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Rigid rules for special diet allowances are hurting

This is how to fix it

by Kendall Worth

Regular contributor Kendall Worth took the fight to restore his special diet allowance all the way to the NS Supreme Court. Here are his suggestions on how to fix the system. Photo Robert Devet
Regular contributor Kendall Worth took the fight to restore his special diet allowance all the way to the NS Supreme Court. Here are his suggestions on how to fix the system. Photo Robert Devet

(K'JIPUKTUK) HALIFAX – Many Nova Scotians on income assistance have lost their special diet allowances since the Department of Community Services announced changes to the rules in 2011.

For many the fight to get those special diets reinstated has been downright difficult.

Question: What is to blame for this?

Answer: Section 6.3.3 of Employment Support and Income Assistance (ESIA) policy. Section 6.3.3 of ESIA policy makes it impossible for caseworkers, casework supervisors, other ESIA decision makers and even doctors to consider dietary needs for all disabled persons.

The problem is that the condition your doctor puts in the medical documentation which you submit to your caseworker has to match exactly the medical condition described in section 6.3.3.

No other reasons are allowed.

The loss of special diet funding for people on income assistance, and especially for those who have serious medical health conditions, has been problematic in more ways than one.

Without the special diet funding as a part of their ESIA budgets, nobody can afford the special diet. Furthermore, availability of special diet foods at food banks is limited to nonexistent.

Through my own investigating I had found out the following:

#1 – Although the policy has existed for ever, the fact is that before the 2011 changes happened Community Services has never strictly enforced this part of the ESIA policy.

#2 – It was the department's senior management and bureaucracy that created this rigid process. This is what I was told by senior bureaucrats at a meeting earlier this year attended by members of the Community Advocates Network.

I must say that what the Department of Community Services did hurt a lot of ESIA clients with disabilities who depend on the system, including myself.

As someone who has been diagnosed with Impulse control disorder. I am required to have Omega 3 in my diet. Omega 3 comes from fish, eggs and meat products. For this reason my condition requires me to have a high protein diet.

My doctor put in writing to Community Services as to why I need this diet, but my condition does not match the criteria set out in section 6.3.3 of the ESIA policy. This is why my caseworker cannot approve my diet.

The criteria for this diet according to section 6.3.3 of ESIA policy states that it is for illnesses such as, but not limited to, cancer, or for post surgery when there has been extensive weight loss.

The confusing part regarding this criteria is: what does the wording of “not limited” mean?

Well the answer I had got when I had asked the caseworker supervisor this question during my second appeal hearing was that it means any illness resulting in weight loss. In my personal case this means, my Department of Community Services caseworker cannot approve a high protein diet for me to get my required Omega 3 into my diet.

At this point in the article, one thing I want to mention about my past is the fact that I grew up in a family where everything which my father did for work was related to fish, including fishing, and working at fish plants.

When I first learned how to cook back when I was teenager, fish is one of the very first things I learned how to cook.

Anyway, every time I am in the grocery doing my grocery shopping, I always take a bit of extra time to observe the seafood department and the price of fish is not cheap. So with an income assisatnce client who needs Omega 3 in their diet, $66.00 opens up the door for them to be better able to afford those products within their budget.

I became a patient of the North End Community Health Clinic in September 2013. My family doctor at the clinic, Rodney Wilson, wrote a note to try and get my diet back.

When Dr. Wilson wrote his medical note, he mentioned the cardiac risk factors which comes with my medical condition. He talked about how this diet can keep elevated cholesterol under control.

Regardless, it got denied.

I appealed the decision through the assistance appeal board and got denied again. This time I took it all the way to the Nova Scotia Supreme Court and there too the decision got upheld.

Several doctors, including doctors at the North End Community Health Clinic in Halifax, and at least one other doctor who I personally know, are finding that section 6.3.3 of ESIA policy overall problematic and difficult to deal with.

They are frustrated with the system in itself because of the wording and the enforcement of section 6.3.3 of the ESIA policy.

This section also gives a caseworker the authority to call a medical professional if medical documentation submitted by the doctor is not clear according to the description of the special diet provided in section 6.3.3 of ESIA policy.

The fact that doctors are getting phone calls from caseworkers further questioning them on why they are recommending these diets for their patients is a practice they are getting fed up with.

As one part of my story, what has outright frustrated this doctor is the amount of phone calls he has gotten from the Department of Community Services further questioning him on why he is recommending this diet in the first place.

Furthermore – when he learned how Section 6.3.3 of ESIA policy was worded and when he personally experienced this section of ESIA policy 6.3.3 being enforced, he made the decision to just give up in helping fight to get the $66.00 High Calorie/High Protein diet back into my budget.

He says that basically Section 6.3.3 of ESIA policy is expecting him to lie about my medical condition in his required medical notes for Community Services to get me approved for getting my $66.00 High Calorie/High Protein diet reinstated.

Doctors at the North End Community Health Clinic deal with a lot of low income patients. They are concerned about the practices within the ESIA program and they all agree that policy reform is needed when it comes to Section 6.3.3 of ESIA policy. They find that working with most of their patients can be difficult because of this part of ESIA policy.

These are my suggestions to improve the policy.

#1 – Under the current version of policy ESIA 6.3.3, there is a chart called Special Diet Rate Schedule. This is the actual part of the ESIA policy that Case Workers and casework supervisors follow. Remove that chart from the wording/format of section 6.3.3 of the policy.

#2 – Have doctors review the special diet requests and sit down with the caseworkers and/or supervisors and make the recommendations to accept the request or not.

#3 -And instead of caseworkers have this doctor call his colleagues if there is a problem.

 

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