While the Self-Managed Attendant Services - Direct Funding program is almost 30 years old, its underlying philosophy and principles date back more than 60 years. It was in the 1960s that a handful of student "consumers" (people with disabilities who use, or "consume" services related to disability needs) attending the University of California defined a non-medical, non-charity approach to disabilities.
Consumers, the students argued, are not sick or in need of a cure. They developed principles of independent living associated with attendant services:
The principles and philosophy spread throughout North America and the world, leading to the founding of Independent Living Resource Centres (ILRCs) established with federal government funding. There are now 12 ILRCs in Ontario and a total of 28 across Canada.
Only a few decades ago, users of attendant services in Ontario were generally limited to two options: residing in supportive housing or using Attendant Outreach services. Some consumers, wanting greater choice, control and flexibility than they were receiving from these programs, began strategizing about a consumer-driven partnership between consumers and the provincial government that would allow funds for attendant services to flow directly to individuals. Such an arrangement, they felt, would more fully meet consumers' needs to exercise full responsibility, independence and self-determination regarding attendant services; to live outside designated housing or catchment areas; to have more control over who would provide the most personal of assistance on a daily basis and over the human relationships involved; and to receive the amount of service needed, as well as exercise flexibility over scheduling their services.
Amid this period of strategizing, the government commissioned a review of Ontario's attendant services in 1988. Among other recommendations, the report, "Independence and Control: Today's Dream, Tomorrow's Reality," indicated the need to provide a direct funding option.
In May 1990, the Attendant Care Action Coalition (ACAC), the Centre for independent living in Toronto (CILT) and London Cheshire Homes organized the first-ever provincial attendant services consumer conference, at Woodeden Camp near London, Ontario. It brought together consumers and their attendants, researchers, Independent Living Centre members, government officials and service providers.
ACAC/CILT completed a position paper and a proposed model for direct individualized funding for attendant services. Together with the Canadian Association of Independent Living Centres (CAILC), they sent a summary letter to the government.
During the summer of 1992, the province of Ontario's Minister of Health met with the Coalition and indicated a commitment to test this service model, with Independent Living Centres playing a key role in managing the proposed pilot project. A steering committee consisting of government policy people, political staff from three ministries, and consumers of attendant services worked collaboratively on the government policy paper for the direct funding pilot.
In 1993, after years of negotiating by consumers and their advocates through three provincial election periods and as many different parties in power - the Ministry of Community and Social Services Act (Bill 101) was amended to enable direct funding.
The following year, at a consumer conference on attendant services held at Woodeden Camp, the Minister of Health announced that funding had been approved for a pilot Direct Funding project to be run by CILT and the Ontario Network of Independent Living Centres.
The provincial government allocated $4.4 million for the two-year pilot project starting in 1994. CILT, an organization run by and for people with disabilities, was chosen as the administrator of the pilot due to its experience with large-budget projects and helping consumers find suitable attendant services. By 1997, 102 consumers were participating in the pilot; all participants took a leap of faith by giving up their rights to use other types of publicly-funded attendant services in favour of hiring and managing their own attendant services through direct funding.
In a subsequent evaluation of the pilot self-managers (as the program participants are called) reported increased self-determination in all aspects of their lives, a reduced sense of vulnerability, greater independence, a stronger sense of self-esteem, more fulfilling personal relationships and greater social participation.
In 1998 the Ontario government increased the Direct Funding budget to $18.7 million and transformed it from a pilot to a full-fledged program with approximately 700 participants. The number of participants has remained at about 700 since 1998, with about 300 on the waiting list. A funding increase announced in late 2011 was aimed at reducing the wait list and enabling up to 50 more consumers to become self-managers.
In 2011, the Ministry of Health announced plans to transfer the administration of the Direct Funding program to the Toronto Central Local Health Integration Network (TCLHIN). This administrative shift meant that CILT receives its Ministry funds through the TCLHIN and is accountable and reports to the TCLHIN instead of directly to the Ministry. CILT also negotiated a three-year agreement with TCLHIN that describes the Direct Funding program, its conception, spells out its unique features and provides demographic statistics so the program is protected in writing and can continue as it is now.
The Direct Funding Program is being expanded to allow more Ontarians with disabilities to live independently in their homes.
You can read more about this in our News Release.