task for repair issues, the municipality cries about lack of budget, whereas we can force private landlords to fix their     properties relatively easily comparatively.

2.   Segregation:

Particular buildings and housing complexes are known as "public housing" and act as ways to   segregate low income people.  When people living in these communities go outside, they do not see a diversity of people, with a diversity of lifestyles and different levels of ambition.  They mostly meet people much like themselves who could only teach one another how to better "survive" poverty.

3.   Social Housing Rules:

The rules determining rent rate depend on what a family's total income is, as well as number of people.  If there is a mismatch between the number of people and the unit size, the family may be forced to move.  If a family with several children live in a social housing unit, as each child leaves the household, the family may be forced to move once again (at their own expense and trouble).  This repeats itself until the person is living alone or half of a couple, whereas then they are not permitted except under slim circumstances to have a second bedroom, where many families outside the subsidized system use the spare bedroom as a place for a child to return home to, to house a family member in temporary need of a place to stay, or even to start a home based business.  In social housing, none of this permitted, even having a home business run out of one's unit (although this might have changed recently although one is still likely not allowed to allocate an extra bedroom to run the said business).  In addition to this, those receiving OW or ODSP are further punished if they attempt to earn significant incomes or try to reduce their reliance on social assistance. It is stated in a study by the Social Housing Services Corporation that a full time worker living in an RGI unit gains a net of only $1 per hour for working full time, as opposed to remaining on social assistance and not working at all.  Further, as individuals work more hours, their housing rents go up accordingly, eventually trapping the person into making very difficult choices: quit the job/reduce one's hours or move to market housing.

4.    Maintaining Families as Permanent Renters:

If you are paying only $139 a month for rent and you go to a bank or mortgage broker seeking a mortgage to buy even a low priced ownership property, you will be laughed out of there.  Somebody paying full market rent for several years without issue has a greater chance of being accepted for a mortgage than somebody that hasn't.  There are some assisted down payment programs available through social housing providers, but they are limited in scope.  Even seniors that own their own homes have to sell within six months of being accepted into social housing, which means they cannot maintain an asset that might do them well as they move on in years and might need additional income or leverage for borrowing, or even to pass down to their children in an inheritance.  This makes poverty further inherited and embedded into the family structure.  In the market, technically home ownership and renting should be competitive and if rents are set too high, tenants should theoretically have the option to move to ownership.  It doesn't work that way, so of course, the rental market is more likely to be difficult for lower earners.  Saving for a downpayment is that much harder for them.

5.    Little Assistance for Low Income Homeowners:

Imagine you became sick and had to leave your job and had to resort to disability benefits.  You own your home, can manage (barely) the monthly costs of ownership, but cannot afford the extras, such as when your roof blows off or your furnace quits in the middle of January.  There are way too many homeowners in this position.  Some of them can afford to take on more debt, by applying a home equity loan to the cost of their repairs, but this would increase the monthly cost burden to those whose income is too low to take that on.  Further, some homeowners end up with something major happening, whereas the insurance refuses to cover it or only covers a portion of the repairs.  There used to be the RRAP (Residential Rehabilitation Assistance Program) run through the federal government and there were provincial counterparts, as well as the Home Repair Benefit for people receiving social assistance.  Virtually all of those programs were scrapped in favour of a municipally-run discretionary forgivable loan (for my region the maximum one can acquire is $5,000 for every 10-year period which is truly inadequate).  There were tax credits, but they were not refundable meaning people have the money to do the repair, spend it and then later can "write it off".  Those people without income to begin with are sharply disadvantaged.  Repair costs can add up rapidly and quiickly exceed the $5,000 maximum, as I've seen in many cases.  Most of these people live in their homes without adequate heat, hot water or other issues, hoping beyond all hope nobody finds out.

In most cases, homeowners do not want to return to the rental market, especially under the current rules in place, which effectively keep them impoverished and cause them to drain all or most of their assets just to receive an inadequate amount of support.  Perhaps, if this help was more realistic and made more readily available to low income homeowners, there would not be the downturn of assets and impoverishment the current rules force on people.

6.    Stigmatization:

Lastly, there is a great deal of stigma with certain addresses or housing run by certain groups (e.g. housing for people with mental health problems).  Most people who have mental health problems do not want to live in a "mental health" housing unit, as this usually denotes the requirement that they need twenty-four hour support or at least daily support.  People may need this support, but it should not be connected to their housing unit and the person should be able to stay there if their needs change later on.

Recommendations include:

1.  Change the RGI income rules so that the same dollar is not clawed back twice or more if the     resident is on social assistance.  The Marginal Effective Tax Rates are very high for this group,       ranging from 85% to sometimes exceeding 100%.    While we have billionaires complaining that if they have to pay a single dollar more than the 15% rate they currently pay, they say they have no incentive to hire or to invest ... why is it any different for poor people?

2.  Be easy on the rules about over-housing/under-housing.  If somebody has a reasonable need for a second bedroom, allow it.  If I had to move to a one-bedroom at the time I was literally being   harassed to do so back in the 1980's, I would have had to quit school not having a quiet place of my own to study.  People's needs differ and the "one size fits all" mentality has to stop.  For others with larger families, they may wish to move to a smaller unit to get in to social housing and out of overpriced rental housing just so they can have a place to stay until an appropriate sized unit is available to them.

3. Quit segregating the poor into specific buildings or projects.  Tie the subsidy to the person or        family, not the unit.  Let people move where they want and give them a portable subsidy to top up their income so they can reasonably afford average market rent accommodations for their needs.  This way, people should have the right to move if the need arises.  People in segregated complexes are often left to live with less than desirable neighbours, one of whom was beaten up by his neighbour for being a Muslim and told to move back to "his country" though he was born and raised here.  He asked for a transfer, but was refused.  If one's neighbours are up all night partying and dealing drugs to others in the complex, one should also have the right to move, esp. if the housing complex refuses to evict them (which is often the case as they refer to themselves as "last resort housing providers").

4. Work on the economy from the bottom up.  Never mind tax breaks for those that can afford to   pay them and get rid of those boutique tax breaks that most low income people will not be able to use anyways, such as children's sports credit, children's art credit, etc. (and myriad of other credits available to families that can easily pay the costs to these things, only to have a tax break for part of the purchase).  These taxes if paid would go a long ways to assisting those at the bottom, many of whom will be able to spend the extra money and grow the economy.

5. Recognize housing affordability at the lower end is an income problem and not a housing       problem.  At the present time, landlords cannot afford to drop their rents so that lower income     people can afford them.  However, there would be less issue with maintaining and developing new rental properties if more people can afford to rent them.  Some of the proposals regarding a portable rent subsidy in Michael Mendelson's paper are worth looking at, particularly those that would allow all low income people on assistance to afford average market rents.  This should also be available for homeowners that are paying too much of their income on basic monthly costs for their homes as well. Supply will eventually develop as more landlords see the potential to rent to more people in the market.

6. For those in |"supportive housing", there should be a disconnection between the support and the     unit.  Therefore, the support would come to the person on an as needed basis, while it would be reduced over time as the person needs less help, but can still remain in the same unit.

7. There should also be innovative funds for people wishing to enter the market for renting units to others.  For example, a homeowner of a single family home may want some assistance to purchase a tri-plex or four-plex and renovate them to enable them to provide affordable rents to those seeking rental housing in their communities.  Doing this should be encouraged, even if the homeowner is on ODSP or other social assistance and can rent the units to recover some additional income over and above the maintenance costs.  Some people on ODSP do want to retire with some assets and not have to rely on GIS.

8.  Also, municipalities should be allowed to buy and sell their housing stock to anybody, or even sell their stock and remain only in the business of managing the housing supports.  Given this additional freedom, this will reduce the repair backlog and also enable some social housing tenants to purchase their own units, either on their own or collectively.

These are my thoughts.  What about yours?

Sunday, May 15, 2016

THE CULTURE OF DESPERATION, ISOLATION AND GEOGRAPHIC IMPOVERISHMENT

It was a few weeks ago that I noted that the Piano Man was back.  He was perched up in his usual bus bench in front of the Farmer's Market playing an endless array of demo strings on his organ.  One was particularly memorable, Beethoven's Ninth Symphony.  This was played out loud and clear at two o'clock in the morning to an empty audience on a clear, but cool night in April.  I was struggling to continue to overcome my stint in the hospital, which whacked me more emotionally than physically, although I am still medicated.  I spoke to the Piano Man once.  He told me lived close by, so each time he was able to bring his equipment by pulling it in his cart.  The last time was when my husband and I were waiting the last bus home, he came to tell us about a hundred "refugees" from Fort McMurray had arrived at Niagara.  I thought to myself, "Those people must be really desperate to come to Niagara, of all places, with no jobs, no money, no future".  Then, it was realized they had come back to their families they had left behind when they first left to Fort McMurray.

The Piano Man was around last year too, when my husband and I would go to the bars, have a few drinks, cheer on the Blue Jays and come back to rest up and then go home.  I haven't been out anywhere in a long time because simply I can't afford it.  Too many people around me in this region are experiencing the Cloud, you know that big hanging gray thing that doesn't leave your stream of consciousness as you attempt to go about your business.  There's a whole section of King Street, especially towards Ontario Street where businesses have literally closed down.  Even Jumpin' Jaxx, one of my favourite after-bar eats when we all used to hang out at Open Mike nights at the Strega Cafe. We'd sit outside on clear nights and chat politics, philosophy, hopes and dreams, none of which ever became true for any of us.  I meet the same people we used to do this with ... many are gone already to Toronto or other better climes, but the ones here are left aimless, with a Cloud over their head, even those who had cheerfully graduated from Brock, even those from Brock's Badgers and others who once held down the fort in this Town.

My illness has left me for broke.  All the bills still come in, even if I am not able to bring in any money.  This is something that two income families do not have to worry about or people who have high paying jobs with the kind of benefits that would carry you over for a short or long-term illness. I've longed for the days when I was able to secure good high-paid employment with these kinds of benefits, but this is not possible in Niagara.  Niagara Region has a culture of gigs, low paying part-time jobs and if you are lucky, you can win a lottery or inherit some money and buy some property by the lake.  It is not that there is nobody that is doing well in Niagara.  I know a few of them, but unfortunately, there are not enough of them to invest in the entire infrastructure we once had and has now collapsed.  There are large companies that feed off the poor, such as payday loan companies, household rental agencies, temp employment agencies, pawn shops and similar enterprises that have scarred our once pristine real estate.

As my husband and I left to catch a cab earlier in the week, a man was shouting to himself as he awkwardly walked down the street.  His eyes, glittering from the dose of whatever hit he took, gazed at me then quickly turned away.  These are part of the downtown landscape these days.  All the days when I used to enjoy time together with my husband and even on my own, are gone.  I leave my decrepit home to go to my office, where the stress and threat level always seems so magnified, that nothing I do relieves this anxiety.  It's not my inability to do my work that is an issue -- it is the kind of problems that walk through my door that create the anger, the sense of hopelessness that I have in this region.  We do many kinds of disability claims, which we are largely successful in but they can be a high climb.  People I deal with often have mental disorders and their visions and anger and lost dreams are part of what they bring through my door.  I compartmentalize.  However, regardless of well I do that, I still remember when private practice was fun.  Those were the days people had more agreements, more hopes, more dreams and we were consulted to assist them with business plans, board training, workshops, etc., which I enjoyed delivering as much as those receiving them enjoyed attending.  I looked forward to this and did not have to think, just put one foot in front of the other and soon, this one will be dealt with and done.  These times were memorable.

Unfortunately, there is not much of that going on anymore.  Many small businesses have disappeared or gone bankrupt.  Even a few of my colleagues had left their practices in less than glowing terms.  There is a high rate of pain and depression among those in my profession.  Around Ontario, I am aware of some who've had to go to rehab, others who have attempted suicide, others who have quit their practices and others who have had health crises, a heart attack, a stroke or something like I just had. To the contrary, leaning on one's fellow colleagues is not always a great thing, especially when we all are feeling the same way, but many will not admit it.  We have to put a look of strength on our faces, while we work to save the folks who come to us who are literally worse off.  Working in the Niagara Region in any small business can be a challenge for anyone.  People have a much lower average and median income than most other parts of Ontario,  At least half of those that have jobs are working precariously.  Most new jobs in the region are low-paying, low skilled positions.  Too many people are resigned to be happy just to get a call centre job, an occupation with high turnover, high stress and in many ways, hard on the family.    

I know when they come through my door - the names of the culprits tend to be repeated, as we prepare to go through our third, fourth, fifth or sixth round with the same parties.  I try not to be too insular at this, as even these parties are hurting in their own way and as Jesus lie dying on His cross, he prayed to His Father, "Forgive them, Father, for they do not know" or words to this effect.  It seems when the Cloud falls over us and we become ensnared in her difficult web, we become outwardly more nasty to one another and unable to come to a consensus.  At the worst of this, I see more hate crimes committed against people, our most vulnerable.  These are the folks that are so distressed that they believe that somehow very vulnerable people are getting something that they aren't and therefore, they must churn their aggression on them.  I've witnessed people kicking a homeless man right on my street, as well as a group of teenagers pushing an older woman off her wheelchair and told her tauntingly that she can walk.  While I do report all of these incidents, I never see how they are dealt with, and it appears that nobody is surprised when I tell them what I saw.

I walk down the streets of downtown.  I notice many businesses closing down, only a few new ones opening up.  The tenure of the new ones always seems uncertain as sometimes it seems a business has a remnant of permanency, but appears to lose it once the economy even slips yet another impossible notch.  When one is at the bottom, one cannot believe how much further we can go.  The fact is Niagara has become more and more bimodal in terms of success patterns.  I've met someone I knew in the 1990's who was always investing money in properties, in businesses and various activities.  The last time I seen him he was receiving ODSP, after a series of heart attacks.  One may say, he should have purchased disability insurance.  The point is he did, and yes - he did collect for a bit - until they decided he was on it for too long and he got kicked off, like most claimants eventually are. ODSP is becoming more and more the point of ONLY resort and not last resort.

There are others who I will refer to as the Temporarily Better Off (TBO).  These are folks that appear to have jobs that last more than a couple of years, pay people enough to eat and have a roof over their head in the same month and might even pay well enough for the person to own and operate a car.  However, more and more studies are pointing to the fact that a majority of these people when asked, believe they are one paycheque, one spouse or one illness away from abject poverty.   One of my female acquaintances who was forced onto CPP after long term disability basically dropped her after she had to sue and settle with them, still does not recognize that she is one spouse away from desperate poverty herself.  Her spouse is a nice man, very ambitious and successful enough to claim and actually keep middle class status ... but like anybody else, all it takes is an illness, an accident or some other issue to lay him out and then he can no longer support the family.  One's own empire of assets gets torn down instantly when you ask for help.  You have to live on your savings, your retirement savings, sell your second property, etc. until you are down to next to nothing, before you can get help.  I don't know what that accomplishes other than keeping people in need of financial support, making it very difficult for them to climb back up, but somehow the TBOs of our society think this is okay.  ODSP keeps stats on how people exit the system.  Less than one tenth of one percent leave the system through employment or self-employment. Most leave through reaching the age of sixty five or through premature death.  Some get married and leave the system as well, but that number is very low as well.

I hear the folks at ODSP wondering why more and more people are getting on this system.  How can we stem the flow, they ask.  Well, if people can just stop getting sick, stop getting into accidents, stop divorcing their spouses, etc., we'd all be happy.  However, misery tends to compound misery and over the past several years, I've watched so many couples separate and/or divorce.  To think this does not affect the upcoming generation is a complete understatement!  Niagara Region has become a bastion of depression, apathy, division, scapegoating and poverty.  One fellow I spoke to said he read a study that said that there are 100 unemployed workers seeking jobs for every single vacancy.  That's not very good and certainly not a unifying factor ... for those that get these jobs, there are always people who think they got these jobs for reasons of nepotism, being a minority, etc.  I have met men in the region that feel that they have no protection under the Human Rights Code or Charter, when in fact this isn't true.  The majority of folks I've represented before the HRTO were white males and we have met with successful settlements and a few times, successful hearings.

The provincial government wants to pick a region to test the guaranteed annual income.  I say, don't pick a region - just implement the damned thing.  However, if any region needs to be picked, pick Niagara Region, as to me, this area seems to be the one that is so badly covered by that gray cloud and is followed by lingering misery and longing for days gone by.  The people here need a boost to their morale, their sense of hope and to aid them in becoming the creative, capable people they were meant to be, and maybe then my practice will grow back into more of what it used to be ... to help people build things, as opposed to constantly fighting for the declining set of crumbs our social safety net offers, or to assist in conflicts with others that led to each one's demise.  Maybe then, the Piano Man will continue to play, but aside from himself, he will have others with him playing guitar, drums and violin, and get invited to play in bars, clubs and other places.  He will no longer be alone playing musical demos at three o'clock in the morning.

Your thoughts?


Thursday, April 7, 2016

WHEN BREATHING BECOMES UNDER-RATED, AND PANAMA COMES CALLING

I recently had a bout of health issues that brought me through the Niagara Health System. Fortunately, I landed in our new hospital in St. Catharines, even though I arrived terrified and thinking I was going to die!  My breathing became very laboured and I was unable to walk anywhere without shortness of breath.  My heart was apparently overworked at 186 bpm and my blood pressure was very high.

I don't know about you, but I really don't want another 'near death' experience, however it might be defined.  A friend, my son and I arrived at the emergency department on the behest and urging of my doctor.  We noted a sign saying "Start Here".  I introduced myself and fortunately, this was the person my physician was speaking to before we flew down there.  I was referred to Triage Unit A, whereby a nurse sat me on the bed and tried to get me lie down (but breathing is even more interesting when I lie down).  They did an ECG telling me my heart is fine but "just a little fast" (one of many euphemisms).  

They took my blood pressure, checked my lungs and so forth, and then sent me back to the wait area.  It wasn't even a few minutes before somebody called in from the entrance to the A Pod. The A Pod had many, many rooms and private work areas.  I brought what I could, but I was unable to walk that far ... the nurse apologizing for making me walk all that way, but I did.  I was relieved when I was placed in my own "room".  In the old hospitals, they did not have separate room areas for emergency patients, just curtained off areas with separate monitoring areas.  This was a room, only separated from the nursing station by a curtain.  

This was very different; they had a large TV screen showing me my ECG readings, my blood pressure automatically taken every fifteen minutes, my heart rate and my respiration rate. What surprised me was how fast the nursing staff were able to stabilize me, aka get me breathing again, slowing my respiration and gradually bringing my blood pressure down.  My heart rate stayed at a worrisome 140- 150 bpm.  Nurses, paramedics and nursing assistants were all busy, coming back and forth, introducing themselves for each twelve hour shift, taking blood tests.  Once I tried to go to use the washroom, but even though it wasn't far I was totally out of breath,  One of the nurses brought me back.  I noted there were a number of police officers at the ER, which I found interesting.

There were several blood and urine tests taken, apparently ordered by the Doctor on Call - who I looked up, and found she was specialized in Emergency Medicine.  She was very nice, calming and reassuring for me, explaining each test as they took them.  While I had my husband and son there, I tried to imagine them as medical detectives, like on True Stories from ER on TLC or even House.  My son who was with me throughout the whole ordeal kept looking at the screen and trying to reassure me too.  He is a medical sciences student, interested in the medical field. I was sitting, remembering the uncomfortable position I was sitting in my bed.  The emergency room beds are nowhere nearly as comfortable as the beds on the hospital inpatient floors.

Noting I was not able to use the washroom, they brought a commode to the unit next to my bed, where I was told to ask somebody to come in if I needed to use it.  Over the night, there were incidents of paramedics bringing people into the Pod.  There were two "Code Blue", as well as a few "Code Whites" in the mental health section.  This poor doctor, alone at night as the sole physician on call, had to deal with two Code Blues, as well as one Code White in Pod A (a fellow who was drunk and did not want to go to detox).  Activity was high speed around me, while inside I was trying to control my breathing.  Even getting up to use the commode was hard on me, bringing my heart rate way up, my breathing, etc. and it took so long to recover ... 

The doctor came in and told me all my lab tests turned out all right, but they wanted to do a chest x-ray.  This was one of their stand-up models they had in the diagnostic section.  They page a porter electronically, who comes to my unit, grabs my bed and transports me literally to where I need to be to wait for my x-ray.  I looked around me each time they did this - there were always other patients, some older, some younger than me, also awaiting radiology.  A technician signals the porter to bring me into the room and then she took over.  I saw the huge machines around me.  She asked me if I can stand.  I was honest and told her it was a challenge, so she showed me a way to stand up without risking my balance.  After positioning me, she took several pictures of my chest and then had me back on the bed and back in the waiting area, for a porter to return me to the A Pod.  

The doctor came back and told me my chest was clear, but she wanted to do another test called the d-dimer test, which can hint at the presence of clots.  She told me if this is positive, I will be scanned and then there will be a diagnosis.  There was more blood drawn.  Later, I was told the d-dimer showed up positive, suggesting a clot.  They then arranged to send me for a CT Scan.  Again, it took some time, but the porter (in green uniform) came around to take me back to radiology and had me sit and wait.  I was moved over to another section where the technician spoke to me about what happens in a CT Scan and had me sign paperwork for the Scan and the radiation dye they put in people to make the veins show up better.  Because I was already on Metformin as one of my diabetes drugs, she explained people generally do not continue on it for another 48 hours after they take a CT Scan.  Inside, the technician knew to grab a pillow to allow me to kind of keep my head up a bit as she knew I could lie flat.   She told me I will be told when to not breathe and when to breathe.

After she went back to this room that was offsite, but exactly like it is on TV (you have technicians and nurses in a window area monitoring the CT screening as it is being completed, as they upload it into my patient record).  My bed then moved into the machine putting me in a large cylindrical area.  As it went on, I felt the dye go into my body (which takes place very fast) and then I heard a woman's voice say, "Breathe", and then the the cylinder turns around and I can hear the whirring and so forth, and then, "Don't Breathe" and the same.  This only took about four or five minutes and then I was moved out, transferred back on my bed and ported back to the A Pod.  It took some time, but I was told by a nurse that the new doctor on call will be in to speak to me.

It was a middle-aged short man who was funny as hell.  He came in and asked, "So you are the person who came into emergency and checked out right and is perfectly healthy, except for clots in the lung?"  He told me the CT Scan showed the clots clearly and they were pretty serious.  A respirologist was coming in shortly to order treatment for me.  He told me I would be placed on injectable blood thinners for a few days, until the doctor can assess any oral medications.  This lung doctor came in, told me that he was admitting me to the hospital and that he ordered some pretty strong blood thinners because the clots in my lungs were fairly large.  He asked me if I was sure I didn't have calf pain, or travelled anywhere or had recent surgery, etc.  The answer was no to all of that.  I told him I was on hormonal medications (which I am no longer on) and that being diabetic and being in a profession that doesn't involve a lot of walking around doesn't help.  He examined my legs and said they did not seem to be swollen, but he set me up for an ultrasound for veins in the leg, pelvic and hip, as well as an echocardiogram.

A nurse came in and injected me with a powerful blood thinner (Lovenox) and told me I will be injected each day in the morning and in the evening, 100 mg IM.  It is interesting that you do not really feel too differently on blood thinners than you do without them, but you bruise easily and in hospitals, they like to draw blood, as well as keep a vein open for saline solution, other medications, etc.  People like me have an interesting time getting these kinds of tests, where veins are sometimes difficult to find.  They were eventually found, but my right arm eventually looked like it went through the Boer War.  They then started on my left arm.  

The porter came calling again to bring me to the ultrasound area where the technician was very thorough and used the doppler all over my legs, behind my calf, behind my knee, and everywhere else where a clot might appear.  This took awhile, as she put me in very difficult and uncomfortable positions to do the test, but I just allowed them to do whatever ... then I was taken directly to the echocardiogram room.  The woman doing the echocardiogram was very nice, reassuring and did a very thorough job as well.  I can see the right ventricle of my heart working so hard to pump blood out with my attempts to breathe.  Inside, I was trying to calm myself ... I wanted to help get my heart to rest.  She also assured me that once the blood thinners take effect, the heart rate will improve.

Later, I was assigned a male nurse who was very friendly and he came in to speak to me, especially when I was beginning to feel afraid of what was happening to me.  I needed to use the washroom, so he went to get a female colleague to assist.  I was still not breathing and I wanted to know when this was going to get better.  He was the one who in a quirky way reminded me about how anxiety can be triggered by the high heart rate and breathing issues, and in turn, aggravate the heart to beat even faster into a vicious cycle.  The doctor put all my prescriptions in (and added some medications for anxiety).  He came in and took some blood tests, then on intervals, tested my glucose as well.  He did inject me with a small vial of insulin (which I had to take because of the CT Scan).  I couldn't sleep very well.  In fact, I don't think too many people sleep really well in a busy emergency department.  

I started getting food trays, which was a treat for me as I had not eaten or even received my blood pressure meds in almost two days at that point.  It was that evening when the nurses came around with my regular drugs including my blood pressure drugs, etc.  My son came in after he had been resting for the day and kicked my husband out so he can rest and my son can take over.  He brought his laptop and did some of his papers for school.  He kept quiet and allowed me to sleep when I could ... In fact, I did sleep and early in the morning, I noted my son was still on his laptop. I noted my heart rate was going down, my respiration was getting back to normal and my oxygen ranked between 96 - 99%, a good rating.  The nurse that was working with me told me my heart rate for the first time went below 100 while I was resting.  

He went off shift and another nurse came in to take more blood and do another glucose test, then later told me I was moving upstairs!  The St. Catharines site has 80% of its rooms as single rooms.  They then moved me to what was called the Telemetry Unit (where people often are sent after cardiac surgery, or pulmonary "events" like I had).  I continued to pay for a week of Wi-Fi/Internet access for this room, using my laptop and my cell phone to text people.  I had many friends and family members come to visit.  In my own room, I was less anxious and both my son and my husband felt comfortable leaving me overnight.  I was fine with that.  I was on monitoring for the first four days upstairs, then I was told the doctor liked my numbers which were going in the right direction, but they will do regular vital signs checks.  

I continued to need oxygen and injections, but on Monday, the doctor came in to tell me he was going to start me on oral medications twice a day.  He explained that the medication I was getting, while still a powerful drug, is one of the new ones that don't interact with foods and most medications like the old Warfarin/Heparin combination did and thus, requires less monitoring (because one is stabilized on a maintenance dose).  He also told me they will set me up with follow-up at their clinic and the hospital's thrombosis clinic for follow-up.    He also wanted to run another test on me, a mammogram (just to be thorough because there might have been a cyst or something that came up on the CT Scan).  (The mammogram did get done and that technician was marvellous! ... if anybody in Niagara needs a mammogram, go to St. Catharines' site of the NHS as the technician there makes it painless).  

At first, getting up and using my washroom was difficult, leaving me breathless and exhausted by the time I rang the nurse to take me back to my bed.  However, after each time doing it, I was less exhausted and recovered faster.  The nurse assured me that although going there would bring my heart back up to 130 - 145, it would much more quickly come back down ... which meant to me that this was going to get easier.  A few days later, I asked about taking a shower. My first attempt at a shower was difficult, but I managed to do this, as well as brush my teeth and refresh.  On Tuesday, my doctor came in to tell me that I can go home the next day.  He was very nice too.  He told me my numbers were much better and that he would ensure that all my prescriptions would get transferred over to my pharmacy on discharge.

Later at night, I was transferred to a discharge floor.  I had to set up again and felt my anxiety coming back on again.  I took a shower the next day and cleaned up and eventually went to the nursing station to organize my discharge (late afternoon, when my doctor was finally upstairs to approve my discharge).  They removed my vein hook up, gave me my ID badges and went over my prescriptions very carefully and faxed over referrals for both specialist clinics and I was able to leave on the Wednesday.  At home, I rested.  I set my medications up the same way they were in the hospital (and my pharmacist was very helpful in making sure the new drugs were taken and organized properly).  I want to say that the care I had received at the NHS hospital here in St. Catharines was very good and the medical staff, even the porters and kitchen staff, were very kind and accommodating and they made me feel more comfortable. 

I am back at work now, but could only put out a part-time (for me) schedule.  Most people work forty hours a week and now that's what I am doing, which is PART TIME for me!  I go and do what needs to be done and that's it.  Over eighty phone messages, several pieces of mail and a couple of faxes.  I did the email replies as well.  I am on an online support group for people that share the same condition I have ... many recover and move on, but some are vulnerable to repeat episodes.  I don't want repeat episodes.  

Then, as I come back out and find out what's happening in the world ... the Panama Papers have been released, or at least what the media is referring to as thousands of people around the world hiding behind offshore accounts, many of them likely not paying taxes in their own country ... one of my colleagues told me who was on the Canadian list.  I became so angry ... why these people think others should be paying their share of taxes for them or accepting cuts in public services.  I just came out of the hospital.  I don't want to see cuts in their service, as they gave me good care and I realize now I could have died.  The NHS saved my life.  These people who seem allergic to taxes now want to further drain the federal (and provincial) treasury so there is less money for important things like health care, education, social services and other things we take for granted in a civilized nation.

Fans of Donald Trump, Kevin O'Leary and others like that ... I don't understand them at all. Neither have a clue how the other 99% of us live, nor do they care.  They truly believe the "trickle down" theory as some kind of religion, which of course has been disproven time and time again.  These same people here in Canada mourn the loss of Stephen Harper.  I celebrate that loss, because I did not get one iota of benefit or find any opportunities to get ahead while Harper was in power, while I watched tax break after tax break get handed to people that can damn well afford to do without that tax break, because even with these breaks, these wealthy people aren't going to create more jobs for the rest of us ... nor are they going to make our small businesses work more in our favour.  People who are ridiculously rich don't care about the working class, the merchant class or even the so-called middle class ... in fact, the way they structure their arguments to keep the economy working in their own favour is to make the middle class and some of the merchant class hate the working class and in turn, all of them hate the poor folks that can't even seem to be elevated to the working class.

I have been warned that there are emotional and psychological effects of my health issues. Many in the online support groups have suffered from them.  But I try to go back to remember what one of the nurses that was in the hospital told me.  She reminded me that it takes a long time to completely recover from this thing, that I will have good days and I will have bad days and not to fret over the bad days, as it gets better over time.  Many of my cohorts are upset to learn that the medications do not get rid of the clots, but simply prevent the clots from growing and keeping new ones from forming.  My doctor told me this, so I know what to expect.  One's body usually absorbs them over time as the medication destroys the clots' support structure, so the clots eventually get re-absorbed into the body.  A few stick around.  One of the doctors told me he only had one in his many years of practice he had to refer to a surgeon to directly take the clot out (a fancy operation, he referred to it as).  

I have an appointment for follow-up and I will also be following up with the family doctor, but I just want to get better.  I make myself walk each day.  Sometimes it is harder to do, and other times, I am exhilarated to do so.  I noted that if I am stressed or pressured too much at work I am less effective, so I am trying to schedule this gradual reintegration.  The legal system still runs like it always did.  I still appeared before the same judges, justices and adjudicators I always have and met many of my colleagues in the process.  I just wish I can be as strong and effective as I was before.  I will write another post shortly in more detail about Panama Papers and why our social system needs to be revamped, especially given that easily fifty percent of all people are working in situations like I am: self-employed, contractors, part-time, no benefits.  I lost a lot of money because of this illness.  I just have to get better and get back on track, because there is nothing else I know how to do.  

I can no longer take breathing for granted.  I think the act of being able to breathe is highly underrated, and it has become so obvious to me through this experience.

Your thoughts?

Wednesday, January 27, 2016

TALKING BACK TO BELL CANADA ON MENTAL HEALTH

January 27, 2016, is the day Bell Canada set out to talk about mental health issues.  I can assure you that I do talk about these things.  Many clients come into my office to talk about these things.  Many agencies have discussed these things.  However, I have a very different perspective when it comes to "talking about" mental health.

This is a good thing that these types of initiatives get people to talk about or think about mental health issues in a way that can help deal with stigma.  However, the discussion that I seen take place, both in their commercials and in the superficial coverage of the topic in the press tends to increase stigma. These commercials focus on the workplace where the protagonist in the first one tries to explain her absences and depression to a colleague who then winces that she had to be absent during inventory.  The second one involved two coworkers referring to a "Stuart" who was off again and they said he was bipolar.  Again, the worry about the workload left on his peers.

While this is appreciated to raise this issue in the workplace and to talk about it among larger employers with human resource departments and the time to do this, it is quite another thing to show real life examples of employers actually hiring somebody they know ahead of time has suffered some type of mental health issue.  Back in the 1990's, advocates cited a statistic that 80 -90% of people with a diagnosis of serious mental health issues were unemployed, I don't see that figure improving today.  It seems that the main advocacy organization in Canada, the Canadian Mental Health Association, agrees with me as it refers to unemployment on its website.  It saddens me that these commercials always seem to take place in large employers, which comprise less than 4.5% of all employers in Ontario which are for the most part, involved in a hiring freeze or laying people off.  A straw poll my own agency in the 1990's conducted with employers of various sizes confirmed that employer attitudes have not changed much.

Mental health issues are complex to address, but it does not have to be expensive or complicated.  Accommodations are as individual as the person concerned.  Most people who have mental health issues will not inform their employer, for fear it will affect their chances of advancement or cause them to be treated differently than others; however, the major fear which seems to be based in reality is that applicants for positions will not disclose for fear of being denied the job.  According to study cited by the CMHA, only 50% of us would disclose to friends and coworkers that a family members has a mental health disorder, while we would disclose the same about cancer and diabetes more than 75% of the time.  Only 12% of respondents stated they would retain a lawyer who is known to have suffered from mental health issues.  Slightly less than half of us would socialize with a friend we know that has mental health issues, and 27% of us are afraid to socialize with such persons.

The public is inundated by the entertainment industry that makes persons with mental health diagnosis seem violent and unpredictable, while the criminal justice system intersects with the media to make it seem that offenders who have mental health issues are violent, irresponsible and incapable of knowing right from wrong.  We see them in movies, slasher films and crime dramas as being haunted by their delusions and hallucinations after they stop taking their medications.  When yet another mass shooter or real life slasher like Luka Magnotta wants to be declared not criminally responsible, it sets us back yet another hundred years.  The defence of not criminally responsible is rarely applied to violent crimes, but the media wants us to believe it happens all the time.  People see this happening and will not seek help, as the conflation between mental illness and violence these situations depict can make an individual not want to be stigmatized in the same way.

The courts have also recognized mental health and addictions as an explanation for an accused's actions and consideration is given in the sentencing, as opposed to using NCR. This still leaves the accused responsible, but offers them a second chance to get clean, to get treatment or to better themselves in a way that will detract them from committing a similar offence in the future.  In fact, ninety-five percent of the time, these explanations are used for much less serious and mostly non-violent offences (e.g. shoplifting, theft, fraud).  I have used this angle myself while defending people in appropriate circumstances, which explains to the court why they did what they did - and giving it the thrust the person needs - to ask for help. I find the courts are genuinely interested in supporting the right outcomes for the specific accused, as opposed to a blunt instrument of right or wrong.

To me, the stigma is a huge problem for people with mental health diagnosis.  The public needs to move beyond the label.  Jack is not a :"schizophrenic"; Lucy is not a "manic-depressive"  Jack is a person who also happens to have been diagnosed as having schizophrenia (a label I question but nevertheless, the argument here is the same). Lucy is also a person first, somebody who just happened to have been diagnosed as being "manic-depressive".  Would it surprise you if I also told you Jack is a published academic, a psychiatrist and the head of a mental health rehabilitation agency?  Would it surprise you to learn that Lucy is a high profile defence lawyer who is also an accomplished pianist who in her spare time raises funds for Sick Kids?  If you met Jack or Lucy in these other roles and never knew about their mental health concerns, you would never consider that they might just happen to be "one of them"?

This is what today's stigma busting campaigns often forget about.  Bringing in accomplished people to talk about their experiences is not a bad thing, but it negates the fact that social class plays a major role in what opportunities each of these folks had in overcoming their issues and obtaining the right supports.  I have yet to meet a single one of these champions that spent a good part of their life on ODSP (Ontario Disability Support Program) who was inadvertently handed a major opportunity and viola - here they are!  The public needs to see the possible:  how these supports, opportunities, respect and understanding, can be extended to all persons with various levels of mental wellness.  Opening doors to self-employment, dignified employment, public speaking engagements, and so forth, to me, is more therapeutic to somebody than simply leaving them on ODSP or referring to their "broken brains" (which again has as much art as well as science fiction).

When you read above that only 12% of Canadians would knowingly hire a lawyer who has had a history of mental health diagnosis, what does that say about Lucy?  What does this also say to hundreds of employment coaches and employers that are so nervous about hiring people with mental health issues, that they prefer to relegate them to low wage, low skilled jobs, regardless of their talents and potential?  I know this because I have interacted with a leader in the insurance industry here in Canada (who I will not identify nor will I identify the companies they work with) who I bumped into at a conference.  She told me her companies hire all kinds of people with disabilities, including mental health disabilities.  "They love them in the mail rooms," she said. This is unfortunately still a major problem or a group of well educated Canadians would not have needed to form Canadian Association of Professionals with Disabilities - protesting employers that ignore one's talents, carry low expectations and assume that most want to stay on their disability benefits.

If Bell and its sister corporations that are involved in this important campaign really want to accomplish a lot of good with their work, how many people with mental health labels has Bell  Canada hired in the past year?  Or intends to hire in the future?  At all levels of the organization, from the mail room to the next CEO?  For its media partners, how many people with mental health disabilities will they hire to produce, direct and appear on various productions?  There are a few journalists I know who have been through horrific barriers due to mental health issues.  Putting them on front and centre to read the news, to report the news, to produce and present documentaries, or even aid in developing television shows that portray people with mental health issues in a much more positive light?  And that is ... just as people.  People like you and I.

Now that was my volley.  I kindly await yours.