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Outcry over service cuts for severely disabled 'unreasonable,' says health authority senior manager

Amid an uproar over cuts in services to some of the most profoundly disabled Montrealers in the English-speaking community, the associate CEO of CIUSSS West-Central Montreal has fired off an email calling critics of the sweeping changes "unreasonable."

Miriam Home's day program for adults dropping 100 clients to make way for those with more potential

Under the changes Miriam Home and Services announced earlier this month, adults with profound disabilities, like Andrew Superstein, 44, will be dropped from its specialized day program. (Zalman Glassner)

Amid an uproar over cuts in services to some of the most severely disabled Montrealers in the English-speaking community, a senior health and social services bureaucrat fired off an email last week calling critics of the sweeping changes "unreasonable."

As CBC reported, Miriam Home and Services, which provides a range of services to people with intellectual disabilities, is kicking scores of clients out of its specialized day program for profoundly disabled adults to make room for others on its long waiting list.

In the internal email obtained by CBC, Francine Dupuis, the associate CEO of CIUSSS West-Central Montreal, the regional health authority which oversees Miriam Home and Services, blames Miriam Home for improperly managing its day program for years.
An internal email from Francine Dupuis, associate CEO of the CIUSSS West-Central Montreal, says Miriam Home and Services is at fault for not properly managing its day program for years. (CIUSSS West-Central Montreal)

"People in real need of a rehab program were left on a waiting list while the ones on 'maintenance' were using our professional resources without any hope of improvement," said Dupuis in the email. 

The day program, run out of the Lori Black Community Centre in the Town of Mount Royal, offers activities and outings and gives profoundly disabled adults of all ages a chance to get out in the community, socialize, learn and integrate.

The program is being reoriented to focus on clients who have the potential to learn new skills.

Under the planned changes, more than 100 clients who now attend the program will be dropped to make way for younger clients who still live at home.

  • Clients of any age who live in a group home will no longer be eligible to attend the program. Instead, each group home's manager will become responsible for providing leisure activities in the home.
  • Clients who are 55 years or older are also being excluded, while those between the ages of 50 and 54 will only be allowed to attend the program part-time.
  • Clients who are frequently absent or who have fatigue issues will also see their hours reduced.

Day program used as 'babysitting?'

Many families call the cuts discriminatory and outrageous.

With the cuts initially due to go into effect in December, a users committee called an emergency meeting last week. An invitation went out to Alan Maislin, the president of the board of directors of CIUSSSS West-Central Montreal, to attend.

Maislin couldn't attend the meeting, but Dupuis wrote back, defending the reorganization of services. She lashed out at critics of the reorganization.

"These people are very unreasonable," Dupuis wrote. "The pressure they are putting on the program managers is unacceptable."

She also accused some group home managers of using the day program as "babysitting," so they could save money on hiring extra staff.

"It's always difficult to change what people consider 'their right,'" she continued, "even if it's our duty to optimize the use of resources."
Shelley Alper Stern's son, Richard Stern, has used Miriam Home's day program for years. At 27, he will no longer have access to the program because he resides in a group home. (George Stern)

Shelley Alper Stern and Rosanne Superstein, who both have relatives being dropped from the day program, were floored by Dupuis's comments.

"How does an organization that looks after disabled individuals come up with a statement like that?" asked Alper Stern.

Her 27-year-old son, Richard Stern, lives at The Benjamin and Vanda Treiser Maison Shalom — a group home in Côte-des-Neiges for adults with profound intellectual, emotional and physical disabilities.

Rosanne Superstein, pictured with her mom, Sheila and brother Andrew, says the government has to rethink the cuts it's making to services for the severely disabled, or there are bound to be ripple effects throughout the entire system. (Zalman Glassner)

Without the day program, Alper Stern is worried her son will deteriorate.

Stern uses a wheelchair at the group home. At the day program, he uses a standing board, which gives him a chance to loosen his muscles, move around and relate to others at eye level.

"He loves to be around people, and you can see it in his eyes," said Alper Stern.

Rosanne Superstein's 44-year-old brother, Andrew, also lives at Maison Shalom and goes to the Miriam Home's day program.

"It gives him a reason to get up in the morning," said Superstein.

She's sympathetic to the fact that there are many people on the waiting list for the day program, but she said her brother will be devastated if he can't continue to go.

"We can't kick one group out to put another one in," said Superstein. 
Miriam Home's day program, run out of the Lori Black Community Centre in the Town of Mount Royal, will be reoriented toward younger clients who have the potential for improvement and still live at home. (CBC News)

1 recreational therapist for 60 group homes

The Miriam Home has promised to hire a recreational therapist to train group home managers. 

However, Superstein says, the services of that single therapist is to be shared among more than 60 group homes under Miriam Home's umbrella.
Rosanne Superstein, a board member at the Maison Shalom, says group home managers risk burn out if they will have to add planning and carrying out leisure activities to their responsibilities. (Zalman Glassner)

That means that therapist would only be available about five days every year to each group home, Superstein said.

Superstein and Alper Stern are both on the board of Maison Shalom. 

They've spoken to several group home managers who don't know how they'll continue.

Many, they say, are already struggling with tight budgets. It's already difficult to find qualified staff.

Superstein says if group home managers are now also responsible for providing leisure activities, she's afraid many will burn out or give up.

"That will leave the client with nothing, no day program and no stable home," said Superstein. 

'No potential for rehab': Dupuis

Contacted by CBC, Dupuis said her email was internal and not meant for public consumption.

She said the Ministry of Health and Social Services has made it very clear it will no longer allow Miriam Home to provide rehabilitation services to clients whose condition can't improve. 

"They are people who are heavily medicated," said Dupuis. "They are usually quite old and have no potential for rehab."

She said there are as many as 200 others waiting to get rehabilitation services.

"It's a bit terrifying to see these people left on a waiting list, while other people could be getting the leisure activities elsewhere," said Dupuis.

Dupuis says she does understand why families are upset and has asked Miriam Home to delay cutting services until the New Year. At that time, each client will be evaluated individually. 

"I can assure you, it will not be done like they were cattle," said Dupuis.

Dupuis says she is trying to get more money from the government to fund an alternative day program. 

"If we keep the status quo, it's like putting our head in the sand," she said.

Little solace in temporary reprieve

Superstein said that even if the current outcry seems to have prompted a temporary reprieve, she fears the CIUSSS West-Central Montreal health authority will still find a way to whittle services away.

Even before this latest cut was announced, she said, Maison Shalom would often get a call to say her brother's educator wasn't available that day — and because there is no replacement staff, on those days he'd have to stay at the group home.

"The government has to wake up and pay attention," said Superstein. "This is a vulnerable population, and the real problem is there isn't enough money."

Another users committee meeting is scheduled for Dec. 5, at which managers of both Miriam Home and CIUSSS West-Central Montreal are to be present to answer questions.


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About the Author

Leah Hendry

Leah Hendry is a TV, radio and online journalist with CBC Montreal Investigates.