..:: Ontario AIDS Network ::..

Any one leaving Ontario or planning to move to Ontario would be wise to plan ahead. If you are living with HIV it is even more imperative to do the research ahead of time to ensure a smooth transition. Some of the things to consider would be;

Contacting an AIDS Service Organization (ASO) in the community you are moving too could answer some of your concerns and be of help in letting you know what services you can expect. If you are moving across Canada, you may want to contact the Canadian AIDS Society to find the ASO closest to where you will be living. If you are moving to Ontario, the Ontario AIDS Network (OAN) can let you know what ASO's exist in the province. Before making the move it is important to have all of your personal information (birth certificate, immigration papers, social insurance card, health card, banking information, income tax, medical information).

Individuals will have different financial and practical resources available to them. Some people will be moving with nothing, while others will be taking all their personal belongings with them. The distance involved in the move will affect the level of difficulty as will their state of health. Planning ahead will prove to be the most economic strategy, rather than paying last minute prices for movers or transportation.

Aside from basic expenses (cost of the move, food) your financial plan should include a 'buffer' for extra or hidden costs (mileage, gas, late fees, drop off fees). If you've already made arrangements for where you will live; obtaining your new home may involve deposits or last month's rent and connection fees for utilities, phone or cable. If you don't have a place to live you may need money for temporary accommodations or storage for your belongings. Budget money for gas or transit costs to get around while looking for a new home. Some apartment rental companies may charge an administration/application fee. You may need to pay for a cell phone or voice mail service so potential landlords can reach you. Remember, if you are on a government income program and you use your whole monthly entitlement for the move, you probably will not be eligible for any money in your new community until the next month.

In terms of living accommodations most people either own or rent or are considered homeless. When planning a move it is important to consider your options and plan ahead. If you are able to purchase a property it will be wise to contact a reputable real estate agency. They can be found on the Internet, in the phone book, in local papers or by word of mouth.

If you plan to rent, it would help to have some idea of the vacancy rate, availability and average rental charges in the area you want to live. In general, larger urban communities are more expensive to live in than smaller rural areas. You can get this information from the Internet, from local rental agencies, the classified section of local papers or by calling the local ASO. The best advice for anyone moving to Ontario is "make sure you have housing before you come". Currently Toronto is facing an 'affordable' housing crisis so be prepared for a long wait. Rental properties can be divided into two categories, Private and Public.

Private properties are usually owned and operated by individuals or management companies who determine their 'market' rent by what the community can pay. A one-bedroom apartment in an average building in central Toronto can cost between $900-$1000/month and more. A bachelor apartment in a basement of a house can average $600-$700/month. Sharing a two-bedroom may cost about the same, per person. If problems arise with your roommate, remember, only the person whose name is on the lease has legal rights to the unit. You can find these rental properties through rental agencies (which may charge a finders fee), the classified section of the local/community papers, notices posted on community centre bulletin boards, by walking around a neighborhood looking for signs on buildings advertising a vacancy or by word of mouth. Most property managers will ask your source of income. It is against the law to discriminate against someone on a disability or fixed income. However, most landlords will look at the ratio between your gross monthly income and what the rent is. Your application could be refused if that ratio is out of sync. When you find a unit you can afford, you will be expected to pay the first month's rent and either a damage deposit or the last month's rent. You may have to sign a one-year lease or rent month to month. You will be expected to give a 60-day notice, in writing, when you plan to vacate.

Public properties are usually owned by the government (Municipal or Provincial) or by groups and organizations (Co-ops or Non-Profits) that receive subsidies from the government. These housing providers offer rent geared to income units. In most large cities there is one organization that processes the applications and manages the wait list for all the housing providers. For example in Toronto it is the Housing Connections. You can find this information on the Internet (enter 'city name' rent geared to income housing), look in the Government Section (blue pages) of the local phone book, or call the local ASO. There is usually a long wait list for rent geared to income units, so it would be wise to apply before you make the move. To apply in Ontario you have to be; -at least 16 years old, -a Canadian Citizen, landed immigrant, refugee claimant, convention refugee, -able to live independently, -not owing money to any social housing provider. Usually the rent will be 30% of the household's gross monthly income. With some housing providers there may be extra charges for utilities and services. There are usually extremely long wait lists. The active wait list in Toronto is 8 to 10 years. You may be eligible for a priority if you live with a family member who threatens your safety. Some housing providers consider other circumstances (a severe health condition) to be a priority. HIV is not considered to be a severe health condition. The priority wait list in Toronto is 2 to 3 years. Once you get into a rent geared to income unit you are obligated to notify your landlord of any changes in your income or household. If you fail to do this it could jeopardize your eligibility for housing. If your income changes your rent will change accordingly. If a person joins your household they are obligated to provide verification of their gross monthly income, which will affect the monthly rental charges. The landlord has the right to do an annual update of information to ensure continued eligibility.

Many larger communities have a range of alternative housing options such as rooming houses, low-end resident hotels or bathhouses. For someone with little or no money there is the shelter system. In Toronto some of the shelter operators give priority to people with HIV, yet many of the shelters are full every night and have to turn people away. Other parts of Ontario may have limited shelter resources.

When you are thinking of making a move it is important to consider where your income will come from. Any personal money or investment assets will not be affected by a move. If you are planning to work, it will be wise to check out the job market before making the move. If you are on long-term disability benefits, they should not be affect. However, it is your responsibility to inform your insurance company of any changes in your contact information. Employment Insurance (EI) and Canada Pension Plan-Disability Benefits (CPP) are federal programs, so you can move anywhere in Canada and your benefits will follow you. It is important to notify them of any changes in your contact information. If you are receiving regular EI benefits it is important that you are still ready, willing and able to work to continue to be eligible. If you are receiving disability benefits other than CPP, it is probably a provincial benefit, which will end if you move out of that province.

In Ontario there are two government income programs that someone relocating here, could be eligible for. Ontario Works (OW) is a municipal government income program, which can be accessed the quickest. You can get your first cheque within 72 hours of being determined eligible. For a single person they give a monthly basic allowance of $195, will pay up to $325 towards rent and provide a drug benefit card that will cover most prescription medication. To apply you must be over 18 years of age, have legal status in Canada, be a resident of Ontario and be able to provide all vital applicant information to verify your immediate and on-going eligibility, such as - bank book or bank statement showing how much money you have, -verification of any assets, -what, when and how much was your last source of income, -previous year's Income Tax Assessment from Revenue Canada, -rent receipt or lease agreement. Your application will be taken and assessed over the phone. Further eligibility will be determined through a meeting with a worker at your local office. Remember if you have already received benefits for that month from a different province, you will not be eligible for OW until the next month, whether you have money or not.

Ontario Disability Support Program (ODSP), which can take up to 6 months to process, is the other disability income you may be eligible for if you are found to be a person with a disability. For a single person they give a monthly basic allowance of $516, will pay up to $414 towards rent, provide a drug benefit card that will cover most prescription medication as well as some dental and optical coverage. To qualify for ODSP benefits you must meet medical and financial eligibility requirements. The medical requirements state you must have a substantial physical or mental health problem that is expected to last a year or more and your health problem substantially limits your ability to work, look after yourself, or carry out daily activities at home and in the community. To satisfy the financial requirements a single person can't have more than $5000 in liquid assets and their monthly income from other sources must be lower than ODSP's entitlement. To apply you must be over 18 years of age, have legal status in Canada, be a resident of Ontario and be able to provide all vital applicant information to verify your medical and financial eligibility. If you have no other source of income you can apply for ODSP through an OW intake. You would receive OW benefits for the months you are being determined eligible for ODSP. If you are a recipient of CPP disability benefits you have already met the medical eligibility requirements for ODSP so you may be fast tracked onto the benefit if you meet the financial eligibility requirements. You would receive the difference between your CPP benefit and your ODSP entitlement (a top up) plus the drug, dental and optical benefits. For example; if you are a single person, receiving $600 from CPP and paying $500 in rent, your ODSP entitlement would be: $516 (basic allowance) + $414 (the maximum rent) = $930 - $600 (CPP) = $330. You would receive $330 plus drug, dental and optical coverage on a monthly basis as a top up to your CPP benefit.

Whether you are moving to or from Ontario it is important to plan ahead to ensure a smooth transition in your health care needs. A first step would be to ask your current doctor if they are familiar with an HIV primary care physician in the community you are moving to. If they do, ask them to make a referral. If they don't, you could contact the ASO in the area, to ask for a referral or a list of the physicians that are most familiar with HIV. It is a good idea to get your current doctor to compose a detailed letter explaining your health situation, including copies of up to date blood work and a list of the medications you are taking. This will quickly bring a new doctor up to speed on your health. It will also help a new doctor fill out government forms you may need to qualify for benefits. Once you are settled with a new doctor, your complete file can be requested from your previous doctor. There may be a cost associated with this.

All provinces provide a Health Card, which usually covers a wide range of health services, such as doctor's visits, medical specialists, hospital stays, etc. In Ontario this is called the Ontario Health Insurance Program (OHIP) and you must show your health card every time you access services. To be eligible for an OHIP card you must; - be a Canadian Citizen, Landed Immigrant or Convention Refugee, and - have lived permanently in Ontario for at least 3 months, and - continue to be physically present in Ontario 153 days in any 12-month period. If you are relocating from another province (with the exception of Quebec) you can use that province's health card for the 3 months you are waiting to be eligible for an OHIP card. Your doctor or hospital will bill the other province directly for services they provide you. If you are coming from Quebec, you will have to pay for the services provided to you and send the receipts to the Quebec government for reimbursement. Likewise, if you are moving from Ontario to another province your OHIP card can be used for 3 months while you are awaiting eligibility for your new province's health card. If you move to Quebec, you will be expected to pay for services and submit the receipts to the Ontario government for reimbursement for the first 3 months.

It is important to know that even if you don't have a health card, you cannot be refused service at any hospital's emergency room. As well, in larger cities, there are usually a few clinics and/or health centers that provide care to those without health cards. However, these places have long waitlists. Some urban areas have health buses that provide care to the homeless and street involved without asking for a health card.

It is important for anyone living with HIV to be able to have continued access to their medications. As a general rule, you should always have a back up of at least one month, but if you are planning a move out of province you would be better to have at least three months backup. If you have private insurance drug coverage, it should not be effected by a move. However, it is your responsibility to contact your insurance company with up to date contact information.

If your medication coverage has been through a government program, it will probably end when you move out of province. It would be wise to contact an ASO in the community you are moving to, in order to get information on what government programs might be available to you. In Ontario there are two government income maintenance programs that provide money and drug coverage.

Ontario Works is a program that offers basic monthly financial assistance to people in immediate financial need, who have no source of income or assets and who can show that their budgetary requirements exceed their income. It can also cover the cost of prescription medication. However, if you have received government assistance from the province you have just left, you will not be eligible for any assistance until the next month. For more detailed information, see our chapter on Ontario Works.

Ontario Disability Support Program is a program for those who have both a proven disability expected to last greater than one year, and financial need. The program can provide both financial benefits as well as prescription drug coverage. However, it could take up to six months to be found eligible for this benefit. If you have no other source of income you may be eligible to receive Ontario Works while you are being processed for ODSP. If you are receiving Canada Pension Plan disability benefits you may be fast tracked onto ODSP depending on your asset level. For more detailed information, see our chapter on Ontario Disability Support Program.

If you are not eligible for one of Ontario's government income maintenance programs, you may be eligible for the Trillium Drug Program. This is a program for residents of Ontario who have high medication costs in comparison to their income. To be eligible you need an OHIP card. This means you can't apply until you've been in Ontario for at least three months (the length of time to get an OHIP card). Once you are able to apply you must provide verification of your previous years income. Trillium will then calculate approximately 4% of your net income as your 'deductible'. Once you have satisfied your deductible, Trillium will cover the costs of your medications. For more detailed information, see our chapter on Trillium Drug Program.

Every community differs in terms of what support services are available. Usually large urban centers have more resources than small rural areas. The Internet is a useful tool to research what services are available. If you are looking for HIV specific support services, the first place to start would be the closest AIDS Service Organization (ASO). If you are moving across Canada, contact the Canadian AIDS Society for listings of organizations. If you are moving to Ontario, contact the Ontario AIDS Network for listings. If you are looking on the Internet for general support services, enter 'Community Information Centre of city name' which is usually a database of social services. The ASO in your community should be able to explain what HIV specific supports are available from them directly and what other services are offered by community agencies. For example, in Toronto, the AIDS Committee of Toronto puts out a directory called THE LIVING GUIDE, which lists HIV specific and general services available.

Supports can be targeted to groups categorized by gender, sexual orientation, age, disability, language, ethnicity, or income level. They can include counseling, practical assistance, financial advice, treatment information, nutrition and housing to name only a few.

When contacting a community organization be sure to ask direct questions and be clear about your needs. Find out what you need to provide in order to qualify for services. You have the right to know what is done with the information you give them and what their policy is on confidentiality.

This checklist is intended as a reminder of the documentation usually required when accessing services from both government and community organizations. As well, it will highlight the things you can do to ensure a smooth transition from one location to another. Please review it BEFORE you make a move.

____ Birth Certificate
____ Immigration Papers
____ Social Insurance Card
____ Health Card
____ Banking Information
____ Notice of Assessment from Revenue Canada

____ Did I submitted a housing application
____ Do I have money for first and last months rent
____ Do I know how long it will take to get an apartment
____ Do I have a place to stay in the mean time
____ Do I need to ship my belongings
____ Do I need storage

____ Do I have a source of income
____ Do I have verification of my last source of income
____ Did I complete a change of address for ongoing income benefits
____ Do I know what benefits I can access
____ Do I know how to access benefits
____ Do I know what my new income will be
____ Do I know how long it will take to receive benefits
____ Do I know what documentation I need to access benefits
____ Do I have money until my benefits start

____ Do I have a referral to an HIV Primary Care Physician
____ Do I know how to find an HIV Primary Care Physician
____ Do I know where the closest AIDS Service Organization is
____ Do I know what other support services are available
____ Do I have verification of my HIV status
____ Do I have a detailed letter from my Doctor regarding my health
____ Do I have a copy of my latest blood work
____ Do I have a list of my medications
____ Does my health card cover my medical needs
____ Do I know how to get a new health card
____ Do I know how long it will take for a new health card

____ Does my medication coverage continue uninterrupted
____ Do I have a 3-month medication supply
____ Do I know how to apply for medication coverage
____ Do I know how long it will take to qualify for coverage
____ Do I have the money to pay for my medications if needed

On a recent visit to St. John's, Newfoundland (April 2002) with the Canadian Working Group on HIV and Rehabilitation (CWGHR), I had the opportunity to connect with various government staff, research further into government programs, participate in the 'Rehabilitation in the context of HIV' workshop with CWGHR, and hear from PHAs (people living with HIV/AIDS) and their experiences living in the province and accessing services.

Learning the intricacies of government programs is always a difficult task, and can sometimes require months or years to fully understand the finer details of how things work. This information will hopefully act as an introduction, and connect you to local experts with more knowledge.

In the province of Newfoundland, Social Assistance is part of the Income Support Program, and is administered under the Department of Human Resources and Employment.

Under the recent report 'Investing in People: New Directions for Social Assistance Legislation' (Government of Newfoundland and Labrador, January 2002), the Department states "the Social Assistance Program is intended to provide financial assistance to meet basic needs such as food, clothing, and shelter for individuals and families who have little or no means of support. The program also provides money for special needs, such as medical transportation or special diets". People who need assistance for medication coverage may also qualify for a Drug Card through Social Assistance.

There are 2 categories of Income Assistance for people living with HIV/AIDS. Basic Social Assistance (generally for people who are healthy and employable) is administered by the Department of Human Resources and Employment, and Enriched Needs Program delivered through the Department of Health and Community Services (generally for people with disabilities who require supportive services).

At the point of intake (either in person or completing and mailing in the application), applicants have to note personal information, family size and dependents, housing/accommodation costs, recent sources of income, assets, employment history, education and special needs. The allowable asset level for an employable single person is $500, $1500 for a family. The Enriched Need category allows assets up to $3000 for a single person, and $5500 for a family.

The income entitlement varies depending on your age, other sources of income, family composition, housing situation, and whether you have enriched needs (i.e. a disability). In Newfoundland, it may be more common for people to board with relatives, or to rent a "bed/sitting room" (what some people might call a "room for rent" or "rooming house") as compared to renting a self-contained apartment. The following chart illustrates entitlement amounts under various situations:

Income Category	Amount
Single, under 30 years, employable, boarding with relatives	$96.00/month
Single, under 30 years, employable, boarding with non-relatives	$140.00/month
Single, under 30 years, employable, renting	$203.00/month + ** rental allowance
Single, under 30 years, not employable, boarding with relatives	$254.00/month
Single, under 30 years, not employable, boarding with non-relatives	$399.00/month
Single, not employable, renting	$421.00/month + ** rental allowance

** An additional amount is given for rent, up to a maximum of $210/month. If a person is disabled and receiving Enriched Needs and their rent is greater than $210, Enriched Needs Program may be able to top up rental amounts.

In order to be eligible for the Enriched Need category (to be classified as disabled), the applicant must be approved to need home support (paid or volunteer supports) to aid community living. The physician will need to provide supporting documentation indicating your health and need, and the Social Worker with the Department of Health and Community Services (responsible for home care services) will need to make an assessment to determine your level of need and make the granting decision. Usually an answer of acceptance/denial is given in a couple of weeks, and the Enriched Need entitlement will be sent as a separate cheque.

This definition of disability may not be beneficial for some people with HIV/AIDS - especially people who experience episodes of illness and wellness. It may favor people who have continues needs for physical assistance to maintain their home and to live independently in the community.

Social Assistance offers a fairly comprehensive program to support people (employable and people with disabilities) to enter, re-enter or remain in the workforce. Some of the services include:

People on Social Assistance with a disability can take part in the Employment and Career Services programs on a purely voluntary basis.

For people who earn income, there is a formula to calculate deductions. The following illustrates what each person can keep from their net earnings, before deductions are made dollar for dollar

Also, as a return to work incentive, clients may be eligible for Extended Drug Coverage where they will automatically receive a drug card for up to 6 months after moving off of Income Support with their employment earnings.

Since Canada Pension is a national program, the eligibility criteria, monthly entitlement, definition of disability and program components are exactly the same for every province across Canada. Should you be relocating to Newfoundland, you will just need to provide Canada Pension with your new address.

Employment Insurance is a national program, available to all workers in Canada who meet the Eligibility criteria.

Regular EI Benefits are for people who have lost their job through no fault of their own, cannot find work, and have contributed to the Employment Insurance Program. Special EI Benefits are for maternal and parental leaves and sickness benefits.

To be eligible for EI Benefits, you must have contributed to EI for a minimum number of hours (called "Insurable Hours") - most people quality with between 420 up to 700 hours for regular EI Benefits, and 700 hours for sickness benefits in the last 52 weeks or since your last claim to EI, whichever is shorter. However, some industries and regions significantly effected by unemployment, such as the fishing industry, may have reduced hours for eligibility criteria. Your local Human Resources Development Office (HRDC) will be able to tell you more. Each person receives 55% of their Insurable income (some increased benefits for low-income families), to a maximum of $413/week. Income tax is deducted at about 5%. Sickness benefits are paid for a maximum of 15 weeks. However, the length of a regular EI claim depends on the rate of unemployment in the region, somewhere between 14 to a maximum of 45 weeks. For many parts of Newfoundland that may have a higher rate of unemployment, the length of claim could be longer.

To learn more about Employment Insurance Benefits, the application process and eligibility criteria, see the section above.

As with most parts of the country, it seems that the need for affordable housing exceeds available resources in St. John's. Some groups such as families and people with psychiatric or physical disabilities may be priority. There are fewer affordable housing resources for single people - they are generally encouraged to move into shared or "bed/sitting room" types of accommodation. Regardless of the type or size of rent geared-to-income affordable house that is needed, there is a long waiting list. The general tip about housing is to have plans before arriving in a new town, and be prepared for a wait for government housing.

In the province of Newfoundland, there are 2 options for having medication coverage

An automatic drug card administered through the Department of Human Resources and Employment Program for people who are receiving Social Assistance. Thus, those receiving financial assistance automatically qualify to receive drug coverage under the Newfoundland and Labrador Prescription Drug Program
Drug coverage as a special benefit from Social Assistance. This is for people who do not qualify for income support (due to earnings from other sources such as employment income, Employment Insurance, Canada Pension Plan - Disability Benefits) but have high medication costs. First off, applicants must complete an application for Social Assistance through the Department of Human Resources and Employment. Applicants must meet the asset level to qualify. If drug costs plus the assessed Social Assistance rate (for that individual or family) added together equals more than the income, the applicant is eligible. A couple of examples to illustrate:

Example 1
Income = $800/month
Drug Costs = $600/month
Social Assistance rate = $203/month (single, 30 years old, renting)

Drug Costs ($600) + Social Assistance rate ($203) = $803

Eligible as Drug Costs + Social Assistance is greater than Income ($800)

Example 2
Income = $1800
Drug Costs = $1000/month
Social Assistance rate = $421/month (single, not employable, renting)

Drug Costs ($1000) + Social Assistance rate ($421) = $1421

Not Eligible as Drug Costs + Social Assistance is less than Income ($1800)

There are a number of concerns and difficulties that people living with HIV/AIDS experience in Newfoundland. The following are some of their concerns:

Affordable Housing: affordable housing is hard to find, either in the open market or through the government. Those struggling to pay high rents are often left with little money after rent is paid, while others are forced into shared or smaller living environments. The wait for government-operated affordable housing is long.
Enriched Need, Department of Health and Community Services: the definition of disability for Enriched Needs may not fully recognize the episodic illnesses associated with HIV/AIDS, or the many emotional difficulties. Some people with HIV/AIDS have had difficulty being granted the Enriched Need financial benefit.
Drug Coverage: for those who are working or have other sources of income, and only need a drug card, it appears there are many barriers. First, assets must be reduced in order to be eligible, requiring people to place themselves in a financially vulnerable position in order to qualify. Having to re-qualify every three months, especially when drug therapy is a long-term need, can be a stressful and unnecessary barrier for many people.
HIV Specialists: there are few physicians in St. John's, and even fewer outside of the city, who understand HIV/AIDS, or who want to treat patients with HIV/AIDS.
Stigma surrounding HIV/AIDS - some PHAs report workers (both with the government and community agencies) who have little understanding of HIV/AIDS, have experienced broken confidentiality, and some experiences of discrimination based on their lifestyle.
Homecare: many PHAs comment of the system of having to hire their own homecare worker, and how difficult this is. Especially difficult is living in small towns where homecare workers can be neighbours. Some PHAs had experiences of homecare workers breeching confidentiality, and how HIV status was disclosed to other neighbours.
Isolation: many people live in remote locations, feeling isolated from other PHAs or organizations that might be able to provide support.

This is by no means a comprehensive list, or documents the feelings of all PHAs, but does highlight some of the feelings of some PHAs.

www.gov.nf.ca - for various Government Services in the Province of Newfoundland and Labrador

www.hrdc-drhc.gc.ca - Human Resources Development Canada (for Employment Insurance) or Canada Pension Plan - Disability Benefits

The Ontario AIDS Network gratefully acknowledges the generous financial support of GlaxoSmithKline in partnership with Shire BioChem to participate in the CWGHR workshop in St. John's Newfoundland in April 2002.