Justice & Health Partnership Workshop Series: Identifying & Addressing Health-Harming Legal Issues www.comm communit nityle ylega galcen lcentr treca eca 158 George Street, Level 1 Toll Free: 1-877-966-8686 Belleville, ON K8N 3H2 Fax: (613) 966-6251 Tel: (613) 966-8686 TTY: (613) 966-8714
We are a non-profit community legal clinic and provide FREE(!!) !!) legal advice, assistance and representation to people living on a low income. We provide service to Hastings County, Lennox & Addington County, Prince Edward County + Tyendinaga Mohawk Territory. Our main office is in Belleville, but we have satellite offices in Trenton, Madoc, Marmora, Tweed, Bancroft, Picton, Napanee and Amherstview. We are funded primarily by Legal Aid Ontario (LAO). www.communitylegalcentre.ca 2
Your name Your role Have you ever made a referral to CALC? What are you looking to get out of today’s presentation? www.communitylegalcentre.ca 3
Why lawyers? Which patients? Identifying legal issues impacting health Addressing legal issues impacting health www.communitylegalcentre.ca 4
www.communitylegalcentre.ca 5
It’s no secret among healthcare providers that the social determinants of health are extremely important in the health outcomes of patients: o “The CMA believes that the social determinants of health can have a larger impact on individual and population health than the healthcare system….” Poverty is not always apparent, but is everywhere – in Ontario 20% of families live in poverty – exacerbates most other determinants Ask “do you ever have difficulty making ends meet?” o Poverty increases risk for many health conditions: Cardiovascular disease: 17% ↑ o Diabetes: 2x o Depression: 58% ↑ ; Suicide attempt rate: 18x o Cancer: lower 5 year survival rate o Also arthritis, COPD, asthma, hypertension, multiple comorbities … o ( From “Poverty: A Clinical Tool for Primary Care” by the Ontario College of Family Physicians) www.communitylegalcentre.ca 6
How can an lawyer ers s hel elp p pr promo mote e opt ptim imal al hea ealth h care e for r my pa patie ients? https tps:// ://www ww.y .youtube.c outube.com om/w /watc atch?list=PL1CSJ h?list=PL1CSJ- HGpbe be51sg sgKI5eJDc7 I5eJDc7npppF ppF-oA6 A64&v= 4&v=JkdQa JkdQa_heH _heHRs Rs www.communitylegalcentre.ca 7
A brief ef hist stor ory y of MLPs Ps Bene nefits its to impr proved d lega gal l health ealth from om US US, UK UK, Australian tralian studies: dies: o Decreased healthcare costs, decreased healthcare spending – particularly complex, high-cost, high-use patients o Fewer emergency room visits o Fewer hospital admissions & re-admissions o Patients better able to comply with health care treatments o Patients report decreased stress and improved well-being o Increased health care staff satisfaction when a medical-legal partnership program is part of the health care services www.communitylegalcentre.ca 8
Issue Related ed Socia ial l Legal l Help Imp mpact on Health h / Health Care Det etermi minan ants ts Tenant ant Rights ts Housing Evictions Stable, healthy, decent housing Disability Repairs → less stress → better Early Life Pests compliance with treatment Food insecurity Privacy plans Gender Harassment Race Discrimination Utility bills /rent Vital services (heat) Lease breaking Incom ome e Securit rity Income ODSP, CPP-D denials Higher income means fewer Income distribution OW denials trade-offs between food, a roof, Disability OW/ODSP “on hold” heat, and healthcare. Early life Overpayments Food insecurity OW/ODSP benefits A stable income means less Health services EI issues stress, better management of Social exclusion WSIB issues chronic illness, better health outcomes for children Employment, loyment, Working king Cond nditions ions, , Unemployment Unpaid wages Education is one of the best Educa ucatio ion Job Security Reduced hours predictors of adult health Working Conditions Termination Education Unsafe work Health insurance is often linked Health services Harassment to employment Gender Discrimination Race Suspensions/expulsions Safer work means fewer Special education injuries Adapted from the National Center www.communitylegalcentre.ca 9 for Medical Legal Partnership
Earlier intervention into people’s legal problems – aka, socia ial l det eterm ermin inants ants of health lth problems lems – resu sults lts in bett etter er legal al out utcom omes es (and nd thus us health lth out utcome comes): s): www.communitylegalcentre.ca 10
Diagnosis? Bedbugs. www.communitylegalcentre.ca 11
We provide legal services in the following areas: Consumer & Income Security Tenant Rights Debt Law (OW, ODSP, CPP) Seniors Issues Employment Human Rights (incld. Powers of and WSIB and Education Attorney and Wills) We also do Public Legal Education, Law Reform and Systemic Advocacy. We do not practice long or short term disability law, immigration law, family law, criminal law, real estate, or estates law. www.communitylegalcentre.ca 12
Poverty correlates to lower education levels, lower literacy levels, more difficulty accessing services… and higher incidence of legal problems “Poor people are not just like rich people without money... Poor people do not lead settled lives into which the law seldom intrudes; they are constantly involved with the law in its most intrusive forms. For instance, poor people must go to government officials for many of the things which not- poor people get privately… Poverty creates an abrasive interface with society: poor people are always bumping into sharp legal things.” Stephen Wexler, “Practicing Law for Poor People” (1970) 79:6 Yale Law Journal 1049 at 1050. www.communitylegalcentre.ca 13
Best way to determine if someone is living in poverty? Ask: “ Do you u have e tr troub uble le mak aking ng ends ds meet?” Sensitivity 98%, Specificity 64% for living below the poverty line https://www.youtube.com/watch?v=FLRT0bvaz98 www.communitylegalcentre.ca 14
03 BENEFIT MY 02 04 LANDLORD OR INJURIES DENIAL . EMPLOYER . 05 01 06 HARASSMENT APPLICATION EX EXAMPLES? AMPLES? www.communitylegalcentre.ca 15
Consider using a screening tool with all your clients/patients. CALC can help you design one. Screening tool or not, consider asking questions like: o Are you having problems with any government programs that provide financial support? ( OW, ODSP, OAS, CPP, EI, WSIB…) o Did you file your income tax return last year? Are you getting the Canada Child Benefit (aka baby bonus?) o Are you being contacted by creditors or collection agencies about money you owe? o Do you rent? How are things with your landlord? Do you have any problems in your rental unit? o How are things at work? Any concerns with your boss or your working conditions? www.communitylegalcentre.ca 16
Higher income means fewer trade- A stable income means less stress, offs between food, a roof, heat, and better management of chronic healthcare. illness, better health outcomes for children What t you might t hear: r: I was DENIED disability I can’t afford my medication I can’t afford to get to my medical appointments What t you might t see: Missed appointments, especially if they have to travel out of town Lack of compliance with treatment plans (ie meds, diet, physio) Frequent changes in address, couch-surfing, staying with family 17 www.communitylegalcentre.ca
Stable housing → less stress → Healthy, decent housing can better compliance with treatment reduce impact of chronic illness What t you u might ght hear: r: anything that starts with MY LANDLORD…. OR: My apartment is too cold My place has mold I’m being harassed I have bedbugs I have to move soon www.communitylegalcentre.ca 18
Education is one of the best Health insurance is often linked to predictors of adult health employment Safe work means fewer injuries What t you might t hear: r: Things aren’t good at work right now Worker’s compensation My boss wants a note won’t pay me benefits from you No one will rent to me because I’m on disability My son isn’t getting the help he needs at school I just had a baby and my boss says he replaced me What t you might t see: Letters from worker’s compensation, or workplace injuries School assessments Lack of compliance with treatment plans 19
Relates to income security – owing money means having less of it What t you might t hear: r: Collections agencies I can’t afford my car payments keep calling me – it’s so stressful I bought a water softener I owe money to the phone system and it costs more company and can’t pay it than I expected I signed something I shouldn’t have The bank froze my account I’m getting sued www.communitylegalcentre.ca 20
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