Accessibility for Ontarians with Disabilities Act Alliance Update United for a Barrier-Free Society for All People with Disabilities Web: https://www.aodaalliance.org
August 5, 2021
On August 3, 2021, the AODA Alliance submitted its final brief to the Health Care Standards Development Committee. It gives our feedback on its initial or draft recommendations on what should be included in the promised Health Care Accessibility Standard. The Health Care Accessibility Standard is needed to tear down the many barriers that impede people with disabilities in Ontario’s health care system.
We want the Health Care Standards Development Committee to incorporate our recommendations into its final report to the Ontario Government. Our finalized brief includes all the recommendations and other content that was in our draft brief that we circulated for public comment on July 23, 2021. There has only been very minor editing and fine-tuning.
Below we set out the 67 recommendations that our brief makes. To download and read the entire brief that explains these recommendations, visit https://www.aodaalliance.org/wp-content/uploads/2021/08/August-3-2021-finalized-AODA-Alliance-Brief-to-Health-Care-Standards-Development-Committee.docx
Help us build support for our cause. Please email the Health Care Standards Development Committee. Tell the Committee if you support our recommendations. You can write them at: healthSDC@ontario.ca
If you or an organization with which you are connected is writing a submission to the Health Care Standards Development Committee it would be great if your submission could state that you endorse the AODA Alliance ‘s recommendations in its August 3, 2021 brief to the Health Care Standards Development Committee. As well, any individual or organization can simply write that Standards Development Committee at the email address listed above, and just say something like:
“I support the recommendations that the AODA Alliance sent the Health Care Standards Development Committee in its August 3, 2021 Brief.”
The deadline for submitting feedback to the Committee is August 11, 2021. Even if you miss that deadline, it can always help to send in an email any time that supports our recommendations.
Do you want more background on this issue? Explore the time line of our efforts to get a strong Health Care Accessibility Standard by visiting the AODA Alliance website’s health care page.
Now 917 days have passed since the Ford Government received the blistering final report of the Independent Review of the AODA’s implementation and enforcement, conducted by former Lieutenant Governor David Onley. The Ford Government has announced no plan to implement that report.
We always welcome your feedback. Write us at email@example.com.
List of the AODA Alliance August 3, 2021 Brief’s Recommendations
Where the following recommendations by the AODA Alliance refer to the “Initial Report”, that is the Health Care Standards Development Committee’s Initial Report in which that Committee sets out draft proposals for what the promised Health Care Accessibility Standard should include.
#1 Throughout the Initial Report, action recommendations should be revised to go beyond providing disability accommodations to patients with disabilities, and making plans for barrier-removal and prevention, so as to also spell out specific measures that must be undertaken to remove and prevent recurring disability barriers to health care services.
#2 The Health Care Accessibility Standard’s primary focus should be on specifying detailed actions to remove and prevent barriers, not by overloading people with disabilities with redundant separate consultations with one hospital after the next across Ontario.
#3 The Standards Development Committee should explicitly and comprehensively make recommendations for the entire health care system, and not merely for the small fraction of the health care system that hospitals comprise. At a minimum, the Standards Development Committee should make a strong recommendation that the Health Care Accessibility Standard must address disability barriers in the entire health care system, and not merely in the hospital sector. It should specify that all health care providers should be required to remove and prevent the same barriers, in terms at least as strong as the Ontario Human Rights Code and the Canadian Charter of Rights and Freedoms
#4 The Health Care Accessibility Standard should cover and apply to all public and private health care programs, services and products available in Ontario, whether or not OHIP covers them. It should cover all health care providers and professions, whether or not Ontario recognizes, regulates or licenses them. It should cover ambulances and other vehicles which can transport patients in connection with health care services. It should cover all parts of Ontario. It should address accessibility barriers that are distinctive to the north, to remote communities, as well as the distinctive barriers facing different racialized, ethnic or other communities within Ontario.
#5 The Health Care Accessibility Standard should address the accessibility needs of patients with any kind of disability, and the accessibility needs of any patients’ support people with any kind of disability. The term “disability” should be defined broadly to include any permanent or episodic disability within the meaning of the AODA or the Ontario Human Rights Code.
#6 The Committee’s final report should clearly state that to make hospitals accessible to people with disabilities, much more is needed than addressing training, accountability and sensitivity within hospitals.
#7 The Initial Report should not recommend that smaller obligated organizations always or presumptively get more time to comply with the Health Care Accessibility Standard than do larger obligated organizations. This especially should not take place in circumstances where smaller organizations can comply more quickly than larger organizations.
#8 The Initial Report should be revised to describe the Standards Development Committee’s mandate as achieving the removal and prevention of disability barriers, the accessibility of health care services, and inclusion of people with disabilities in the health care system. It should not describe the goal as merely making the health care system more accessible or more inclusive, or merely reducing barriers.
#9 The long term objective of the Health Care Accessibility Standard should be to ensure that Ontario’s health care system and the services, facilities and products offered in it, become fully accessible to all patients with any kind of permanent or episodic disabilities and to any support people with disabilities for any patient, by 2025, the AODA’s deadline, by requiring the removal and prevention of the accessibility barriers that impede people with disabilities, and by providing a prompt, accessible, fair, effective and user-friendly process to learn about and seek disability-related accommodations tailored to a person’s individual disability-related needs. It should aim to ensure that patients with disabilities can fully benefit from and be fully included in the health care services and products offered in Ontario’s health care system on a footing of equality. It should aim to eliminate the need for patients with disabilities and any support people with disabilities to have to contend with and fight against health care accessibility barriers, one at a time, and the need for health care providers to have to re-invent the accessibility wheel one health care facility or one health care provider at a time. It should aim for health care services, facilities and products in Ontario to be designed and operated based on accessibility principles of universal design.
#10 The Initial Report’s vision of an accessible health care system should be expanded to include the following:
a) The health care system will be designed and operated from top to bottom for all its patients, including patients with all kinds of permanent or episodic disabilities, as disability is defined in the Ontario Human Rights Code and the Canadian Charter of Rights and Freedoms. The health care system will no longer be designed and operated from an implicit starting point of aiming predominantly to serve the fictional “average” patient, who is too often assumed to have no disabilities.
b) Patients with disabilities, and where needed, any patients’ support people with disabilities, will be able to effectively communicate with health care providers and health care staff in connection with requesting or receiving health care services and products throughout each stage of the healthcare process. This will include face-to-face interactions, telephone or alternates to telephone use, accessible information and forms as well as alternate arrangements for providing one’s signature. For example, health care facilities and ambulances will be equipped with needed equipment to ensure effective communication with people with communication-related disabilities.
c) Patients with disabilities, and where needed, any patients’ support people with disabilities will be able to get and receive information relevant to their health care needs in private, e.g., when giving information at a health care provider’s office or when seeking or receiving information about their medication at a pharmacy, rather than in a public place where others can overhear. Effective procedures will protect the confidentiality of private information relating to patients with disabilities who rely on others to assist them with communication.
d) Information technology and applications which patients can use at home, or at a health care facility in connection with seeking and receiving health care services, will be designed based on principals of universal design and will be accessible to and usable by patients with disabilities, and where needed, to patients’ support people with disabilities. Where needed for effective communication, health care facilities will also provide alternatives to telephone use including email, text, video and authorized human assistance.
e) Health care products, and any instructions for their use, will be designed and available based on principles of universal design so that people with disabilities and not just people with no disability can use and benefit from them.
f) Support services such as sighted guides for visually impaired patients and attendant care will be available to patients with disabilities who need them while going to or at a facility to receive health care services.
g) Publicly funded appointments for receiving health care services will be sufficiently long to enable those patients with a disability, who need more time, to be able to receive the health care services they need. If a patient with disabilities cannot attend a health care provider’s premises due to their disability, there will be in place measures whenever therapeutically possible for remote appointments or home visits.
h) Patients will be free to use their own accommodation supports, such as service animals, when seeking or obtaining health care services and products.
i) New Government strategies, services and facilities in Ontario’s health care system will be proactively designed from the start and operated to fully include the needs of patients with disabilities. Those responsible at the provincial and local levels for leading, overseeing and operating Ontario’s health care system will have strong and specific requirements to address disability accessibility and inclusion in their mandates and will be accountable for their work on this issue. Ontario’s disability community will have effective input into public decisions on the design and operation of Ontario’s health care system to ensure that existing disability accessibility barriers are removed and no new ones are created.
j) An accessible health care system is one where people with disabilities can work in a barrier-free workplace.
#11 The Initial Report should not merely recommend that an obligated organization “consider accessibility.” It should instead require specific actions that will achieve accessibility.
#12 The Health Care Accessibility Standard should require each health care facility and health care provider to create a welcoming environment for patients with disabilities and any patients’ support people with disabilities to seek accommodations for their disabilities when receiving health care services.
#13 Each major health care facility such as each hospital should be required to establish a permanent committee of its board to be called the “Accessibility Committee.” This Accessibility Committee should have responsibility for overseeing the facility’s compliance with the AODA, and with the requirements of the Ontario Human Rights Code and the Canadian Charter of Rights and Freedoms in so far as they guarantee the right of people with disabilities to fully participate in and fully benefit from the health care services that the facility provides. It should endeavour to reflect the spectrum of disability needs.
#14 Each major health care facility such as each hospital should be required to establish or designate the position of Chief Accessibility/Accommodation Officer, reporting to the Chief Executive Officer. Their mandate, responsibility and authority should be to ensure proper leadership on the facility’s accessibility and accommodation obligations under the Ontario Human Rights Code, the Canadian Charter of Rights and Freedoms and the AODA, including the requirements of this accessibility standard. This responsibility may be assigned to an existing senior management official.
#15 Beyond the specific measures to remove and prevent barriers set out in the Health Care Accessibility Standard and in other accessibility standards enacted under the AODA, each health care facility and health care provider should be required to periodically and systematically review its health care services, facilities, equipment and products to identify recurring accessibility barriers that can impede the provision of health care services to patients with disabilities. A comprehensive plan for removing and preventing these accessibility barriers should be developed, implemented and made public with clear timelines, with clear assignment of responsibilities for action, monitoring for progress, and reporting to the facility’s accessibility committee. This plan should aim at all accessibility barriers that can impede patients with disabilities from fully benefiting from the facility’s health care services, whether or not they are specifically identified in the Health Care Accessibility Standard or in any other AODA accessibility standards.
#16 The Initial Report should be expanded to recommend specific, detailed accessibility requirements in the built environment of hospitals and other health care facilities such as those recommended in Appendix 1 to this brief. The goal of these should be that the built environment in the health care system, such as hospitals and any other places where health care services are provided, including the furniture there, will all be fully accessible to people with disabilities, and will be designed based on the principle of universal design. For example:
a) The front area or drop-off areas for a hospital or other health care facility should be accessible, with automatic power doors that do not require a button to be found and pressed, and with tactile walking surface indicators both to warn when a person is walking into a driving area and to guide a person to the facility’s entrance. All other entrances and exits should be fully accessible, with automatic power door operators and an accessible path of travel to the door. This includes entrances from indoor or underground parking to the health care facility.
b) Inside the health care facility, major public areas such as emergency room doors should always be fully accessible and have automatic power door openers.
c) For the benefit of patients and others with learning and cognitive disabilities, vision loss or other disabilities that can affect mobility or way-finding, hospitals and other health care facilities should have way-finding markings in important areas such as the main lobby from the front door to the help desk and other major routes such as to main elevators, including colour contrasted markings such as a carpeted path or tactile walking surface indicators.
d) Hospitals and other health care facilities with elevators should have accessible elevators that can accommodate people using mobility devices. They should also have accessible elevator buttons (with braille and large print on or beside each button), braille and large print floor numbers just outside elevator doors, and audible floor announcements on elevators. Elevator button panels should be consistent in layout from one elevator to the next.
e) Health care facilities, including hospitals, should never install “destination elevators” which require a person to pre-select the floor to which they are going before entering the elevators. These present unfixable accessibility problems.
f) Hospitals and other health care facilities should have accessible signage throughout, including braille and large print, for key locations. For example, public bathrooms should have accessible braille and large print signs on them. These signs should be placed in consistent and predictable locations.
g) Where a health care facility has power doors that require a button to be pushed (i.e., they don’t open automatically), the button should always be located throughout the health care facility in a consistent place to make it easier to find. The button should be located near the door, so that a slow-moving individual can make it through the open door after pressing the button before the door closes. The button should always be located on the wall, and not on a free-standing post or bollard.
h) Despite weaker requirements in other AODA accessibility standards, the Health Care Accessibility Standard should set out specific and strong requirements for the accessibility of any electronic kiosks in hospitals and other health care facilities, such as:
i) specifying their required end-user functionality that effectively address recurring known needs arising from specific disabilities, and,
ii) ensuring that they are at an accessible height e.g., for those using a wheelchair or other mobility device.
As a starting point, see the US Access Board’s standard for accessible electronic kiosks.
i) Patient consultation or treatment rooms should have enough space to enable people using mobility devices to navigate in them and reach any treatment or consultation area. They should have enough space to enable a Sign Language interpreter to be positioned in the room to interpret for a deaf patient or support person.
j) Movable furniture such as desks, tables or chairs should not obstruct accessible paths of travel around a facility where health care services are delivered, such as a doctor’s office, e.g., in their hallways or treatment rooms.
k) Major health care facilities should provide accessible waiting areas for accessible transit pickup and drop-off, close to the pickup/drop-off point, with clear sight lines.
l) Major health care facilities such as hospitals should be designed to avoid major sensory overstimulation or acoustic overloads, such as bright lights, loud music, large atrium areas, or frequent loud announcements. This is especially important in treatment areas or hospital rooms.
m) Throughout a health care facility, proper colour contrasting should be required to assist people with low vision and cognitive disabilities, such as around elevator opening, doorways, and on the edge of stairs and handrails.
n) Health care facilities should be required to have accessible bathrooms so that all patients can use the facilities, including adult change tables, sufficient transfer space and maneuvering room for mobility devices.
o) Major health care facilities should include sensory rooms for people with sensory overload issues, such as in hospital emergency rooms.
p) In a health care facility, all stairs and staircases, including “feature staircases” (included as aesthetic design enhancements) should be accessible, e.g., with tactile warnings at the top and bottom of each set of stairs, no open risers and with proper colour contrast on railings and step edges. There should never be curving staircases.
q) Health care facilities should provide charging areas for electric mobility devices.
r) Hospital rooms should be able to accommodate a patient’s mobility device so they can keep theirs with them and readily available when admitted to hospital.
s) In a health care facility, waiting areas, isolation areas, breastfeeding rooms, staff areas and volunteer areas should be designed to be accessible.
t) Accessible and bariatric paths of travel should be provided in health care facilities.
u) Despite the more limited provisions regarding the provision of accessible parking spaces in other AODA accessibility standards, the Health Care Accessibility Standard should set higher and more specific requirements for accessible parking spaces for health care facilities, such as:
i) requiring a greater number of accessible parking spots for the facility, where possible.
ii) requiring that the accessible parking spots be located as close as possible to the doors of the health care facility.
iii) requiring that at least some of the accessible parking spots have larger dimensions to accommodate larger accessible vans, so that a passenger with a disability can park in that spot and have sufficient room to exit the vehicle, and
iv) requiring that there be accessible curb cuts and an accessible path of travel from the accessible parking spots to the health care facilities’ entrances.
v) Health Care facilities should have designated snow-piling areas outside, to prevent snow from being shoveled onto accessible paths of travel.
w) Major health care facilities such as hospitals should provide service animal relief areas close to the facility’s door, covered wherever possible, with an accessible path of travel to them.
x) When a major new health care facility like a hospital is being designed, or a major new wing or renovation is being planned, especially if public money is helping fund it, a properly trained and qualified accessibility consultant should be required to be engaged on the project from the very beginning. Their accessible design advice should be transmitted unedited to the Government or other organization for whom the project is being built and should be made public. Direct consultation with end-users with disabilities should be part of the design process from the beginning.
#17 The standard should require that:
a) Each hospital patient’s bed should have an accessible means for a patient with disabilities to notify the nursing station of a health care need, not just a button or pull-string that they may not be able to reach and operate.
b) Furniture such as seating in health care facilities should be designed with accessibility features and positioned in a manner that does not block accessible paths of travel.
c) A Help Desk should be positioned immediately inside the main entrance of any major health care facility, including hospitals, to assist patients, including patients with disabilities, to get directions or help to their destination within the facility, or to request other accommodation supports.
d) In any discrete department or area where health care services are provided, (such as an area for day surgery), the check-in desk should be located immediately adjacent to the entrance to that area, so that patients and support people with disabilities can easily reach it after entering the room or area.
e) Accessible public service counters should be installed, even in existing health care facilities, with a specified height requirement, no glass barrier creating barriers for people with hearing loss and knee space for people using a mobility device.
f) A large health care facility like a hospital should have rest areas along routes through the building so that people with fatiguing conditions can stop and rest along their route to get health care services.
g) Health care facilities such as hospitals should have emergency areas of refuge with separate ventilation in case of fire, so that people with disabilities who cannot escape the building have safe areas to wait, while being protected from life-threatening smoke.
h) The Ontario Government should make available to health care facilities and providers: guides on accessible procurement including procurement of accessible furniture, lists of vendors of accessible furniture. The Ontario Government should provide a hub for procuring accessible furniture to help health care facilities and providers reduce the cost of their acquisition.
#18 the Ministry of Health should within one year survey all offices of physicians, chiropractors, occupational and physiotherapists and other like health care providers where they provide direct health care services to patients, on the extent to which their premises are accessible for patients with disabilities. The Ministry should make public a report on the results of this survey (anonymized).
#19 The Health Care Accessibility Standard should set specific technical requirements for the accessibility of diagnostic and treatment equipment. As a starting point, the Health Care Standards Development Committee should consider the accessible medical diagnostic equipment standards that the US Access Board has formulated. The needs of patients with all kinds of disabilities, and not only those with mobility disabilities, should be met by the technical requirements that the Health Care Accessibility Standard sets.
#20 The Ontario Government should impose a strict funding condition on the purchase or rental of any new health care diagnostic or treatment equipment anywhere in the health care system requiring that it must be accessible to patients with disabilities and designed based on principles of universal design, in compliance with the technical standards to be included in the Health Care Accessibility Standard.
#21 The Ontario Government should be required to make readily available to health care providers and facilities, and to the public, an up-to-date list of accessible health care diagnostic and treatment equipment and venders, so that each health care provider and facility does not have to re-invent the wheel by re-investigating these same issues.
#22 To save money, the Ontario Government should be required to attempt to negotiate bulk purchasing of accessible diagnostic and treatment equipment so that health care facilities and providers can obtain them at lower prices.
#23 When health care facilities and providers purchase, rent or otherwise acquire new or replacement diagnostic or treatment equipment, these should be required to be accessible to patients with disabilities and to be designed based on principles of universal design.
#24 Health care facilities and providers should survey their existing diagnostic or treatment equipment, and take the following steps to address any accessibility problems they have, if that equipment is not now being replaced:
a) Identify where the nearest place is where a patient can get diagnosis or treatment services where there is accessible diagnostic and treatment equipment, and to help facilitate the access of the patient with disabilities to health care services from that provider or facility.
b) Adopt and implement an interim plan to make any readily achievable accessibility improvements to the health care facility’s or provider’s existing diagnostic or treatment equipment.
c) Develop plans to purchase, rent or otherwise acquire accessible diagnostic or treatment equipment over a period of up to five years.
#25 These accessibility/universal design requirements should also apply to consumer health care products, such as for example, pill bottles.
#26 Because Ontario’s system for electronic health care records has been centrally created, the Health Care Accessibility Standard should require the Ontario Government and any provincial agency that is responsible for overseeing the design, procurement or operation of the system for electronic health care records to ensure that these records will be kept and available in accessible formats for patients and support people with disabilities, and, as a related benefit, to health care providers and their staff with disabilities, except where technically impossible. PDF format should not be treated as being an accessible format.
#27 Individual health care organizations or facilities, including laboratories, that create their own health care records in electronic form should also be required to ensure that they are readily available in accessible formats for patients with disabilities and any patients’ support people with disabilities, and, as a side benefit, for health care providers and their staff with disabilities, except where technically impossible.
#28 All the Initial Report’s recommendations on training on accessibility laws should be revised to explicitly include training on the accessibility requirements regarding people with disabilities in the Ontario Human Rights Code and the Canadian Charter of Rights and Freedoms.
#29 The Health Care Accessibility Standard should require training on disability accessibility, disability human rights and disability Charter obligations for existing health care professionals as a condition of continuing in practice.
#30 The Ontario Government should be required to impose a condition of its funding for post-secondary education programs to train anyone in a health care discipline, profession or field, that the college or university that offers that degree or course must include a sufficient designated and mandatory curriculum on meeting the needs of patients with disabilities.
#31 Wherever possible, any new health care facility or provider receiving public funds that is setting up a new location should be required to locate at or near an accessible public transit stop on an accessible public transit route, with an accessible path of travel from the public transit stop to the health care facility or provider. Similarly, where an existing health care facility or provider is going to move to another location, it should be required to attempt to relocate to a location that is on an accessible public transit route.
#32 Where it is medically possible for a patient to take part in a health care service without physically attending at the health care facility or provider, an option should be provided for taking part remotely, e.g., via Facetime or other remote video conferencing. The Health Care Accessibility Standard should also require the removal of the OHIP barrier to funded physicians house calls.
#33 Where OHIP or a health care facility or provider has a policy or practice of permitting only one health issue per visit, an exception should be created for patients with disabilities for whom transportation to the health care facility is impeded by accessibility barriers.
#34 A health care facility or provider should not be permitted to charge a late fee or a missed appointment fee where a patient with a disability has in good faith attempted to attend on time but was made late or precluded from attending by transportation barriers (such as being made late for the appointment by the community’s para-transit service).
#35 When the Ontario Government is undertaking planning for new health care services, or for improvements to health care services, it should be required to include in those plans, and to make public, requirements to ensure that wherever possible, health care services and facilities are provided in locations on accessible public transit routes, with an accessible path of travel from the accessible public transit stop to the facility or provider.
#36 The 2011 Transportation Accessibility Standard should be amended to set accessibility requirements for public transit stations and stops, as the joint July 31, 2017 AODA Alliance/ARCH brief to the Transportation Standards Development Committee recommended.
#37 The Health Care Accessibility Standard should set technical specifications to ensure the full accessibility of ambulances and other vehicles that transport patients, including patients with disabilities, to or from health care services. See also below re: the need to include equipment in those vehicles for communication with patients with communication-related disabilities.
#38 Any health care facility or provider, including such places as doctors’ offices and pharmacies, should be required to designate an accessible private area where patients with disabilities can give and receive private information in connection with their health care services or products without others being able to overhear this.
#39 Health care facilities and providers should be required to notify all patients, including patients with disabilities, of their right to have their health care needs and issues discussed and information exchanged in a private location, and should instruct their staff, including any who deal with patients or the public, of their duty to fully respect this right.
#40 Without limiting the information and communications to which this part of the Health Care Accessibility Standard should apply, it should address:
a) Information or communications needed to provide a health care provider with the patient’s history, needs, symptoms or other health problems.
b) Information and communications regarding the patient’s diagnosis, prognosis or treatment, including any risks, follow-up or other health care services to secure.
c) A health care facility’s discharge instructions.
#41 Health Care facilities should be equipped with assistive listening devices to enable patients with hearing loss and support people with hearing loss to be able to effectively communicate e.g., at nursing stations, help desks, and when dealing directly with health care providers.
#42 Health care-related products such as prescription and non-prescription medications should be provided when needed with accessible labels, instructions or users’ manuals, available in accessible formats. Those who sell or rent these to the public should be required to regularly notify the public, including their customers, that accessible labels, instructions, and users’ manuals are available on request. See e.g. work on developing standards and practices for accessible prescription drug container labels by the US Access Board. See also the February 6, 2020 news release announcing that the Empire chain of stores, including all Sobeys Stores, will provide accessible prescription labels to customers with disabilities free of charge on request. If they can, so can all other drug stores.
#43 Where a health care facility or health care provider provides information about their services or facilities in print or via the internet, they should be required to ensure that their website meets current international accessibility requirements along prompt time lines, even if the Information and Communication Accessibility Standard does not now require this. Currently, the Information and Communication Accessibility Information and Communication Accessibility Standard has too many exemptions, leaves out too many providers of goods and services, and has timelines that are too long. Whether or not those exemptions, exclusions and long timelines are justified for other sectors, they are unjustified for a sector as important as the health care sector.
#44 Ambulances and other vehicles that transport patients should include equipment to facilitate communication with patients with communication disabilities, such as remotely-accessed sign language interpretation and other communication supports.
#45 The Ontario Government should be required to set up hubs or centralized services to enable health care facilities and providers, including small providers, to quickly and easily access communication supports needed for patients with communication-related disabilities (for example Sign Language interpreters and real time captioning). The Ontario Government should fund these services as part of its funding of the health care system, in furtherance of the Supreme Court of Canada’s Eldridge decision.
#46 Any prepared information on health care conditions, treatment instructions, prognoses, risks, laboratory or other test results and the like which a health care facility or provider makes available to patients, whether in print or electronic form, should be made available at the same time on request in an accessible format. The standard should direct that PDF format is not sufficient to be accessible, and that if information is available in a PDF document, it should also be posted in an accessible format such as HTML or MS Word. Health care facilities and providers should be required to notify patients, including patients and their support people with disabilities, that any hard copy or electronic documents provided to them can be requested and obtained in an accessible format on request.
#47 Where a health care facility or provider asks patients or their support people to use information technology hardware or software in connection with the delivery of health care services (such as asking them to fill out their medical history on a portable computer or tablet device), the facility or provider shall:
a) In the case of new or updated information technology or equipment to be acquired, ensure that it is accessible to people with disabilities and is designed based on principles of universal design;
b) In the case of existing information technology now being used, retrofit to be accessible except where this would pose an undue hardship and,
c) For those people who prefer this option, ensure that patients with disabilities or their support people with disabilities are assisted to use that technology, in private, at the same time as others would use it, where this would not reduce their access to the health care services to which it pertains.
#48 The Ontario Government should be required to develop and make public a strategy for ensuring that health care promotion initiatives in Ontario are accessible to people with disabilities. For example, it should require that:
a) All advertisements for health care promotion should have captioning and audio description.
b) All mail-out, printed and online materials focusing on health promotion should be required to be in accessible formats, regardless of any exemptions in the Information and Communication Accessibility Standard.
#49 Hospitals and other major health care facilities should be required to provide support services for patients with disabilities when needed to ensure that those patients can fully access and benefit from the health care services that the facility offers, to let patients know about the availability of these services, and to annually publicly report on the number of staff available to provide this support, such as:
a) Attendant care.
b) Assistance with meals.
c) Assistance with being guided to and getting around the health care facility e.g., for patients with vision loss or cognitive disabilities.
#50 In a hospital or other major health care facility, there should be one nurse at each nursing station designated to receive training and to be responsible for addressing the needs of patients with complex needs due to their disability.
#51 Each health care provider and facility should be required to put in place a system and designate a person to solicit and receive requests from patients or their support people for disability accommodations in connection with health care services or products.
#52 Each health care provider or facility should be required to make readily-available to the public, including to their patients, in an accessible format, information about how to identify themselves in advance to the health care provider as having disability-related accessibility or accommodation needs, and to ask to arrange for these needs to be met.
#53 Each hospital and larger health care facility should be required to collect anonymized information on disability-related accessibility and accommodation requests received from or on behalf of patients with disabilities, to assist that health care provider or facility in planning for future disability accessibility and accommodation. This anonymized information should be available for study by the Government or other health policy planners.
#54 The Chief Executive Officer of any hospital or large health care facility should be required to annually review the information that the facility has collected on the requests for disability accessibility and accommodation that the facility has received and report to the board of directors on measures that could improve the facility’s capacity to meet these needs.
#55 Each health care profession’s self-governing college should be required to:
a) Review its public complaints process to identify any barriers at any stage in that process that could adversely affect people with disabilities filing a complaint, or about whom a complaint is filed.
b) Develop a plan for removing and preventing any accessibility barriers identified, whether or not those barriers are specified in any current AODA accessibility standards.
c) Publicly report to its governing board of directors and the public on these barriers and the college’s plans to remove and prevent such barriers, in order to achieve a barrier-free complaints process.
d) Establish and maintain a standing committee of its governing board of directors responsible for the accessibility of the services that the college offers the public, including, but not limited to its public complaints process.
e) Consult with the public, including people with disabilities, on barriers that people with disabilities experience when seeking the services of the health care professionals that that profession regulates, to be shared with the board’s Accessibility Committee. To avoid duplication of efforts and burdens on the disability community, several regulatory colleges can jointly undertake this consultation.
#56 The Ministry of Health should be required to designate a senior official at the “Assistant Deputy Minister” level as the leading public official who is responsible for ensuring accessibility, accommodation and inclusion for patients with disabilities in Ontario’s health care system. They should be responsible for ensuring that any policies, plans or proposals regarding the health care system are screened to ensure that they will not create any new barriers for patients with disabilities, and will instead remove barriers.
#57 The Ministry of Health should be required to conduct a system-wide review of the health care system for any systemic barriers, in consultation with the public including people with disabilities. It should identify and make public a plan to remove and prevent systemic or system-wide barriers that impede patients with disabilities from receiving accessible health care, along time lines that the Health Care Accessibility Standard will set.
#58 Each hospital and other major health care facility should be required to establish and regularly publicize a dedicated disability accessibility/accommodation complaints hotline, to trigger prompt action when problems are raised.
#59 The Ministry of Health should be required to establish and regularly publicize a hotline to receive complaints about accessibility problems facing patients and support people with disabilities in Ontario’s health care system. The Ministry should be required to annually publish a report with an anonymized summary of the substance of complaints received and action taken to prevent their recurrence.
#60 The Health Care Accessibility Standard should require the creation of authoritative, well-trained system navigators to assist patients with disabilities and their support people to navigate Ontario’s health care system.
#61 The OHIP fee schedule should be revised to provide for added time to serve the needs of patients with disabilities who need more time for assessment, diagnosis and treatment, to eliminate the harmful financial incentive that the Ontario Government now creates for physicians to avoid treating taking on those patients.
#62 Each hospital and major health care facility should be required to establish a committee of those employees and volunteers with disabilities who wish to voluntarily join it, to give the facility’s senior management feedback on the barriers in the health care facility that could impede patients with disabilities or any patients’ support people with disabilities, and/or employees/volunteers with disabilities.
#63 The Health Care Standards Development Committee should endorse the recommendations regarding health care services in the Initial Report of the K-12 Education Standards Development Committee on barriers facing students with disabilities in Ontario schools.
#64 The Initial Report’s Recommendation 15 regarding the conduct of an after-the fact review of the problems facing people with disabilities in accessing health care during the COVID-19 pandemic should be revised so that this review is an Independent Review conducted by trusted and respected persons who are independent of the Government and of the health care system.
#65 The Initial Report should recommend that the Health Care Accessibility Standard
a) Require the Government to immediately rescind the January 13, 2021 critical care triage protocol and all directions and training materials relating to it, and should direct that these are not to be followed or considered appropriate under any situation.
b) Require the Ontario Government to immediately make public all versions of the critical care triage protocol that have been in force in Ontario, or distributed to hospitals, as well as any critical care triage protocol or directions to ambulances or other emergency services, and any reports that the government received from the Government-appointed Bioethics Table.
c) Require that if critical care triage is directed to occur during this or other emergencies, the Government shall make public on a daily basis the number of patients who are refused or denied critical care that they need and want, due to critical care triage.
e) Require that the Clinical Frailty Scale shall not be used as a tool to decide who is to ever be refused critical care they need and want.
f) Forbid the use or distribution of the “Short Term Mortality Risk Calculator” that was made available under the auspices of Critical Care Services Ontario to all Ontario hospitals.
#66 the Health Care Accessibility Standard should require the Government to ensure the availability of remote or distance delivery of health care services where medically feasible, and where patients with disabilities face barriers attending at a health care office or facility to receive such services.
#67 The Initial Report should be expanded to list a full range of disability barriers reported to the Standards Development Committee in access to health care during the pandemic.