Category "Opinion"


Daphne Bramham: Searching for happiness in the novel coronavirus era

by admin

This is a particularly joyless March and what have we got to look forward to? April, which T.S. Eliot called the cruelest month.

There’s angst all around. It’s impossible to have even a casual conversation with a stranger without the dreaded COVID-19 virus being raised, let alone dinner with friends or a few hours on social media.

We don’t know whether to be afraid or whether to risk being reckless by going to a restaurant, hockey game or pick up a friend at the airport.

We’re worried about the unknown ‘what next’ because even when there is a lull in the seemingly endless news coverage of all things viral, there’s so much more bad news.

The stock market collapse, the joyless battle of the American grandpas for president, the oil shock caused by a seemingly crazed prince, continuing migrant crises in Europe and the Americas, riots in India and so on and so on.

I want to run away from it all. Except for the virus, I would literally have been packing my suitcase right now for Bhutan — the first place on Earth to put happiness before the economy.

But COVID-19 put a stop to that.

My trip was postponed because of the turmoil of changed and cancelled flights, not fear of catching the virus. Ironically, it was only in cancelling that we discovered we’d been rebooked on a return flight that left a day later, took 35 hours with three stops and landed us in Detroit with no indication of how we’d get home.

I’m relieved, but grounded and surrounded with fear of the unknown. How do I — how do any of us — find happiness now when it seems there’s nowhere safe to go?

Naturally, I turned to Google. It’s perhaps a sign of the times that among the first quotes that came up was this misanthropic one: “Happiness comes from peace. Peace comes from indifference.”

That misanthropic recipe from tech entrepreneur Naval Ravikant belies the research, which says the opposite. Happiness comes from engagement, social contact, a feeling of belonging.

Then, up popped Marie Kondo’s exhortation to “spark joy” by decluttering. I nixed that as an immediate solution. But it’s something to keep in mind if ever the time comes for self-isolation.

Beyond that are dozens of others advising that the route to happiness is to find one’s “authentic self” or one’s “inner awesomeness.”

I retreated to the kitchen and put on a pot of soup. But rather than the usual Zen of chopping vegetables as the stock bubbled, it reminded me that I couldn’t find any lentils on the grocery store shelf Monday. Should I join the panicked rush? What if the crisis is real?

Most of us are urban-dwelling, just in time people. Grasshoppers, not ants. We’re a frail lot too when you consider the Inuit and Dene in the north, Andean highlanders in the south, nomadic Mongolians or our ancestors.

That’s why I travel, to see how others live. It’s how I’ve come to be on six of the seven continents and travelled in more than 40 countries. It’s why Bhutan beckoned and not a Caribbean beach.

It’s why on a gloomy, rainy day with a case of fake jet lag from the time change, I went looking and found happiness at the Museum of Anthropology. Pulling open drawers, there are small things of beauty and purpose. Towering poles are testament to survival and renaissance against astounding odds.

Wandering aimlessly, it’s impossible not to see the interconnectedness of human imagination and endeavour from the fearsome to the sublimely decorative to the practical.

(If fear or the virus keeps you home, you might want to try it virtually. The collection is online at http://collection-online.moa.ubc.ca/)

There were spears, swords, fertility figures, wedding dresses, bowls, spoons, as well as religious objects and necklaces with charms meant to ward off the unforeseen, the unpredictable and the deadly that have always stalked us.

On a recent trip to Edinburgh, I took a tour of Mary King’s Close where in 1645 the pneumonic or ‘black’ plague stalked the residents of the crowded underground tenements.

Their doctors dressed in long leather cloaks with large brimmed hats and wore grotesque, beaked masks made of tin and filled with herbs to repel the evil smells that were thought to carry disease. The sight of today’s health-care workers in HAZMAT suits, N-95 masks, visors and gloves are not less disturbing, albeit far more effective.

Humans understand science better now than in the past. With every new outbreak from HIV/AIDS to Ebola to SARS, the time from first detection to getting it under control has improved. Yet, the unseen and the unknowable remains no less frightening to us than it was to a 17th century Scot or a 19th century Haida.

Where once people flocked to church looking for benediction and salvation, these days they head to Costco.

But for some peace and perspective? Try some homemade soup and some quiet time at a museum … Just don’t touch your face and make sure to wash your hands for at least 20 seconds before you leave.




Daphne Bramham: Canada’s other public health crisis also needs urgent attention

by admin

There is a very real and deadly health crisis in B.C. from which two people died yesterday and two more will likely die today, tomorrow and the days after that.

It’s not COVID-19, and no news conference was hastily called to talk about it.

Most of those dead and dying are blue-collar guys in what should be the prime of their lives.

This is the reality as B.C. lurches into the fifth year of an opioid overdose crisis. It’s a seemingly unending emergency that by the end of 2019 had already killed 5,539 people here and more than 13,900 across Canada.

Five years in, this crisis has become normalized, with the only certainty as we face another day is that first responders are now better at resuscitating victims because, year over year, the calls have only continued to increase.

Last week, Prime Minister Justin Trudeau appointed his top ministers to a committee tasked with responding to the COVID-19 crisis. At that point, Canada had only 30 confirmed cases. Of the 21 B.C. cases, four of the patients have fully recovered.

Not to belittle the concerns about COVID-19 becoming a global pandemic, but with nearly 14,000 dead already, no committee — high-level or otherwise — has yet been struck to devise a national addictions strategy that would deal not only with opioids, but also the biggest killer, which is alcohol. A 2019 report by the Canadian Institute for Health Information found that 10 Canadians die every day from substance use, and three-quarters of those deaths are alcohol-related.

During the 2019 election, the issue flared briefly after Conservatives placed ads — mainly through ethnic media — claiming that Trudeau’s Liberals planned to legalize all drugs, including heroin.

Already beleaguered, Trudeau not only denied it, he quickly disavowed the resolution overwhelmingly passed at the party’s 2018 convention that called on the Canadian government to treat addiction as a health issue, expand treatment and harm reduction services, and decriminalize personal-use possession of all drugs, with people diverted away from the criminal courts and into treatment.

Trudeau disavowed it again this week when a Liberal backbencher’s private member’s bill was put on the order paper.

Liberal member of Parliament Nathaniel Erskine-Smith (in front) pictured in 2018.

Adrian Wyld/The Canadian Press

Depending on how you read Bill C-236, it’s either calling for decriminalization or legalization. Regardless, the fact that Nathaniel Erskine-Smith’s bill will be debated at least gets it on the political agenda because unless there are some major changes, Canadians are going to continue dying at these unacceptably high rates that have already caused the national life expectancy to drop.

Erskine-Smith, an Ontario MP from the Beaches-East York riding, favours a Portugal-style plan of which decriminalization plays only a small part.

But parliamentary rules forbid private member’s bills from committing the government to any new spending, so he said his bill could only narrowly focus on decriminalization.

The slim bill says charges could be laid “only if … the individual cannot be adequately dealt with by a warning or referral (to a program agency or service provider) … or by way of alternative measures.”

Erskine-Smith disagreed with the suggestion that it gives too much discretionary power to police — especially since in B.C., it’s prosecutors, not police, who determine whether charges are laid.

Still, what he proposes is quite different from what happens in Portugal.

There, police have no discretionary power. People found with illicit drugs are arrested and taken to the police station where the drugs are weighed, and the person is either charged with possession and sent to court or diverted to the Commission for the Dissuasion of Drug Use to meet with social workers, therapists and addictions specialists who map out a plan.

Since private members’ bills rarely pass, Erskine-Smith doesn’t hold out much hope for his.

It created a firestorm on social media, with some recovery advocates pitted against advocates for harm reduction, including full legalization.


Federal Conservatives also repeated their trope that drug legalization is part of Trudeau’s secret agenda.

Meanwhile, Alberta’s United Conservative government inflamed some harm-reduction advocates with the release of a report on the adverse social and economic impacts of safe consumption sites, even though it didn’t recommend shutting them down.

The report acknowledged that they play an important role in a continuum of care, but it also called for beefed-up enforcement to lessen the chaos that often surrounds them.

The committee questioned some data provided to them that suggested Lethbridge — population 92,730 — may be the world’s most-used injection site.

The committee also questioned why some operators report all adverse events, including non-life-threatening ones as overdoses, leaving the impression that without the sites “thousands of people would have fatally overdosed.”

Among its recommendations are better data collection using standardized definitions as well as better tracking of users to determine whether they are being referred to other services.

More than a year ago, Canadians overwhelmingly told the Angus Reid Institute that they supported mandatory treatment for opioid addiction.

Nearly half said they were willing to consider decriminalization. Nearly half also said that neither Ottawa nor the provinces were doing enough to ease the epidemic.

It seems Canadians are eager for change even if they’re not yet certain what it should look like. The only ones who seem reluctant are the politicians.



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Daphne Bramham: It’s not enough to just keep overdose victims alive

by admin

There was some good news in the 2019 data from the B.C. Coroners Service. Overdose deaths in the province declined for the first time since fentanyl-tainted drugs hit the streets and a public health emergency was declared in 2016.

The decrease was significant — down 36 per cent from 2018 — even though the death toll remains heartbreakingly high. As B.C. enters its fifth year of the crisis, nearly three British Columbians are dying every day.

It does mean that all of the money poured into this crisis — for naloxone kits, the training for paramedics, medical professionals and laypeople in how to use naloxone, more supervised consumption sites, and more people now on prescriptions for drugs like methadone and Suboxone to staunch addicts’ opioid cravings — is keeping more people alive.

But that’s really where the good news ends.

Alarmingly, the number of 911 calls has continued to climb.

Paramedics and other first responders took more than 24,000 calls last year, with calls spiking to more than 130 overdose alerts on “cheque days” or “welfare Wednesdays.”

Being revived from an overdose or living with an opioid addiction comes at a high cost.

Opioids affect the receptors in the brain, causing breathing to become dangerously slow, which in turn slows the heart and sometimes causing cardiac arrest. When the hearts doesn’t pump at capacity, less oxygenated blood makes it to the brain. Without oxygen, brain cells die — and they don’t regenerate.

It’s called toxic brain injury.

Within the coming weeks or months, the B.C. Centre for Disease Control will release data on the prevalence of brain injury among opioid users, including those who have been successfully restored to life with naloxone.

“We know that many hundreds of people will need a lifetime of care,” said Dr. Perry Kendall, who raised the alarm during the coroner’s news conference earlier this week. “It will be a tremendous burden.”

It’s far from the only one.

The burden carried by first responders is different and no less costly. They are burning out and checking out of the system, unable to cope physically, mentally or emotionally with the constant stress of being called to deal with all the overdoses.


This is not to say that harm-reduction measures aren’t working. No one disputes that they are keeping many people alive.

But until now, little attention has been focused on the quality of their lives, post-overdose.

Five years into the public health emergency, Chief Coroner Lisa Lapointe said B.C. still doesn’t have a comprehensive system that includes prevention, treatment and recovery.

The lack of a seamless system is particularly problematic and even deadly for people in rural areas and those coming out of jails and prisons, according to Dr. Nel Wieman, senior medical officer at the First Nations Health Authority.

The numbers back that up. The death rate in the Northern Health Authority, at 22.5 per 100,000, trails Vancouver Coastal, which has the highest rate, by a mere half a percentage point.

Regardless of where they live, Lapointe said families frequently tell coroners how their loved ones managed through detox only to come out and die while on the waiting list for a recovery bed.

The problem isn’t necessarily that there aren’t enough treatment beds. On most days, some lie empty because the government only funds treatment for welfare recipients. Everyone else has to pay their own way. And except for those with generous employee benefits, many can’t afford treatment that comes at a cost of $900-plus a day.

Lapointe also decried the lack of provincial treatment standards. Different operators have different approaches. Some aren’t evidence-based. Some are strictly abstinence-based and refuse to accept people on drug therapies such as methadone and Suboxone, even though without that, they are more vulnerable to overdose if they relapse.

Decriminalization is touted by some as the answer. Without fear of criminal charges, the theory is that people would be more willing to seek help.

They point to Portugal, where decriminalization was brought in as part of a massive overhaul of its drug treatment system.

But decriminalization has only worked there because Portugal also boosted spending on the other three pillars — prevention, enforcement and treatment.

Here, the crucial elements are missing. With a minority government in Ottawa, the Liberals already have enough problems on their plate to risk raising the controversial idea of decriminalization.

Meanwhile, most provinces, including B.C., haven’t invested enough in the infrastructure to put a Portugal-style model in place.

This week, Mental Health and Addictions Minister Judy Darcy agreed that there are enormous gaps in B.C.’s fragmented system.

When the New Democrats were elected less than three years ago, she said the drug treatment system had been neglected for so long that it was not able to cope with regular tasks, let alone a public health emergency.

The government is taking steps to fix that. But whether it’s moving fast enough is a conversation that both the coroner and chief medical health officer are pushing British Columbians to have because the lives of many loved ones depend on it.


Twitter: @bramham_daphne


Stephen Wiseman: A doctor’s take on no-fault insurance

by admin

By now, everyone has heard of the NDP’s about-face on what it describes as the wonderful new world of ICBC no-fault insurance. Increased benefits and decreased premiums for all, says Premier John Horgan, affirming the change as almost “too good to be true.”

But is it? British Columbians and their doctors already have lots of experience with no-fault insurance through their interactions with WorkSafeBC and some other disability insurers. Let’s hope everyone is happy with this kind of model and service, because ICBC will be offering the same thing as of 2021.

The big picture is that every injured citizen will be dealing directly — without legal advice or support — with a vast bureaucratic apparatus whose interest is split between offering benefits and protecting its bottom line. The government itself says that 700,000 of us don’t even have a regular family doctor in our corner. Any thoughts on how this might turn out?

Take the issue of causation. Say you were injured in a crash but were pushed hard to return to work after six months in spite of ongoing pain. You are not at your best, your boss is unsupportive and critical, and you go off work with symptoms of depression and anxiety. If ICBC decides unilaterally that your symptoms are due to “workplace stress” and not related to your original injuries, you will not qualify for further wage-loss support or psychological treatment. How will you argue otherwise, without a lawyer and quite possibly without a regular doctor?

If you are covered, you will not receive a lump-sum settlement to use as needed, but will be joined at the hip to the ICBC bureaucracy, possibly forever. In the language of no-fault Manitoba Public Insurance, “income replacement will continue for as long as the claimant meets eligibility criteria.” So, every few months, or year or two, you may need to submit burdensome medical proof of ongoing impairment to continue with your wage-loss benefits. Also, at any time ICBC may decide that you could do job X, even part-time, instead of your own job — in the Manitoba plan, this is called “determined employment” — and, of course, if you don’t pursue it, your benefits can be docked accordingly.

About that impressive-sounding new $1,200 per week maximum wage loss benefit? Remember, ICBC must first accept that you cannot work, and they may disagree with you and your doctor about this. Most concerning is that this will be awarded solely based on your current income. If you are doing well in an apprenticeship and stand to finish and make a lot more money, for example, you will not be compensated for those future earnings if you cannot continue with your career.

Then there is treatment. It may be offered, but only continued if ICBC deems you to be objectively improving in your functioning. As with WorkSafeBC, it is irrelevant that, say, massage therapy reduces your suffering and so is important to you. You must essentially prove that it actually makes you function better. And, of course, every condition has a predetermined number of treatments that will be supported, and no more. With the current lump-sum settlement system, if you decide you want the treatment, you can afford it and are not answerable to anybody.

WorkSafeBC also keeps a list of medicines it deems appropriate for any condition, based on its own take on the scientific literature. It decides what is “evidence based” and this trumps your own experience of the treatment almost every time. So, it does not cover opioid painkillers, for example, even at low and stable doses, even if both you and your doctor agree they are helping.

And if you want me to treat your post-traumatic fibromyalgia with slightly more novel approaches such as low-dose naltrexone or transcranial magnetic stimulation, we are both out of luck. Sorry, not enough evidence, in their opinion. The new ICBC model will likely follow this approach to a T.

Finally, there is the issue of access. If ICBC decides you need to see a specialist, will they like the current MSP wait lists? Further enhanced payments to physicians for expedited consultations and treatment will be put in place almost certainly. For those on non-ICBC wait lists, you will go further to the back of the bus, and it will remain illegal for you to pay to expedite your own care.

In my practice, I treat many patients with chronic pain and psychiatric complications caused by car crashes. While the stress of litigation under the current system is often severe and intrusive, it typically comes to an end with a settlement or a court award. While this does not cure any symptom, it does provide many with a degree of closure and relative peace of mind to move on with their lives as best they can.

My patients under prolonged WorkSafeBC and some other disability insurance claims, however, are not afforded such relief. The ongoing interactions with bureaucracy, the paperwork, the treatment rejections, the appeals, the demands to return to work — all can feature in these patients’ lives, and in certain cases have driven some to contemplate and even attempt suicide.

Every approach to car insurance surely has benefits and drawbacks. But don’t let David Eby convince you that he has suddenly cooked up a miracle. We all know about no-fault insurance already. Talk to your family and friends, and to your doctor, about their experiences with the approach ICBC is now adopting.

And be careful of politicians offering shiny new objects. They may not be so good for your health.

Stephen Wiseman is a Vancouver psychiatrist with a special interest in pain.

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Daphne Bramham: Lack of addictions treatment for youth needs urgent fix

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As B.C. heads into the fifth year of a public health emergency due to the high number of opioid overdose deaths, Vancouver Island still doesn’t have a single residential-treatment for youth. Provincewide, the number of youth beds and services lag demand.

For youth who do get one of those precious treatment beds, their transition back to community-based services is badly planned and poorly managed.

Had all of that been in place, 16-year-old Elliot Cleveland Eurchuk might have survived his addiction rather than being counted among the 4,850 British Columbians to have died between January 2016 and Oct. 31, 2019.

But the teen’s legacy could be — should be — that Health Minister Adrian Dix and Premier John Horgan making addictions treatment as much of a priority as harm reduction.

Recommendations from the coroner’s inquest into Eurchuk’s 2018 death released on Monday provide some direction: More acute-care beds for youths including a residential treatment centre in Victoria; more and better access to addictions services; and resources for early detection of mental-health and substance-use disorders among youth.

For more, the government ought to dig out its copies of the 2018 report from the B.C. Centre on Substance Use that recommended a “full, evidence-based continuum of care including building an effective and coordinated addiction treatment and recovery system that has traditionally been lacking.”

That report also singled out the need for youth-specific services and treatment including residential care. It also recommended “recovery high schools” where not only are drugs and alcohol are strictly prohibited, treatment and services are part of the curriculum.

Men aged 19 to 59 make up the overwhelming majority of the people who have died of opioid overdoses. But, an average of 18 youths have died in each of the past four years.

The recommendations aren’t only aimed at preventing youth from dying. They’re aimed at providing treatment to prevent their addictions from becoming entrenched.

In addition to the recommendations, the coroner’s report provides a glimpse of the other opioid crisis far away from Vancouver’s Downtown Eastside.


Eurchuk knew about harm reduction services, but he didn’t get his drugs tested, didn’t go to safe injection sites, didn’t seek treatment or replacement therapies such as methadone or Suboxone.

He’d started using cannabis in November 2015 when he was 13. After injuring his shoulder wrestling a year later, he began self-medicating, buying hydromorphone from a classmate at Oak Bay High School.

In December 2016, he broke his jaw playing soccer and, after surgery, was prescribed hydromorphone for the pain. Two months later, he had the first of two surgeries on his shoulder and was prescribed another opioid, Tramacet, for the pain.

After reinjuring his shoulder that fall, Eurchuk was given another prescription for Tramacet. He was also suspended from school, accused of selling drugs to classmates.

After a second shoulder operation that October, Eurchuk got a five-day prescription for Oxycodone, followed up by a prescription for Tramacet.

In the final months of his life, Eurchuk was routinely using opioids to the point that when he was hospitalized in early 2018 for a serious infection, he got a day pass and got fentanyl and cocaine while he was out. He went into cardiac arrest in the hospital on his return.

He was home briefly in February before being readmitted under the Mental Health Act. Discharged after a week, Eurchuk was in the emergency room of Vancouver’s St. Paul’s Hospital in March because of decreased consciousness and released after a few hours.

On his final day, Eurchuk bought a two-day supply from a street dealer, used with a friend early in the evening and was heavily intoxicated by the time they parted ways. As the evening wore on, people who saw him described him as everything from fine to agitated to disoriented. He was last seen at midnight.

The teen died on the morning of April 10 at home from a heart attack, fluid in the lungs and aspiration caused by “mixed intoxication” from fentanyl, cocaine, heroin and methamphetamine.

Attempts to revive him with naloxone, chest compressions, suction and a defibrillator failed.

While the government will provide a written response to the coroner’s recommendations in the coming weeks, last summer it committed $2.4 million over three years to addictions and mental health programs.

It has opened four youth detox beds in Victoria. There are eight Foundry Centres across the province providing comprehensive supports with three more being developed.  And, this spring, a 20-bed treatment facility in Chilliwack is scheduled to open.

There is no guarantee that better acute-care treatment, earlier interventions and more comprehensive community services will save the lives of every addicted youth or that they would have saved Eurchuk.

Addiction is, after all, a chronic, relapsing condition.

Elliot Eurchuk was just a kid and there are others like him. They deserve the best chance possible to grow up to be healthy adults.


Twitter: @bramham_daphne


Bruce Dewar: 2010 Olympics and Paralympics were about more than just games

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The lighting of the Olympic cauldron 10 years ago this month not only served as the formal kickoff of Vancouver’s Winter Olympics, but kick-started a legacy of philanthropy and public service that went beyond sports and sport-related facilities, says Bruce Dewar.

Ric Ernst / PNG files

February marks the 10th anniversary of the 2010 Olympic and Paralympic Winter Games in Vancouver.

For those of us lucky enough to have been in B.C. for those 17 days in February (and 10 days in March during the Paralympics), we saw the city and province come alive in ways few of us could ever have imagined. When Sidney Crosby scored his “golden goal” to deliver the men’s hockey gold, Vancouver and Canada erupted in a shared sense of relief, celebration and pride. Vancouver, British Columbia and Canada had delivered.

As we look back to 2010 with fond memories and nostalgia, there are obvious questions: Was it worth it? Is Vancouver better off from hosting the Games? Did Games proponents deliver on their promise of legacies?

As a board member of Tourism Vancouver, I was involved from the outset of the domestic bid and then worked on the international bid for the Games. Throughout the process, we talked about legacies beyond bricks and mortar. We wanted to redefine legacies within the Olympic family, looking at how sports and the Olympic movement could be a catalyst of social, cultural and community legacies that would truly benefit communities long after the Olympic cauldron was extinguished.

As part of the Games journey, I became CEO of an organization called 2010 Legacies Now — a non-profit organization arm’s length from all three levels of government, the Canadian Olympic and Paralympic Committees and Vanoc (Vancouver 2010 Organizing Committee). We worked with communities and organizations across the province to discover and create inclusive social and economic opportunities. Delivered through partnerships, our work affected more than two million people across B.C. by 2010, creating legacies in sport participation, improved literacy, sport tourism, accessible tourism and accessible communities, arts and more.

ViaSport, established in 2011 by 2010 Legacies Now in consultation with the provincial sport system, continues to lead a consultative and co-ordinated provincewide approach to increase participation in sport and physical activity. Today, the amateur sports sector in British Columbia is thriving. On average, more than 718,000 athletes register for organized sports every year, with over 16,000 coaches attending training sessions. B.C. has outperformed other provincial and territorial jurisdictions in the number of registered athletes on national teams, with 38 per cent of Canada’s 2018 Olympic team tied in some way to B.C.

Sidney Crosby and Scott Niedermayer celebrate after Canada’s ‘golden goal’ won Olympic gold for its men’s hockey team over the United States in overtime at the 2010 Winter Olympics in Vancouver on Feb. 28, 2010.


AFP/Getty Images files

The Games and 2010 Legacies Now have been instrumental in increasing literacy levels in marginalized communities in the province. 2010 Legacies Now helped to establish Decoda Literacy Solutions, a provincial organization committed to the development of strong individuals, families and communities by providing literacy resources and training. Over the last decade, Decoda supported children and families, youth, adults, seniors, Indigenous and immigrant communities through community-based literacy programs and initiatives in more than 400 communities across B.C., benefiting 1.6 million people.

We worked closely with B.C.’s own Rick Hansen Foundation and other partners to tap into the growing accessibility tourism market and awareness created by the Games to ensure ours were the most accessible. We then transitioned 2010 Legacies Now’s accessible tourism program to the Hansen foundation, where they used the tools and resources as the basis for the highly successful Rick Hansen Foundation Accessibility CertificationTM (RHFAC) rating system. More than 1,200 buildings across Canada have been rated, and 752 RHFAC certified. This Games-time legacy and investment will assist people with disabilities for generations to come.

And then there is the legacy of 2010 Legacies Now itself. Fuelled by the experience and knowledge gained from working with organizations and communities, 2010 Legacies Now reinvented itself as LIFT Philanthropy Partners ― the first national non-profit organization that uses a venture philanthropy approach to help build the capacity and capabilities of social purpose organizations (SPO) Canada-wide. SPOs are charities, non-profits and social enterprises that operate with the primary aim of achieving measurable social impact.

The model has been a success. We work with SPOs like Jump Math, which encourages an understanding and a love of math in students and educators; Women Building Futures, which helps women looking to enter the trades; Neil Squire Society, which uses technology, knowledge and passion to empower Canadians with disabilities; and Indspire, a national Indigenous registered charity that invests in the education of Indigenous people.

Bruce Dewar, in 2011, announces the establishment of LIFT Philanthropy Partners.

David Martin /

PNG files

We help SPOs be more sustainable and effective at delivering greater social impact in the areas of health, education and skills development leading to employment. Now, more than ever, Canadians need the tools and opportunities to thrive, not just survive. Our work is made possible with the generous support of our partner network and the individuals, corporations, governments and foundations that provide philanthropic investments to LIFT.

Critics of hosting the Games challenged the idea of legacy and impact. From the earliest days of the bid to today, all the partners took that challenge to heart. I stand behind the footprint we have left behind: Stronger literacy levels; greater participation rates in healthy activities by youth; better, increased barrier free access to facilities for people with disabilities — and more.

There are also intangible legacies ― an unwavering sense of national pride, new capabilities and the belief that anything is possible if we work together as a team. We grew as a province and a nation.

The Olympic motto states: “Faster, Higher, Stronger.” Thanks to the 2010 Olympic and Paralympic Winter Games, we are very much the latter.

Bruce Dewar is president and CEO of LIFT and former CEO of 2010 Legacies Now.


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Opinion: A co-ordinated group of family, friends and allies key to keeping disabled safe

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Florence Girard, 54, was found dead in a private home on Oct. 13, 2018. An RCMP probe alleged that the victim didn’t receive the necessities of life, such as food, shelter, medical attention and protection from harm, Coquitlam Mounties said in a statement Jan. 29, 2020.


The news of Florence Girard’s tragic death and subsequent charges against her caregivers reminds us that family, friends and neighbours have a critical and irreplaceable role in keeping disabled people safe. While the courts deal with the RCMP charges let’s not make the mistake of relying solely on formal accountability mechanisms. Instead let’s ensure a network of supportive relationships is in place for every vulnerable person in care so that no one ever has to die alone and unnoticed again.

Our comments aren’t wishful thinking. We write this as co-founders and leaders of the Planned Lifetime Advocacy Network (PLAN.) We have more than three decades of experience developing support networks for disabled people in B.C. and around the world. One of us has a daughter who, like Girard, has Down syndrome. Research studies back up what we’ve learned. When disabled people have a network of supportive relationships they’re safer, healthier, require less paid services, have a higher quality of life, and their risk of abuse and neglect is dramatically reduced.

Caring networks create safeguards. We aren’t referring to an occasional volunteer visit, but to an intentional and co-ordinated group of family, friends and allies. Network members are companions, watchdogs and advocates. They serve as trustees. They monitor guardianship arrangements. They assist with health care, banking and everyday decisions. Because they’re in a committed, continuing relationship with the disabled person, they know when something is wrong, they spot changes to the person’s health and temperament, and motivated by love they take action to make things better.

The outcry for more formal safeguards is understandable but misplaced. Compare the difference in coverage. An occasional monitoring visit by a government agency combined with a once-every-three-years formal certification process versus a network of friends that is always checking in, visiting regularly and sharing updates with each other.

There are many ways to establish a stable network that lasts. PLAN’s approach is to hire a community connector who works closely with the individual. When there is no family nearby, network members come from neighbours, service clubs, faith groups and people who share similar interests. In our experience most people welcome the opportunity to join with others in a caring network.

We have witnessed network members identify changes in a person’s mental health, detect tumours and arrange for medical care that was missed by service providers. They have found jobs and volunteer opportunities. They have taken up the slack when aging parents or family members weren’t available. They have protected people from being exploited and abused. They have made sure they have suitable clothing and nutritional food. And they have helped people with a terminal illness die in peace and love.

Sadly, most disabled people in care don’t have caring networks. It’s time for the B.C. government to make these relational safeguards a fundamental ingredient of our service-delivery apparatus. Not as a “nice-to-have.” Not as part of another study or investigation. But as essential in keeping people safe as all the formal safeguards combined.

We recommend the B.C. government:

1. Mandate the funding body Community Living B.C. (CLBC) to ensure relational safeguards exist for every one of their clients. This will take a modest investment of money in community groups who aren’t service providers but nowhere as much as implementing yet another system of monitors monitoring monitors, monitoring contracted agencies.

2. Require all relevant government and service-provider agencies to take courses in relational safeguards. This orientation is just as important as safety and health certificates or criminal record checks.

3. Appoint a vice-president of relational safeguards at CLBC. Unless there is a senior position with power and resources nothing will change.

4. Document the difference. The added benefit of relational safeguards is that it results in happier lives for disabled people and reduced program costs. Use the data and any savings as the basis for improving supports for British Columbians with a disability.

We can’t think of a better way to honour Girard’s memory.

Vickie Cammack and Al Etmanski received the Order of Canada for their work with disabled people and their families. They co-authored Safe and Secure — Seven Steps to a Good Life for People with Disabilities. Rebecca Pauls is executive director of the Planned Lifetime Advocacy Network.


Andrew Longhurst: B.C. needs to significantly boost supply of public assisted living for seniors

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The B.C. government should provide new capital and operating funding to non-profit organizations and health authorities to increase the supply of publicly subsidized assisted living units as part of a provincial seniors’ care capital funding plan, argues Andrew Longhurst.

AlexRaths / Getty Images/iStockphoto

Too many seniors in our province struggle to find publicly subsidized assisted living where they can be supported as they age. Amidst an affordable housing crisis felt across generations, the need to significantly boost the supply of subsidized assisted living is more urgent than ever before.

Assisted living is a type of supportive housing for people with moderate levels of disability who need daily personal assistance to live independently (meals, help with bathing, or taking medications, etc.). Publicly subsidized assisted living is part of B.C.’s larger home and community care system. There is also a large private-pay assisted living sector, where seniors pay entirely out-of-pocket and fees are completely unregulated. For-profit corporations provide the vast majority of private-pay units, while non-profits provide the majority of publicly subsidized units.

In a new study published by the Canadian Centre for Policy Alternatives, my research found a number of concerning trends.

Access to publicly subsidized assisted living units in B.C. dropped significantly — by 17 per cent — between 2008 and 2017. (Access is measured as the number of units for every 1,000 seniors age 75 and older).

Perhaps not surprisingly, the private-pay assisted living market has benefited as a result, as seniors and their families look for other options when subsidized care is unavailable. Between 2010 and 2017, 1,130 private-pay units were added throughout the province, while a mere 105 publicly subsidized units were added.

Private-pay care may be an option for some, but it is beyond the means of most low- and moderate-income seniors. Senior couples at the median (middle) income of $61,900 can scarcely afford a one-bedroom assisted living unit, which would eat up 58 per cent of their income. For seniors living alone, even a bachelor suite would require over 80 per cent of their income.

Without access to subsidized assisted living, seniors who can’t afford to pay privately may go without care altogether or wait until their health deteriorates to the point of requiring a nursing home or hospitalization. This situation does not serve seniors or our public health system well at all.

Over the last two decades, the provincial government has not made the public investments needed for health authorities and non-profits to develop new assisted living spaces, which means very few new subsidized facilities are being built.

At the same time, skyrocketing real estate prices have led to a growing financialization of seniors’ care, where real estate assets are bought and sold as commodities on international markets. But allowing assisted living facilities to be treated this way is fundamentally at odds with the basic social purpose of providing care to vulnerable seniors.

It is clear that B.C.’s policy approach is not working. Access to publicly subsidized units has fallen and yet we know that the for-profit sector is more likely to build private assisted living units because the rate of return on capital invested is higher.

What is the solution?

B.C. currently relies on private-sector financing of assisted living, which is more expensive than the provincial government financing new construction. This approach is a relic of the early 2000s when government refused to take on debt in order to build critical social infrastructure.

Aside from an initial injection of federal and provincial capital funding in the early 2000s, the provincial government has provided very little ongoing direct capital funding to expand subsidized assisted living. In fact, over nearly 10 years (2009-10 to 2017-18) the B.C. government provided a mere $3.3 million in capital funding. To put this into perspective, this represents 0.04 per cent of total capital investments in the health sector over this period.

The B.C. government should provide new capital and operating funding to non-profit organizations and health authorities to increase the supply of publicly subsidized assisted living units as part of a provincial seniors’ care capital funding plan. Seniors and their families deserve no less.

Andrew Longhurst is a research associate with the Canadian Centre for Policy Alternatives and author of the just-released report Assisted Living in British Columbia: Trends in access, affordability and ownership.


Daphne Bramham: Urgent overhaul of long-term care funding and oversight needed

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In 2017-18, for-profit operators failed to deliver 207,000 hours of care for which the B.C. government paid them.

AlexRaths / Getty Images/iStockphoto

Some corporate-owned, long-term care homes in B.C. are getting money for nothing, while not-for-profits may be getting less than they need for their services to be sustainable.

But the bottom line is that the losers are both vulnerable seniors and taxpayers who are footing the $1.3-billion annual bill.

To be clear, it may be unconscionable, but for-profit operators who run a third of all the long-term homes and beds in B.C. are not breaking any rules. Just as it’s fair to assume that not-for-profits, who account for another third of the total, aren’t deliberately leaving money on the table.

The problem is that the system is broken.

B.C. Seniors Advocate Isobel Mackenzie (Richard Lam/PNG)

Patients and their families have been complaining for years. On Tuesday, B.C. Seniors Advocate Isobel Mackenzie clearly set out the evidence in her report, A Billion Reasons to Care, which comes within a few months of Island Health taking over three privately operated homes.

Mackenzie’s funding review is a scorching indictment of the government’s failure to properly manage one of the largest contracting relationships it has with service providers. To some extent, Mackenzie said, the government is handing long-term care operators blank cheques.

She said the rules haven’t kept pace with the fundamental shift in government procurement policy that began 20 years ago when long-term care was contracted out to private operators who were then allowed to opt out of the Health Employers Association of B.C., which once bargained on behalf of all publicly funded, health-care employers.

Rules are non-existent, vague or not uniformly applied. Direct care hours, for example, aren’t necessarily separated out from the hours that care aides spend on food service or housekeeping. Financial monitoring is scant with no requirement for detailed or audited reports.

In 2017-18, for-profit operators failed to deliver 207,000 hours of care for which the B.C. government paid them. Were they fined? No. They got to keep the money.

Meantime, not-for-profit operators delivered 80,000 hours of care more than they were contracted to provide. Those extra hours were paid for either by lower costs in another area or by other funding sources.

It is true that all operators face a staffing crisis that Mackenzie describes as being of epidemic proportions, with nearly 90 per cent of care homes not able to meet minimum staffing guidelines.

But it’s partially self-inflicted. For-profit operators’ wage costs for each hour of direct care is lower across all classifications than the costs at not-for-profits and the homes run directly by health authorities.

Some for-profits are paying care aides, who provide two-thirds of the care, nearly a third less than the industry standard, which works out to $6.63 an hour. Part of the difference is that for-profit operators are more likely to hire part-time rather than full-time workers, which eliminates the need to pay benefits.

Raise the salaries, says Mackenzie, and workers will follow the money.

The government and health authorities should also follow the money. Rather than setting a minimum wage or requiring that all operators pay the industry standard, Mackenzie says to simply end the incentive to not deliver the care. If operators didn’t deliver 207,000 hours of care, they should have been required to give that money back.

But there are no penalties in any of the contracts. Don’t deliver and, ka-ching!, the bottom line suddenly looks a lot better as taxpayers’ money transforms into shareholder profits.

Disturbingly, Mackenzie found that contracts varied both between and within health authorities.

“All spoke to delivery of care,” she said Tuesday. “But none specified the type of care. None outlined any legal requirements to provide the care. And none had explicit penalties for non-compliance.”

Every health authority also had different reporting systems. Different ones allowed expenses to be claimed differently. There were also anomalies between the profit and non-profit operators, including for-profits having surpluses 12 times higher and profits three times higher.

The health authorities allowed for-profit operators to claim building expenses at 20 per cent of their revenues compared to the not-for-profits’ nine per cent. They also allowed mortgage interest rates considerably higher than market rates, double the depreciation rates, unexplained lump-sum payments to contractors working for affiliated companies, unspecified management fees in addition to administrative expenses that are higher than non-profits.

One concern Mackenzie has about non-profits claiming lower building expenses is that they will not be able to upgrade their facilities as they age, meet any new accessibility requirements that may be required, or expand to meet the tsunami of demand from an aging population.

It all needs to change and change quickly before even more public money is funnelled into corporate profits at the expense of vulnerable seniors who aren’t getting the care they need and deserve.


Twitter: @bramham_daphne


Adrienne Montani: Minimum-wage work shouldn’t be a ticket to poverty for B.C. families

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Holly is a single mother of two, Ezra, 13, and Emily, 17. Emily is a complex kid with multiple health and developmental challenges, including Down Syndrome. Emily is reliant on a feeding tube and since she was born Holly has been her round-the-clock caregiver. Unable to return to work, Holly relies on social assistance.

Emily needs special medical equipment, a variety of therapies and must travel monthly to B.C. Children’s Hospital from the family’s home in Nanaimo. While they have been fortunate to receive support from charities to cover some costs, living on social assistance means this family lives in deep poverty.

Holly’s situation is not unique. First Call has been tracking child and family poverty rates in B.C. for over two decades and our 23rd annual Child Poverty Report Card, released this week, still shows one in five B.C. children lived in poverty in 2017. That means 163,730 children and youth were living in poor households, including 51,760 children under the age of six.

Overall, B.C. had the eighth highest child poverty rate of all the provinces and territories. At just over 19 per cent, B.C.’s child poverty rate was slightly higher than the national child poverty rate of 18.5 per cent.

For the first time since 2009, the number of poor children in lone-parent families increased, from 81,960 in 2016 to 86,690 in 2017. This is the first time we have seen children in lone-parent families make up more than half of B.C.’s poor children.

The gender inequality gap persisted with the median income for female lone-parent households at $44,960 and the median income for male lone-parent households at $62,550.

Many of the regional districts with the highest child poverty rates were located in coastal areas, particularly along the north and central coastal areas. Indigenous children, new immigrant children, children in visible or racialized minority groups and those with disabilities all have much higher poverty rates than the B.C. average.

Adrienne Montani, provincial co-ordinator at First Call: B.C. Child and Youth Advocacy Coalition.

Arlen Redekop /


In 2017, a single parent with one child living on social assistance survived on only $19,795 per year, 40 per cent below the poverty line. Unfortunately, the average number of children living in households on social assistance rose by 1,900 between 2016 and 2017. And, like Holly, for most of these families (66 per cent), working is not an option.

However, the story of most family poverty in B.C. is one where one or more parents are working. Many families raising children on minimum-wage jobs, often without benefits, are still far below the poverty line.

Overall, the median after-tax income for a poor lone parent with one child in 2017 was $17,920, more than $12,000 below the poverty line. The median income for poor couple family with two children was $30,540, almost $14,000 below the poverty line.

Over the past few years both federal and provincial governments have taken steps in the right direction, including a more generous Canada Child Benefit and B.C.’s new Child Opportunity Benefit, set to kick in this fall.


Government has an opportunity here to raise all families (those with working parents and those on social assistance) over the poverty line through the combined income transfer programs currently in place. Better universal public services like affordable housing and child care, along with free or low-cost public transportation access, would also reduce a family’s expenses and improve their quality of life.

In fact, there is recent evidence showing the nominal increase in the CCB resulted in decreased food insecurity for families while making a substantial contribution to Canada’s economy.

So while we’re cautiously optimistic about governments’ plans, the 2017 Child Poverty Report Card shows us there is so much more to be done to ensure all children have what they need to thrive. Having a child with complex needs or working full time at minimum wage or living with a disability should not be a ticket to poverty for B.C.’s families.

Adrienne Montani is provincial co-ordinator at First Call: B.C. Child and Youth Advocacy Coalition.

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