Human Resources Committee on Dec. 6th, 2018

[The Chair, Liberal, Bryan May]

I call the meeting to order.

Pursuant to the order of reference of Friday, November 2, 2018, and the motion adopted by the committee on Tuesday, November 20, 2018, the committee is resuming its study of M-192, episodic disabilities. Today the committee will hear from witnesses and provide drafting instructions to the analysts for a report.

I have a quick announcement before we get started. As I mentioned in the previous meeting, there were plans to meet with the Canada-China Legislative Association. That unfortunately has been cancelled due to an issue in obtaining visas. They weren't able to be here on time for that meeting.

Going on to our witnesses, we have joining us as an individual Adele Furrie, President and Chief Executive Officer of Adele Furrie Consulting Inc.

Welcome, Ms. Furrie.

From the Canadian Council on Rehabilitation and Work, we welcome Maureen Haan, President and Chief Executive Officer.

From the Institute for Work and Health, we have Monique Gignac, Associate Scientific Director and Senior Scientist, and Emile Tompa, Senior Scientist.

We welcome both of you.

Next, is it “Realize”?

[Tammy Yates, Executive Director, Realize]

Yes, thank you.

[The Chair, Liberal, Bryan May]

From Realize, we welcome Tammy Yates, Executive Director.

Thanks to all of you for being here this morning.

We're going to get started with Adele Furrie. The next seven minutes are all yours.

[Adele Furrie, President and Chief Executive Officer, Adele Furrie Consulting Inc., As an Individual]

Thank you.

Good morning. Thanks to all of you for the invitation to be part of this panel.

I'll give you a little bit of background on who I am and where I come from.

I've spent the last 34 years of my career working on issues facing children, adults and seniors with disabilities, both here in Canada and through a number of consultancies throughout the world.

The first 12 years of my 34 years were spent at Statistics Canada, where I was responsible for the first two disability surveys that had been conducted and also for the very first aboriginal people survey that was conducted as a postcensal survey.

From 1996 to the present day and ongoing, I've operated my management consulting business. I've successfully completed over 90 projects, with the majority of them focusing on disability. In a major project that spanned three years with the U.S. department of labour statistics, I helped design questions consistent with the definition that was embedded at that time in the ADA, the Americans with Disabilities Act.

I've done similar consultancies—again, trying to take a definition and putting it into a series of questions—in North Korea, Colombia and New Zealand, and in two workshops with developing countries in Malta and Hungary.

There are three main points that I want to cover in my seven minutes.

The first is to advise you of the new data available on episodic disabilities from the 2017 “Canadian Survey on Disability”. Maybe you already know it.

The second point is to describe the research that my company has done, in collaboration with a number of people, that deals specifically with episodic disabilities.

Finally, my third point is to share with you my concern about not having in the current support programs a common definition of “disability” that has kept up with the evolution of the concept of disability, both here in Canada and internationally.

To my first point, you may already know this, but I'm excited to tell you that a collaboration between Statistics Canada, ESDC, Realize and my company resulted in questions being added to the 2017 “Canadian Survey on Disability” to identify the population with episodic disabilities. It was no small feat to get a couple of questions added to the questionnaire. We all felt that it was such a great opportunity, so it was well worth the effort.

Initial results from the survey were released on November 28. In the handout to you, I provided a copy of an infographic and a couple of bookmarks that describe some of the main findings. However, this release did not include any stats on episodic disabilities. It's my understanding that staff at Statistics Canada are available to handle any special requests. I've also been advised that the analytical file will be available to approved research projects through Statistics Canada research data centres in mid-January to late January of the coming year.

I'll now move on to my second point.

Episodic disabilities have been a part of my research since 2009. I've completed five research projects and I've just signed another contract for a sixth one using the 2017 data. For all six projects, I've been part of a team of researchers that included academics, independent researchers such as Cameron Crawford and John Stapleton, and various service providers and organizations.

The clients have been Employment and Social Development Canada, two SSHRC grants and the federal/provincial/territorial persons with disabilities advisory committee. Unfortunately, none of the research reports have been translated, so I wasn't able to bring copies with me today.

Each of the five completed projects was a building block for the next one, culminating in this fifth one, which I think will be of most interest to you.

In 2016, with funding provided by the Office for Disability Issues and with the support of organizations representing many of the health conditions that result in an episodic disability, we conducted a survey in which we heard from 953 Canadians who were living with an episodic disability.

Unlike the surveys conducted by Statistics Canada, it was not a probability-based sample. Rather, it included people with lived experience who took the time to complete an online questionnaire. The questionnaire focused on employment but also included three open-ended questions: What is most challenging about living with a chronic health condition? What do you think could be done to improve your quality of life? Do you have any additional comments about your experience living with an episodic disability?

The responses ranged from short answers about such issues as the unpredictability, having to work through pain and fatigue, unsupportive employers, need for financial support with medications and treatments, to longer responses that highlighted both the incredible supports received to the heart-wrenching need for more supports and more understanding.

It's a great resource because it gives the lived experience of 953 individuals who every day have to deal with life with an episodic disability.

Finally, I want to turn to the definition of “disability”.

What happened at Statistics Canada when we started the disability stats program was that we kept in line with the evolution of the concept of disability. The questions that are included on the surveys reflect that. Did the federal government keep that same evolution in mind with its disability support program? It hasn't. Not only that—and this is really disturbing to me—ODSP, the Ontario disability support program, seemed to have had a more progressive definition that included episodic disabilities, and now it is reverting back to the more restrictive one, the CPP disability benefit definition.

Those are my comments. That was a fast one at the end.

[The Chair, Liberal, Bryan May]

Thank you very much.

Next we have, from the Canadian Council on Rehabilitation and Work, Maureen Haan, President and Chief Executive Officer.

[Maureen Haan, President and Chief Executive Officer, Canadian Council on Rehabilitation and Work]

Thank you very much.

Good morning. My name is Maureen Haan. I am the President and CEO of CCRW. I want to thank you very much, first of all, for having me here and for giving me the opportunity to provide some supplemental information related to the employability of Canadians with episodic disabilities that I've witnessed over my last six years with CCRW and over 25 years of direct involvement in the disability community.

First I'll talk a bit about CCRW.

We are the only national charitable organization with the sole mission of employment for persons with disabilities. With a history of 40-plus years, CCRW has been successfully promoting the employment of jobseekers with disabilities across Canada, as evidenced by the 73% success rate seen in our 2016-17 funding year.

CCRW has successfully connected and dually focused on jobseekers with disabilities and employers to ensure local hiring needs are met. With eight successful program models across 15 Canadian communities, CCRW has implemented a range of successful employment programs, thereby shifting the unemployment rate needle away from the charity model towards the business case model for hiring a person with a disability. For the last six years, I have been proud to serve as the president and CEO, and I strive every day to further our mission of promoting and supporting the meaningful and equitable employment of people with disabilities.

As successful as we have been, it has not been without challenge. Oftentimes we are asked how we define “disability”. As you know, there are multiple definitions that can conflict with each other and often lead jobseekers with disabilities to wonder whether they have a disability and whether they count—that is, can they access employment services and are they eligible for additional supports, whether it be for income or otherwise?

Finding the answers can be arduous, as programs often use differing definitions and criteria to determine eligibility. Episodic disabilities pose unique challenges by their definition. For example, an illness that has sporadic and intermittent symptoms that fluctuate with little warning can create a disability for the individual during the flare-up. With an aging population, we see an increase in the number of Canadians who are living with visible and invisible episodic disabilities, including MS, arthritis, cancer, HIV/AIDS, diabetes and some forms of mental illness.

One key distinction that I want to highlight is the notion of unpredictability. An episodic disability is marked by fluctuating and unpredictable periods and degrees of wellness and disability. In addition, these periods of wellness and disability are often experienced differently by individuals even with the same medical diagnosis, making it almost impossible to form generalizations across disability type.

An employee’s unpredictable labour force participation can consequently pose challenges for employers and work colleagues alike. At best, this fluctuation often leaves employers unsure as to how to accommodate; at worst, it can leave them questioning the authenticity of an employee’s disability. We have heard many stories at CCRW from clients with episodic disabilities who, while they were at work, experienced co-workers who were unsupportive and even jealous of the accommodations received. Having a nationally accepted definition of “disability” that includes episodic disabilities would provide common ground for employees with intermittent work capacity and their co-workers and supervisors to have an open and honest conversation without fear of reprisal or stigma.

Policies to date have historically focused on static forms of disability that, relatively speaking, make it easy to develop, monitor and evaluate policy and changes over time. With episodic disabilities, though, evaluation becomes significantly more complicated and poses challenges for stakeholders of varying forms, including community agencies tasked with developing and providing employment programs and services to this underserved population.

Program eligibility issues can further complicate matters and raise issues of subjectivity and fairness regarding who gets to access services, by whom, and under what conditions. Who decides whether a person's disability qualifies them to access such services?

As the severity of a person's episodic disability symptoms is likely to fluctuate, a person must become adept at advocating and at navigating social service systems and programs, which will likely exacerbate symptoms related to stress and anxiety.

For example, worries around losing access to subsidized housing or access to drug plans during periods of wellness become heightened. For this reason, episodic disabilities must be recognized within the larger definition of disability and accounted for when designing resulting programs and services, including income support program eligibility.

At present, definitions and criteria used by provincially based income support programs differ widely and often leave people with episodic disabilities unsure of whether they qualify for benefits. On a federal level, “temporary” is often used to describe employment insurance eligibility, whereas “severe and prolonged” phrasing is used when describing CPPD, Canada pension plan disability, and it should be noted that both of these programs have a return-to-work or a vocational rehabilitation component in the services. The question then remains of where people with episodic disabilities fit in. Their symptoms are often temporary yet chronic, and can be severe and prolonged over a lifetime. With the real shift in disabilities as historically labelled, people with episodic disabilities often fear having supports clawed back with little or no warning, or ineligibility being determined prematurely and unfairly.

Accounting for the ever-changing nature of episodic disabilities is important when designing income support programs as well as return-to-work or vocational rehabilitation programs, to ensure that people are encouraged to remain engaged in the workforce, thus creating a win-win situation benefiting everyone.

Expanding and accounting for those with episodic disabilities within the legal definition will ensure fairness and equality with regard to accessing services and implementing policies, and will ultimately produce a positive outcome for all.

I thank you very much for your time and look forward to your questions.

[The Chair, Liberal, Bryan May]

Thank you.

Up next we have, from the Institute for Work and Health, Monique Gignac, Associate Scientific Director and Senior Scientist, and Emile Tompa, Senior Scientist.

Welcome to both of you.

Whoever is to speak first, please go ahead.

[Dr. Monique Gignac, Associate Scientific Director and Senior Scientist, Institute for Work and Health]

I'm going to go first. Emile and I will share our time.

As mentioned, we're senior scientists at the Institute for Work and Health, which is a not-for-profit independent research organization.

I'm also a professor at the University of Toronto, where I've been conducting research into this area for about 20 years, and I currently direct a large partnership grant funded by CIHR and SSHRC that aims to improve work participation and work sustainability among individuals with episodic disabilities.

I'm going to focus my remarks on two critical at-work issues that can be uniquely challenging for those with episodic disabilities.

The first is what I would characterize as an increased risk of hastening the decision that a worker with an episodic disability has created undue hardship for at-work accommodations, which can lead to a dismissal.

The second is the process by which workplaces often become aware of an episodic disability, and the characterizing of episodic disabilities as performance problems requiring progressive disciplinary actions rather than as triggering a more positive, supportive, problem-solving approach to sustaining work. Both of these challenges are related to the nature of episodic disabilities and are shaped by policies related to health privacy and accommodations.

First of all, what do I mean by the nature of episodic disabilities? As mentioned by Maureen, the label highlights the intermittent nature of the condition, but very often two other characteristics are important. First, many of these episodic conditions are invisible to others. Looking around the room, it's not apparent who here might have depression, anxiety, IBD, arthritis, MS, HIV, migraine and a range of other conditions. Second, as also mentioned by Maureen, the flare-ups or episodes associated with these disabilities are often unpredictable, even when a condition is being well managed by the health care system.

Also important is that workplace support plays out in the realm of privacy and duty-to-accommodate legislation. Both of these areas of legislation are important, and Canada is recognized as a leader in them. The difficulties are often in implementing the legislation. Workers and various workplace parties may come together to identify initial supports and accommodation. However, the episodic nature of the condition often means that it ebbs and flows, and so accommodation plans typically need to be revisited and revised. In having to revisit accommodation plans, workplace parties who may not be fully aware of a person's needs or who think a worker looks fine may perceive that the ongoing and potentially changing nature of the disability really reflects undue hardship for them in the workplace, and that may hasten actions that result in a person's dismissal.

The second point is that workers with episodic disabilities often require time away. They have greater absenteeism. When we talk to workplace parties, they often tell us that people with episodic disabilities often get caught in their attendance management programs. The program tends to then trigger a series of disciplinary actions and starts to cast disability as a performance problem.

Workers now sometimes feel forced to disclose health information when they are unprepared and maybe not well equipped with information about their rights and obligations. Sometimes they are so concerned about workplace reactions like stigma or even job loss that they continue not to provide the workplace with information about their needs. Once they have then been characterized as having a performance issue, it's difficult for all the parties involved to move beyond this and take a more positive approach, and there's often a lack of trust.

What's needed? There needs to be a better understanding of the unique nature of episodic disabilities, of their impact on issues like communication and support at work, as well as tools and resources to help workplaces and workers. Some of the work many of us are doing here is actually aimed at doing just that.

I want to echo Adele's comments about the value of ESDC and Statistics Canada's Canadian Survey on Disability as a really important resource that we need to continue to build and use.

I'll pass it over to you, Emile.

[Dr. Emile Tompa, Senior Scientist, Institute for Work and Health]

Thank you.

In addition to being at the Institute for Work and Health, I'm a co-director at the Centre for Research on Work Disability Policy. I'm also an associate professor at the Department of Economics at McMaster University.

We've heard from the others here about the definition of episodic disability. There's no widely accepted definition that's easily operationalized. This is one of the things we found in our research: It can vary on a daily basis, on a weekly basis and over longer periods of time. Sometimes it really has a lot to do with the context. In this case, the context is the work environment and how accommodating it is. The key message we get from our stakeholders is that one size doesn't fit all. It's really important that the work environment be flexible and be tailored to meet the needs of different people with diverse types of episodic disabilities.

In my field research, one of the pieces we've been doing is a project for the Mental Health Commission of Canada on accommodation best practices for people from what they describe as “the aspiring workforce”, people with serious mental health conditions. What we found was that depending on the work culture and the quality of the work relationship, it may be very risky for workers from the aspiring workforce to disclose a need for workplace accommodations, particularly if the disability is stigmatized. In the case of mental health, it often is. They often rely on the supports available to all employees, such as flexible hours, the location of work and various kinds of leave. These are what we describe sometimes as universal supports that don't require disclosure of the individual to their supervisor or manager. Employers, including the public sector, can often provide universal supports as a way for people to self-accommodate.

Currently I'm developing, with the CSA Group, a Canadian standard for work disability management systems. What we find is that in general, employers lack the skills on how to accommodate workers with disabilities. They find it even more challenging to address invisible and episodic disabilities. There's really a need for skilling up employer abilities, and the standard is one way of doing that.

They often have fear, ignorance and an inability to see past irrelevant characteristics to focus on the talent and skills of the worker. We're building up disability confidence and creating a culture of inclusivity as a key aspect of the standard we're developing.

It's challenging for employers to deal with the multiplicity of programs as well. That's a really big problem with them. There are many programs that provide supports, but they're not very flexible and they're often not very conducive to supporting episodic disabilities.

I'm also undertaking a pan-Canadian partnership strategy on disability and work in Canada. Maureen is part of that. We recently had a two-day conference, yesterday and the day before, held here in Ottawa. Its launch pad is a UN convention and the federal legislation, Bill C-81.

We framed it around four pillars that we think are important for a pan-Canadian strategy.

The first of the four pillars is the strategy about disability confidence, much like our standard, which is focused on that as well.

The second of the four pillars is about comprehensive supports. One of the things that's really important is changes to existing income-support programs that might enable people with episodic disabilities to exit and re-enter the labour force as their work capacity fluctuates. It's really important to think about some of the definitions that restrict that ability to easily enter and exit, and to seek the supports when you need them.

Much of the policy arena on labour and disability supports, as you may know, is at the provincial level. That really limits the capacity at the federal level to make changes, but there are some efforts through the transfer payments from ESDC's opportunities fund. Possibly there's some way for those transfer funds to put more emphasis on employment supports for persons with disabilities.

Thank you.

[The Chair, Liberal, Bryan May]

Thank you very much.

Now, from Realize, we have Tammy Yates, executive director.

[Tammy Yates]

Thank you so much, Mr. Chair.

Good morning to members of the committee. As the chair mentioned, my name is Tammy Yates, and I'm the Executive Director of Realize. I'm also originally from Trinidad and Tobago. If anyone knows Trinis, we talk very quickly. I'm going to do my best. I can't promise, but I'll do my best.

Realize currently holds the secretariat of the national Episodic Disabilities Forum, otherwise known as the EDF. On behalf of all of the members of the EDF—many of whom are actually here in the room, so it feels like a reunion—I would like to thank members of this committee for leading this important discussion, as well as for the private member's motion, M-192.

The term “episodic disabilities” was first coined about 15 years ago by former board members of our organization, namely Kelly O’Brien, Stephanie Nixon and the late Elisse Zack, who was the founding executive director of Realize, which was then known as the Canadian Working Group on HIV and Rehabilitation, or CWGHR.

It makes me smile to be back on the Hill. About five years ago, Elisse Zack and I—prior to her transitioning into the next life—were presenting to this committee. It looked very different at that time. When we spoke about episodic disabilities, everyone in the room had a very strange, querying look on their face. It is amazing to be in this room here. We're all discussing episodic disabilities and we're all on the same page.

I also have a little information about the definition of “episodic disabilities”. The episodic disability framework was created to reflect the lives of people living with HIV at that time, based on the social model of disability, to describe the conditions that many of my colleagues mentioned. As Canadians are living longer, an increasing number of people are living with lifelong chronic illnesses that include episodes of disability. These illnesses include arthritis, Crohn's disease, MS, cancer and mental health conditions.

When we apply a life course approach to the topic, we are cognizant that many young people are also living with episodic disabilities. I'm sure that most, if not all, of you in the room know people living with episodic disabilities. You can therefore appreciate how these fluctuating episodes wreak havoc with someone's life in terms of social inclusion and participation.

Very early on in our advocacy and awareness-raising around episodic disabilities, we were joined by organizations like the DisAbled Women's Network Canada, the MS Society and the Arthritis Society. They were some of the earliest cross-disability organizations that collaborated with us. We all recognized that these groups of people living with these conditions were living with similar trajectories. However, the trajectories were different, so we developed three broader definitions, which I'll share with you now.

Episodic stable conditions are characterized by periods of relative wellness, interspersed with unpredictable and fluctuating periods, like severe migraines and HIV—now that HIV is a chronic condition.

Episodic degenerating conditions are similar to episodic stable conditions early on, but over time are progressive in their decline, such as Parkinson's or even, unfortunately, MS at times.

Episodic remissive conditions may start as episodic stable, but in some instances the person may have a full recovery or remission, as in some forms of cancer or mental health illnesses.

It would be remiss of me not to note at this juncture, however, the fact that Bill C-81, once it becomes an act, will be the first federal act to officially include episodic disability in its wording. Let me tell you something: In my office, when we read that, we were high-fiving each other. It took us 20 years, but we're here.

Over the past decade, an increasing amount of research on episodic disabilities has been done across diseases and conditions, as many of our academic partners and organizations that have been testifying this entire week have shared. We've developed at least 20 conditions that may be defined as episodic in nature. Ladies and gentlemen, that represents a significant percentage of our population in Canada.

We have a number of recommendations that we will be submitting. However, I would like to articulate three long-term recommendations and three short-term recommendations.

The first of the three long-term recommendations is that nationally, we establish a body, whether it's a commission or a federal committee, to oversee and report on the coordination between the interjurisdictional disability support programs and employment services areas to establish clear options for people with episodic disabilities within these disability programs.

The second recommendation is to make employment insurance sickness benefits more flexible.

The third recommendation is to negotiate, develop, pilot, and eventually implement, in tandem with jurisdictional-level government partners, an individualized funding model for income and social supports. There are examples of these individual portable models in jurisdictions at the moment.

For these three recommendations, I did not say a five- or a 10-year time frame. It may be another 20 years, but these recommendations are what it's going to take for people living with episodic disabilities to remain in the workforce and have full social participation.

Now, I have three short-term recommendations. When I say “short-term”, I mean these three things can be done within the next year.

First, when Bill C-81 becomes law as the Accessible Canada Act, the definition of disability that's now included in that bill should be harmonized across jurisdictions and across policies and programs to reflect that harmonized definition.

Second, we all mentioned community-based research and academic research that has been happening over the last 20 years in a very piecemeal and puzzle-like approach. Our recommendation is that a dedicated part of funding be provided for community and academic researchers, since it is imperative that we explore program and policy issues for women, for youth and for new immigrants living with episodic disabilities and for indigenous and other racialized groups who we know, from an intersectional perspective, will be affected differently and inequitably.

Finally, as the secretariat of the Episodic Disabilities Forum, Realize has been raising awareness about episodic disabilities for almost 20 years, as I shared. It's our 20th anniversary this year. We're the only national organization that has a dedicated staff member on episodic disabilities. However, we have been doing this without operational funding for episodic disabilities. Along with partners like CCRW, DAWN Canada, the MS Society, the Arthritis Society, and so on, who are current members of the EDF, we have achieved so much in this area, so that we're all here today, 20 years later. Therefore, the final recommendation is that...if we could do that without operational funding, can you imagine what we could do with operational funding?

Life is unpredictable, ladies and gentlemen. While you and I may not be living with an episodic disability today, it does not mean that tomorrow our life circumstances may not change, and we may then be diagnosed with an illness that is episodic in nature. To this extent, policies and programs, or revisions to policies and programs, that we have all suggested will not only work for people living with episodic disabilities currently, but they will work for everyone in Canada.

I use the term “everyone in Canada”, and not just “Canadians”. In three days, I will celebrate my one-year anniversary as a Canadian. Prior to that, I was a permanent resident of Canada. If I was living with an episodic disability and saw in a document that it's only Canadians who are eligible, it would have totally left me and my taxpaying dollars out of it.

Canada has always been a country of innovators and an example to other countries. We are the world leader on episodic disabilities. As such, the Government of Canada and all of you have the opportunity to maintain that leadership on episodic disabilities. We look forward to supporting the government and all of you on this.

Thank you.

[The Chair, Liberal, Bryan May]

Thank you. On behalf of all of us, congratulations.

[Tammy Yates]

Thank you.

[The Chair, Liberal, Bryan May]

First we have MP Diotte.

[Kerry Diotte, Edmonton Griesbach, CPC]

Thank you, Mr. Chair.

Thanks to everybody for coming. There's quite a panel of expertise here, and it really helps us with our jobs.

One of the questions that comes up most often is how you define episodic disabilities. I know Ms. Furrie commented on that. Could I get you to weigh in on that? What are the difficulties there?

[Adele Furrie]

The main difficulty is getting across the concept of “intermittent and fluctuating”.

We can define “disability”. We've done a good job in defining disability in surveys, but it's to get across the idea that an episodic disability isn't like being in a wheelchair. It comes and goes. It's the fluctuating and the intermittent nature. It's never knowing when you're going to have a migraine and never knowing if the migraine is going to be totally debilitating or just a headache. It's that unknown....

Associated with episodic disabilities is the fact that it brings in other things like fatigue, primarily, which goes along with it, and then all the attitudinal barriers this individual faces as a result of it.

[Kerry Diotte]

Would anyone else like to chime in on that?

[Dr. Monique Gignac]

Perhaps I could, very quicky.

I think the entire term “episodic”, which is a very high-literacy term, is great for us. We're all on the same page. However, putting that in a research document to try to ask people if it is them or not becomes an issue. Even the word “disability” is very loaded. Many people we speak to in research have all these conditions we've been labelling, that we've been talking about, but if you ask them if they have a disability, they'll say no. They don't see themselves as disabled, so we use language around “difficulty” or “limitations with”. That opens it up to a whole range of other reasons that you might have difficulties with various issues in your life.

We struggle to come up with ways to make sure people can capture this. Sometimes it's by asking if they have any of these conditions. We assume that if they do, perhaps they have an episodic disability. It's not perfect. Other times we talk about limitations as a way to try to get people seeing themselves in this group.

[Tammy Yates]

Thank you so much, Adele and Monique, and thank you for the question. It's an excellent question.

Two years ago I was at the international AIDS conference in South Africa. We were at the disability networking zone, doing a presentation. The sign language interpreter in South Africa had never heard of episodic disability, so she asked me if I could define it. Of course I shared the long definition that we all give and then when I was speaking and she signed it, I asked her what sign she used. She said she used an illness or condition that comes and goes and whatever the sign is for unpredictable. Those were the three criteria she used: a long-term illness or condition that comes and goes and is unpredictable.

[Kerry Diotte]

While we talk about that, because I know you have expertise in AIDS and HIV, how do you balance the need to accommodate those in the workforce with episodic disabilities, especially with AIDS and HIV, with their right to the privacy of their medical records and their medical conditions?

[Tammy Yates]

That's an excellent question.

We work consistently very closely with the community. First of all, with respect to community members, we always say they have the right either to not disclose or to disclose. That is totally up to them.

Second, within the duty to accommodate, you don't necessarily legally have to share your diagnosis. I think Monique and Maureen mentioned you have to share your functional limitations—what you can do, what you cannot do, and so on. Needless to say, with the stigma and discrimination that still unfortunately exist around many of these conditions in 2018, and mental health as well....

It's interesting. A very close relative of mine has recently been diagnosed with a mental health condition. The discussions around the coffee table with respect to sharing and disclosing information were quite similar to what I hear in my professional life that people living with HIV share.

Again, in the duty to accommodate, you are not mandated to share the diagnosis, but you do need to indicate your limitations and your capacities.

[Kerry Diotte]

Thanks very much.

[The Chair, Liberal, Bryan May]

Mr. Long is next.

[Wayne Long, Liberal, Saint John—Rothesay, NB]

Thank you, Mr. Chair, and good morning to our head table, fellow MPs, and witnesses.

It's very good testimony this morning. Thank you.

I'm going to ask this question right across the panel, because all of you have wonderful expertise here.

Ms. Yates, how would you structure and fund increased supports for people with episodic disabilities? You have touched on that a bit, but how would you fund this such that it provides them with income security without discouraging workforce participation? Also, do you feel that we would need to increase EI and CPP premiums in order to fund such support?

[Tammy Yates]

Those are two very loaded questions.

On my answer to the first question, I think, if I'm not mistaken, that British Columbia may have just started a model that could be something we could use with respect to increasing the annual income threshold for someone who may be accessing income supports or disability supports. Increasing the annual threshold is critical, rather than a time-bound threshold, because—