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UBC Theses and Dissertations

Rehabilitation in Canada : policies and provisions : a study of obstacles to the implementation of comprehensive rehabilitation services for Canadians Choy, Ivy Fung-Tsing

Abstract

It should be axiomatic that Rehabilitation is part of the social policy of any modern state. When Canada signed the United Nations Charter, she pledged herself to implement a comprehensive range of health services for her people. Health services according to United Nations definitions, have always included the five major aspects of prevention, diagnosis, treatment, restoration and rehabilitation. The purpose of this study, which is the first of a planned series, is to examine what progress Canada has made toward the implementation of that promise, made to her people in 1948. Its focus is on identification of the barriers legal, political, economic social and administrative which mitigate against the realization of this nationally set objective. The study began with the hypothesis that because in modern industrialized societies, programmes of rehabilitation services usually stem from a legislative base, the logical place to begin identification and analysis of obstacles to implementation of a full range of services, would be a review of the statutory provisions for services. If obstacles were identified at this level, their effect on the patterning and levels of services could then be examined and indications could be obtained as to how far a modification of the legislative structure of services might contribute to the development of a more comprehensive system. As a prelude to this analysis it was necessary first to delineate what is entailed in the concept of a comprehensive system of services and to define the terms "disability" and "handicap". International sources were used extensively, and it was found that in spite of widely differing political, economic and social institutions, and arrangements, there was almost complete agreement on the basic principles of rehabilitation. Ten major principles were identified and recorded. Next an attempt was made to identify criteria for rehabilitation goals as related to the individual disabled person. It was found that both the national and the international material consulted was geared to vocational rehabilitation as a goal and that most statements did not take sufficient cognisance of the person who cannot reach this goal, but who might achieve a different level of achievement and satisfaction. An attempt was made to classify these goals in a way which would be useful both to clients and agencies. Because each country has implemented the basic rehabilitation principles in its own way, there is no one system of services which can be used as a model for a comprehensive system. However, working from the base of the philopsophy and the ten principles, it was found possible to classify the kind and range of services which would have to be included in a comprehensive scheme. This was spelled out for use in this study and in future projects in the series as a "touchstone" or model profile of services with a cautionary reminder that no system of services is or should be static and that rehabilitation itself is a constantly evolving concept. It is anticipated that it will serve at least as a useful base against which to examine a wide range of problems relating to rehabilitation in future parts of the series. The many faceted nature of rehabilitation as a concept was next examined in more detail because the total concept needs to permeate the whole range of services. Emphasis was placed on the concept of rehabilitation not just as a set of services but as a process, a "for ward movement towards a goal" which the client chooses and which the various rehabilitation personnel help him to reach. The study then focuses on an examination of the current Canadian picture in rehabilitation. This was preceded by a brief summary of the early developments in rehabilitation in Canada, stressing the "piecemeal" and "categorial" approach characteristic of the times, and the unique features in the Canadian situation. Material for this was obtained from the general literature, together with material obtained from the office of the National Coordinator of Rehabilitation for Canada and from correspondence with the Provincial Coordinators offices of nine provinces, excluding Quebec. The role of the federal government was then analysed, with particular reference to its responsibilities under the division of constitutional powers made under the British North America Act of 1867. The specific groups for whose rehabilitation the federal government has responsibility are then referred to. The policy of the federal government in its attempts to assist the provinces to carry their responsibility for rehabilitation services is critically reviewed. There is then a closer examination of the three specific act relating to the disabled in Canada, first the Disabled Persons Allowance Act, secondly the Vocational Rehabilitation of the Disabled Act, and thirdly the relevant sections of the Technical and Vocational Training Act. There is next a focussing on the effects of this legislative structure on the patterning of services in one particular province, British Columbia. Emphasis is laid on the relationship between the role of the Provincial Coordinator, the place of the government agencies, and the important role of voluntary agencies. Material for this section was gathered from government statistics, Royal Commission Reports, surveys and reports of local agencies, interviews with the Provincial Coordinator and the Provincial Consultant in Rehabilitation for the Province of British Columbia as well as with the personnel of selected representative agencies offering a broad coverage of the spectrum of services in British Columbia. As a contrast, the neighbouring province of Saskatchewan was selected as an illustration of the differing ways in which identical federal statutes can be interpreted and followed, and the differing ways in which a provincial programme of rehabilitation service can be structured and administered. In Saskatchewan, the provincial government of the Co-operative Commonwealth Federation party coming into office in the 1945, took an active role in the rehabilitation field from the time it first took office, until its defeat in 1962, the now famous "medicare issue." This government interpreted its own statutes and those of the federal government very broadly, including from the beginning socially handicapped groups such as the Metis. In relation to the federal acts, it included groups such as alcoholics in its concept of the "disabled" which is not yet a common practice in the rest of Canada. This government's approach was also characterized by an extensive use of the "needs" test rather than the means test as a base from which to offer rehabilitation help to the entire family if necessary. While the "needs" test is used in British Columbia also there are a number of restrictions in its use, which do not operate in Saskatchewan, such as a "maximum floor" of financial aid which might be below the level of help an individual or family needed in order to become rehabilitated. Among the findings of the study are the following:- (1) that the fate of a Canadian needing rehabilitation sew ices depends very much on which part of Canada he lives in. Even within his own province, his neighbour across the street who happens to live within the boundaries of another municipality may fare far better than he does. (2) The kind and amount of help he receives would appear to be determined by three factors (a) the nature of the help available under the statutes, (b) the liberality or rigidity of their interpretation by the authorities of this particular locality (c) the availability of the kind of help he needs through the voluntary agencies(3) all the attempts by the Federal government to overcome the obstacles posed by the constitutional division of powers have not resulted in "national minimum" floor or service below which no Canadian shall be allowed to fall, despite many reiterations by the federal government that this is the intent, both of the legislation and of the efforts to assist the provinces which the federal government has made to date.(4) In essence, the federal role is basically limited to assisting the provinces with whatever services or facilities the provinces themselves are willing to initiate.(5) The conclusion is inescapable that the effect of the present constitutional division of powers on the development of comprehensive rehabilitation services is an impeding one. (6) In effect, the provinces and the voluntary socities carry full responsibility and the major portion of the load, without having either the legislative authority or the financial capacity. A series of recommendations broad,and specific,are then made. They include (1) Changing the British North America Act as a necessary step to the flexibility of patterning needed to make Canada's Rehabilitation Services comprehensive.(2) That the Federal government should assume a vigorous role as the standard setting body in the field of rehabilitation services, and should implement the concept of a national minimum of service. This is viewed as a necessity whether the federal government continues its policy of extending financial aid to the provinces, or whether a different system of legislative and fiscal responsibility is eventually worked out. A series of"research questions" arising out of this study are listed with the intent that these will form a nucleos of further research follow-up studies later in the series.

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