Accessibility for Ontarians with Disabilities Act Alliance Update United for a Barrier-Free Ontario for All People with Disabilities https://www.aodaalliance.org aodafeedback@gmail.com Twitter: @aodaalliance
August 26, 2016
SUMMARY
The AODA Alliance has finalized its august 26, 2016 brief to the Wynne Government on accessibility barriers in Ontario’s health care system. We submitted it to the Accessibility Directorate of Ontario as part of its “Pre-Consultation.” We set out this 14-page brief below.
It would be great if you could email the Government to say if you support our brief. Send your email to the Government by writing to aoda.input@ontario.c a
You can just send in one sentence. Feel free to say more, if you wish. Of course, if you write the Government, add any other accessibility barriers in the health care system that we may have missed.
Please encourage other people to do this too. If you are part of a community organization, encourage your organization to send in an email to the Wynne Government indicating if the organization supports our brief.
The Government set the deadline for feedback as August 31, 2016. However, even if you write the Government after that date, it will still help us.
We thank everyone who sent us examples of barriers and who also gave us feedback on the August 18, 2016 draft of this brief that we earlier circulated for your feedback. This finished brief includes everything that was in our earlier draft brief. It adds a few additional points. Those points all come from input from our supporters.
Once the Government appoints the Health Care Standards Development Committee that will develop recommendations on what the promised Health Care Accessibility Standard should include, we will prepare an expanded brief. We welcome your input at any time on accessibility barriers in the health care system.
Our brief mentions a 226 page study on health care barriers that the KPMG firm conducted for the Wynne Government on accessibility barriers in the health care system. Click here to download the 2015 KPMG health care accessibility study in MS Word format: https://www.aodaalliance.org/strong-effective-aoda/ADO-Final-Report-Healthcare-Baseline-Data.docx Here is a summary of our brief:
a) The Ontario Government should not impose any prior restrictions on the health care accessibility barriers in the health care system that the forthcoming Health Care Standards Development Committee will be able to consider for action in the promised Health Care Accessibility Standard.
b) People with disabilities are the best experts in knowing what accessibility barriers they face.
c) The goal of the Health Care Accessibility Standard should be to ensure that Ontario’s health care system becomes fully accessible to people with disabilities by 2025. It should require Ontario’s health care services and facilities to be designed and operated based on strong accessibility principles of universal design. It would be grossly inadequate for the Health Care Accessibility Standard to set a weaker and less specific goal, e.g. to “improve accessibility” in the health care system.
d) The Health Care Standards Development Committee should start its work by developing a clear vision of what a fully accessible and barrier-free health care system would be like. Our brief offers such a vision. Then the Standards Development Committee should develop the measures needed to ensure that that vision becomes a reality by 2025.
e) The promised Health Care Accessibility Standard must cover all parts of Ontario’s health care system.
f) If the Health Care Standards Development Committee identifies a recurring accessibility barrier in Ontario’s health care system, it should address recommendations about it, even if there is an existing health care regulation or statute that may already apply in whole or in part.
g) The Health Care Standards Development Committee should identify the barriers that need to be fixed, the measures to be required to remove and prevent them, and the time lines for action.
h) The Health Care Standards Development Committee must address both the removal of old barriers and the prevention of new ones.
i) This brief offers examples of accessibility barriers that the Health Care Accessibility Standard needs to address, including:
i) Barriers impeding people with disabilities from getting to health care services;
ii) Barriers to getting into and around facilities where health care services are provided;
iii) Barriers in diagnostic equipment;
iv) Barriers to health care information;
v) Barriers to effective communication with health care providers;
vi) Barriers in other technology in the health care system;
vii) Barriers in provision of support services needed to receive services in the health care system;
viii) Barriers in the health care system facing people with developmental disabilities, identified in the Ontario Ombudsman’s August 24, 2016 report on Ontario developmental services, entitled “Nowhere To Turn”.
ix) Other sundry barriers.
j) The Health Care Accessibility Standard must set detailed requirements for specific accessibility action. It is not sufficient for this accessibility standard to impose requirements for health care providers to make plans and policies on accessibility, or to vaguely require obligated organizations to consider or include accessibility features in health care facilities or services.
You can always send your feedback and ideas to us on this and on any AODA and accessibility issue at aodafeedback@gmail.com
Have you taken part in our “Picture Our Barriers campaign? If not, please join in! You can get all the information you need about our “Picture Our Barriers” campaign by visiting www.aodaalliance.org/2016
To sign up for, or unsubscribe from AODA Alliance e-mail updates, write to: aodafeedback@gmail.com
We encourage you to use the Government’s toll-free number for reporting AODA violations. We fought long and hard to get the Government to promise this, and later to deliver on that promise. If you encounter any accessibility problems at any large retail establishments, it will be especially important to report them to the Government via that toll-free number. Call 1-866-515-2025.
Please pass on our email Updates to your family and friends.
Why not subscribe to the AODA Alliance’s YouTube channel, so you can get immediate alerts when we post new videos on our accessibility campaign. https://www.youtube.com/user/aodaalliance
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Follow us on Twitter. Get others to follow us. And please re-tweet our tweets!! @AODAAlliance
Learn all about our campaign for a fully accessible Ontario by visiting https://www.aodaalliance.org
Please also join the campaign for a strong and effective Canadians with Disabilities Act, spearheaded by Barrier-Free Canada. The AODA Alliance is proud to be the Ontario affiliate of Barrier-Free Canada. Sign up for Barrier-Free Canada updates by emailing info@BarrierFreeCanada.org
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Accessibility for Ontarians with Disabilities Act Alliance
United for a Barrier-Free Ontario for All People with Disabilities www.aodaalliance.org aodafeedback@gmail.com Twitter: @aodaalliance
Brief to the Accessibility Directorate of Ontario’s “Pre-Consultation on Accessibility Barriers in Ontario’s Health Care System
August 25, 2016
1. Introduction
This is the AODA Alliance’s brief to the Accessibility Directorate of Ontario, part of the Ontario Government, for its July-August 2016 “Pre-Consultation” on the accessibility barriers that people with disabilities face in Ontario’s health care system. The AODA Alliance is a voluntary non-partisan coalition of individuals and organizations. Our mission is:
“To contribute to the achievement of a barrier-free Ontario for all persons with disabilities, by promoting and supporting the timely, effective, and comprehensive implementation of the Accessibility for Ontarians with Disabilities Act.” To learn about us, visit: https://www.aodaalliance.org.
Our coalition is the successor to the Ontarians with Disabilities Act Committee. The ODA Committee advocated more than ten years for the enactment of strong, effective disability accessibility legislation. Our coalition builds on the ODA Committee’s work. We draw our membership from the ODA Committee’s broad, grassroots base. To learn about the ODA Committee’s history, visit: http://www.odacommittee.net
This is a preliminary brief on what the promised Health Care Accessibility Standard needs to address. The AODA Alliance plans to expand on this brief, in a future submission to the Health Care Standards Development Committee. The Ontario Government has not yet appointed that Standards Development Committee.
We thank all those from the community who shared with us the accessibility barriers they have experienced, as are reflected in this brief. We also thank all those who sent us even more ideas and feedback, based on reading our August 18, 2016 brief, which we circulated for public comment. The AODA Alliance has not sought to itself investigate information and feedback we received. We also acknowledge with thanks the assistance of the ARCH Disability Law Centre in helping us gather information on these accessibility barriers, and the superb team of Osgoode Hall Law School students who selflessly contributed their volunteer time to help with this project.
There is a pressing need for the Government to immediately appoint the promised Health Care Standards Development Committee, and for that Committee to get right to work on tackling the many recurring barriers that people with disabilities too often face in Ontario’s health care system. The need for a substantial change in direction on the accessibility front is powerfully made by the fact that in the brand-new Women’s College Hospital, recently re-opened in the heart of downtown Toronto, there are a series of unjustified, preventable and unacceptable accessibility barriers. These are addressed in part in a powerful recent Toronto Star article, available at https://www.aodaalliance.org/strong-effective-aoda/08112016.asp
This brief is summarized as follows:
a) The Ontario Government should not impose any prior restrictions on the health care accessibility barriers in the health care system that the forthcoming Health Care Standards Development Committee will be able to consider for action in the promised Health Care Accessibility Standard.
b) People with disabilities are the best experts in knowing what accessibility barriers they face.
c) The goal of the Health Care Accessibility Standard should be to ensure that Ontario’s health care system becomes fully accessible to people with disabilities by 2025. It should require Ontario’s health care services and facilities to be designed and operated based on strong accessibility principles of universal design. It would be grossly inadequate for the Health Care Accessibility Standard to set a weaker and less specific goal, e.g. to “improve accessibility” in the health care system.
d) The Health Care Standards Development Committee should start its work by developing a clear vision of what a fully accessible and barrier-free health care system would be like. Our brief offers such a vision. Then the Standards Development Committee should develop the measures needed to ensure that that vision becomes a reality by 2025.
e) The promised Health Care Accessibility Standard must cover all parts of Ontario’s health care system.
f) If the Health Care Standards Development Committee identifies a recurring accessibility barrier in Ontario’s health care system, it should address recommendations about it, even if there is an existing health care regulation or statute that may already apply in whole or in part.
g) The Health Care Standards Development Committee should identify the barriers that need to be fixed, the measures to be required to remove and prevent them, and the time lines for action.
h) The Health Care Standards Development Committee must address both the removal of old barriers and the prevention of new ones.
i) This brief offers examples of accessibility barriers that the Health Care Accessibility Standard needs to address, including:
i) Barriers impeding people with disabilities from getting to health care services;
ii) Barriers to getting into and around facilities where health care services are provided;
iii) Barriers in diagnostic equipment;
iv) Barriers to health care information;
v) Barriers to effective communication with health care providers;
vi) Barriers in other technology in the health care system;
vii) Barriers in provision of support services needed to receive services in the health care system;
viii) Barriers in the health care system facing people with developmental disabilities, identified in the Ontario Ombudsman’s August 24, 2016 report on Ontario developmental services, entitled “Nowhere To Turn”.
ix) Other sundry barriers.
j) The Health Care Accessibility Standard must set detailed requirements for specific accessibility action. It is not sufficient for this accessibility standard to impose requirements for health care providers to make plans and policies on accessibility, or to vaguely require obligated organizations to consider or include accessibility features in health care facilities or services.
2. Important for the Ontario Government Not to Restrict the Range of Accessibility Barriers that the Forthcoming Health Care Standards Development Committee Can Consider
It is commendable that on February 13, 2015, the Ontario Government committed to develop a Health Care Accessibility Standard under the Accessibility for Ontarians with Disabilities Act. The first step that the Government must take in the development of a Health Care Accessibility Standard is to appoint an independent Health Care Standards Development Committee under the AODA. This Standards Development Committee will be responsible to identify the range of recurring accessibility barriers in Ontario’s health care system that the Health Care Accessibility Standard should address, and to make recommendations on what that accessibility standard should require to ensure that Ontario’s health care system becomes fully accessible to people with disabilities by 2025.
The Government has said that the purpose of its summer 2016 “Pre-Consultation” on health care barriers is to determine the scope of the work of the forthcoming Health Care Standards Development Committee. The AODA Alliance strongly urges the Government not to impose any prior restrictions on the health care accessibility barriers that this Standards Development Committee can consider.
It would work against the AODA’s goals for the Government to try to stop the Standards Development Committee in advance from even exploring a range of health care accessibility barriers. The AODA clearly defines the terms “disability” and “barrier.” These definitions set the limits of the work of the Health Care Standards Development Committee.
For example, during this summer’s Health Care Accessibility “Pre-Consultation,” the Accessibility Directorate of Ontario initially said built environment within the reach of the Ontario Building Code would not be addressed in the Health Care Accessibility Standard. We strenuously objected to this at the Government’s July 26, 2016 “Pre-Consultation” meeting. In the face of this, the Accessibility Directorate of Ontario agreed at that meeting, in the presence of representatives of several community disability organizations, that there would be no such prior restrictions on the kinds of accessibility barriers that the Health Care Standards Development Committee could consider. This is very important. As addressed further below, there are quite significant physical barriers in too many places where health care services are delivered in Ontario.
Before conducting this “Pre-Consultation,” the Ontario Government hired the KPMG firm to study barriers in the health care system, among other things. When preparing this brief, the AODA Alliance did not have time to fully study the KPMG Report. It is some 226 pages long. The Government only released it to us days before this brief was being prepared. We will later respond to that report.
It is essential that nothing in the KPMG report restrict the range of barriers that the Health Care Standards Development Committee can examine, or the measures it can recommend for inclusion in the promised Health Care Accessibility Standard. At the Accessibility Directorate of Ontario’s July 26, 2016 “Pre-Consultation” meeting, Government officials confirmed that in preparing that report, KPMG did not seek the input of any people with disabilities. For example, the AODA Alliance was never contacted for input, even though we are the leading voice that has pressed for over half a decade to get the Ontario Government to agree to develop a Health Care Accessibility Standard under the AODA.
The Government has in the past repeatedly recognized that people with disabilities are the best experts in knowing what accessibility barriers they face. By failing to ever ask people with disabilities about the barriers they face in the health care system, KPMG fundamentally failed to take the most important and obvious step needed for a study of this kind. As such, its conclusion in its executive summary deserves no credit or weight, where KPMG stated:
“Overall, Ontario appears to be comparable or better than the other jurisdictions examined in helping to make healthcare more accessible to persons with disabilities.”
That conclusion is inaccurate and fundamentally misleading for any Standards Development Committee that is going to embark on the important work needed in connection with Ontario’s health care system. The AODA does not require Ontario to just strive to be as good at advancing accessibility as other jurisdictions. It requires the Ontario Government to lead Ontario to full accessibility by 2025.
3. Goal of the Health Care Accessibility Standard
The goal of the Health Care Accessibility Standard should be to ensure that Ontario’s health care system becomes fully accessible to people with disabilities by 2025. It should require Ontario’s health care services and facilities to be designed and operated based on strong accessibility principles of universal design.
This is what the AODA requires this new accessibility standard to achieve. The goal of a fully accessible health care system with fully accessible health care services is especially important because people with disabilities are disproportionately the consumers of health care services. Disproportionately, seniors use health care services. We each make the greatest use of health care services towards the end of our lives. Disabilities are far more prevalent among seniors.
This goal also lives up to the accessibility requirements of the Ontario Human Rights Code and the Charter of Rights. Some incorrectly think that the AODA imposes new requirements for accessibility. In fact, it simply seeks to get obligated organizations to do what the Ontario Human Rights Code, and for some organizations, the Charter of Rights, have required for over three decades.
For the Health Care Accessibility Standard to set a weaker and less specific goal, e.g. merely to “improve accessibility” in the health care system, would be grossly inadequate. By simply removing only one barrier somewhere in Ontario’s huge health care system, would fulfil that limited goal. Yet it would leave our health care system with far too many accessibility barriers in place.
In recent years, the Ontario Government has unfortunately conducted itself as if the 2025 deadline were not looming. Inclusion of that deadline in this accessibility standard’s purpose clause would serve as an important reminder to the Government and to all organizations involved in the health care system.
4. Vision of a Barrier-Free and Fully-Accessible Health Care System
The Health Care Standards Development Committee should start by developing a clear vision of what a fully accessible and barrier-free health care system would be like. We need to know where we aim to arrive before we can properly design the best way to reach that destination.
In a fully accessible health care system, people with disabilities and their family members and care-givers with or without disabilities must be able to:
* find out what health care services are available and how and where to get them;
* get to the places where health care services are delivered or provided;
* independently get into and make their way around the places where health care services are delivered or provided;
* communicate effectively and in private with health care professionals and other staff to give the information needed and receive their diagnosis, prognosis and advice in connection with health care services;
* be able to use and take part in all diagnostic services and equipment needed to enable health care professionals to assess the condition of a patient with a disability;
* obtain any support services they need in order to get to, receive and fully benefit from health care services they need;
* be able to receive and fully benefit from any health care treatments that the health care system provides and which they have been diagnosed as requiring.
* be able to obtain their health care records to which they have a right of access in an accessible format, in a prompt and timely fashion.
A fully accessible health care system is also one where people with disabilities can work in a barrier-free workplace. The barriers which impede people with disabilities as patients and their family members and care-givers also impede health care providers and workers with disabilities.
5. Parts of the Health Care System to be Covered
The promised Health Care Accessibility Standard must cover all parts of Ontario’s health care system. It should cover all health care services 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 every location or facility where health care services can be delivered in Ontario, including e.g. hospitals, long term care facilities, offices and clinics for doctors, dentists, physiotherapists, psychologists, occupational therapists, speech pathologists, and other health care providers. It should cover ambulances and other vehicles which can transport patients in connection with the receipt of 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.
6. Other Laws Governing Health Care Services Should be Subordinate to the Health Care Accessibility Standard
If the Health Care Standards Development Committee identifies a recurring accessibility barrier in Ontario’s health care system, it should address recommendations about it, even if there is an existing health care regulation or statute that may already apply in whole or in part. The AODA and accessibility standards enacted under it prevail over all other laws that provide less accessibility. AODA accessibility standards are not subservient to other laws, such as existing health care legislation and regulations. The Government cannot decline to address a health care accessibility barrier, just because some other health care regulation wrongly allows that barrier to continue in place, in whole or in part.
7. Barriers the Health Care Accessibility Standard Will Address
After establishing a vision of a fully-accessible health care system, the Health Care Standards Development Committee should identify the barriers that need to be fixed, the measures to be required to remove and prevent them, and the time lines for action. To do this, the Standards Development Committee should consult directly with those affected, including people with disabilities. The Government will then decide which regulations provide the best place for addressing these.
At the Accessibility Directorate of Ontario’s July 26, 2016 “Pre-Consultation” meeting, disability sector representatives were asked to identify which barriers are a “priority” for action. We strongly recommend that this sort of thing should not be pre-decided, especially before the Health Care Standards Development Committee even begins its work.
Moreover, such a question has serious problems. It would be wrong to create a hierarchy of importance among some disabilities over others. As well, each barrier in the health care system can reinforce other barriers. To become barrier-free, all accessibility barriers must be removed. All new barriers must be prevented.
We also recommend that the Health Care Standards Development Committee must address both the removal of old barriers and the prevention of new ones. The accessibility standards enacted to date under the AODA deal almost exclusively with the prevention of new barriers. They leave the vast majority of old and pre-existing barriers in place. Perhaps the Government contemplated that within the 20 years that the AODA gave from 2005 to 2025 for reaching full accessibility, it was best to first stop any new barriers from being created. Perhaps the Government planned to later deal with removing old and existing barriers.
Ontario cannot now afford the time for such an approach for Ontario’s health care system. Less than eight and a half years remain before 2025. The Health Care Accessibility Standard will have to set out a comprehensive set of requirements that ensure that existing barriers are removed before 2025, and that no new barriers are created. There simply is not enough time for the promised Health Care Accessibility Standard to solely or primarily address the prevention of new barriers in the health care system, while leaving old, existing barriers in place indefinitely.
Here is a preliminary review of accessibility barriers in the health care system that the Health Care Accessibility Standard should address, from feedback the AODA Alliance has received. These are not listed in order of priority or importance.
a) Barriers Impeding People with Disabilities from Getting to Health Care Services
We have received feedback about accessibility barriers that impede people with disabilities from getting to places where they need to go to receive health care services, such as:
i) Health care facilities and doctor’s offices that are not accessible, limiting access to treatment and diagnostic services.
ii) Inaccessible community mental health agency facilities, leaving emergency room services as the only option for those requiring accessible mental health services.
iii) Patients with disabilities that restrict their ability to travel cannot access health care services
iv) Technology, such as mobile apps, for remotely accessing health care services may not include accessibility features that enable people with disabilities from being able to fully and independently use that communication technology.
v) “One issue per visit” policies in doctor’s offices prevent those with multiple disabilities, or disabilities plus illness/ailment from receiving adequate treatment. This can leave them discouraged from even seeking treatment
vi) The new ‘mega hospitals’ that replace older hospitals create transportation barriers for those who live in rural areas. They also create access barriers for people with lung disease or fatiguing conditions who must walk long distances from the parking lot to the entrance and through the building to get to elevators.
vii) Limited accessible parking lots and spaces near hospitals i.e. which cannot accommodate modified vans with raised roof or side lift for wheelchair.
viii) Transportation barriers, such as restrictions on para-transit services crossing over municipal boundaries, can make it very difficult to reach health care facilities.
ix) When a para-transit service fails to show up on time, a patient can arrive late to a doctor’s office, and have the doctor’s office impose a financial penalty for supposedly missing the appointment.
b) Barriers to Getting into and Around Facilities Where Health Care Services are Provided
As far as we can tell, the Ontario Government has no accessibility standard, required for the design of a new health care facility such as a hospital or long term care facility, beyond the Ontario Building Code, to ensure that it is fully accessible. Similarly, it has no such accessibility standard, beyond the Ontario Building Code, for retrofitting an existing health care facility which is undergoing a major renovation. It has no detailed accessibility standard whatsoever for a health facility to be retrofitted for accessibility, if that facility has no major renovation underway. Yet the Ontario Human Rights Code, and in some cases, the Charter of Rights, require these facilities to become disability-accessible.
The Ontario Building Code and current AODA accessibility standards are palpably and substantially inadequate to meet the need for fully accessible facilities where health care services are provided. A new building in which health care services are provided, that is fully compliant with the Ontario Building Code and current AODA accessibility standards, is not assured to be fully disability-accessible. As such, the promised Health Care Standards Development Committee needs to set built environment accessibility standard requirements to address existing barriers, and to prevent the creation of new barriers.
Each time a new hospital or other health care facility is built, or a renovation to one is undertaken, the organization must hire consultants to reinvent the accessibility wheel. This wastes public money, and leads to patchworks of varying levels of accessibility. The significant accessibility deficiencies in the brand-new Women’s College Hospital, recently covered in the Toronto Star, and referred to above, proves this point.
As a result, Ontario’s health care system is full of barriers in the built environment where health care services are provided. These impede people with disabilities from getting into these facilities, or safely and independently getting around these facilities. Examples of such barriers include:
i) Older hospitals are still being used despite their lacking obvious needed accessibility features like ramps, accessibility features in washrooms like transfer spaces at toilets, grab bars, accessible signage to departments or elevators, etc.
ii) Brand new hospitals, such as Toronto’s Women’s College Hospital, that has several obvious accessibility problems despite being opened eleven years after the AODA was passed,
iii) Parking facilities with automated parking payment kiosks that are inaccessible to wheelchair users.
iv) Newly renovated facilities with inaccessible doors to the check-in/waiting areas causing patients to be late or to miss appointments.
v) Reception areas that use print signs to communicate important information or directions to patients and which offer no accessible means for patients with vision loss or dyslexia to obtain this information.
vi) Signage that does not use plain language for those with intellectual disabilities.
vii) Health care facilities that are obstacle courses or that have diagnostic, isolation, consultation and/or treatment rooms so small they cannot accommodate wheelchairs.
viii) Physical spaces in an emergency room or waiting room that are too small for mobility aids such as scooters, or support workers or support animals
ix) Reception desks behind windows with “speakers”, inhibiting communication for those with hearing loss, and which are placed too high for those in wheelchairs or those having smaller stature. These also result in privacy issues.
x) Wheelchair-accessible reception desks, where access to them is blocked, or where knee space is blocked, preventing face to face access.
xi) Public areas that are littered with furniture and obstacles restricting paths of access, creating hazards for people with vision loss.
xii) Environments such as Emergency Rooms, reception counters, and corridors or that have signage that are dimly lit, creating challenges for people with low vision, or who have hearing loss who rely on lip reading.
xiii) Medical offices and labs (x-ray, ultra sound, blood testing) where the doors are too tight to allow a wheelchair to pass through.
xiv) Elevators lacking audio floor announcements and buttons marked in Braille and colour-contrasted large print for persons with vision loss.
xv) The absence of way-finding guidance such as tactile floor strips or signage to direct people with vision loss through large open areas like hospital lobbies.
xvi) Health care facilities that are not free of substances affecting those with environmental sensitivities.
xvii) Equipment e.g. commode, alternating mattresses, nurse call switches, etc., that are not accessible for use by a person with quadriplegia.
xviii) Children’s play areas in a health care facility that lacks furniture that accommodates children using a mobility device like a wheelchair.
c) Barriers in Diagnostic Equipment
People with disabilities face accessibility barriers in diagnostic equipment used in our health care system. For example:
i) Examination/testing beds that are too high and not adjustable.
ii) Testing equipment that requires the patient to stand.
iii) Too many healthcare facilities, including hospitals, do not have Hoyer lifts or alternative means to transfer patients from wheel chairs to examination beds. This leads to challenging bed-to-stretcher-to-bed transfers, or examinations conducted in chairs. This can result in limited examinations and potential misdiagnosis.
iv) Stretchers that are too high for patient transfers to a bed
v) No step-stools
vi) Self-testing tools, i.e. stool sample test kits, may not be accessible to people with vision loss or dyslexia.
viii) Mammogram equipment not suitable for use by a person with mobility issues.
d) Barriers to Health Care Information
Our health care system does not ensure that people with disabilities can access their health care records and information in an accessible format. This situation continues even though the Government enacted information and communication requirements in the Integrated Accessibility Standards Regulation a half a decade ago.
For years, the AODA Alliance has pressed the Government to take action to ensure that Ontario’s new E-Health technology, funded by the taxpayer, provides access to one’s health care information in an accessible format. We have received no commitments or assurances.
Examples of information access barriers in the health care system include:
i) Forms requesting medical histories or information that are not available in accessible formats i.e. large font, braille or accessible soft copy. This forces the patient to have someone else complete the form on their behalf, frequently in a public space without privacy
ii) Pharmacies do not offer accessible labelling of medications, including their instructions and possible side effects. The information and communication provisions of the Integrated Accessibility Standards Regulation impose no accessible labelling requirements on any products.
iii) Lab results posted to websites that are not accessible.
iv) Health facilities such as Emergency rooms that don’t print discharge instructions in large print (or other accessible formats). Treatment instructions are only provided orally or are not provided in accessible formats
v) Consultation guides, pre-op instructions or other documents associated with any procedure are in an accessible format. Evidently they are available in multiple languages.
e) Barriers to Effective Communication with Health Care Providers
The Supreme Court of Canada has recognized that it is essential for patients to be able to effectively communicate with health care providers (such as doctors and nurses), in order to be able to use and benefit from health care services. Yet many communication barriers in the health care system persist. These include:
i) Nurses, assistants and doctors have little training in how to guide, speak to or deal with people with a wide range of disabilities.
ii) Patients with disabilities too frequently encounter implicit presumptions of incapacity. Healthcare providers too often speak to support persons instead of the patient with a disability.
iii) First responders can lack effective tools to communicate with patients.
iv) Healthcare providers can be reluctant to invest the time to effectively communicate options or decisions to patients.
v) Tools required to appropriately communicate with patients with communication disabilities (e.g. alphabet, word or picture board, or a communication device) may not be available.
vi) A lack of Sign Language interpreters or other communication support services for emergencies, regular appointments and mental health conferences. Parents, siblings and friends can be at times asked to interpret in sensitive health situations.
f) Barriers in Other Technology in the Health Care System
Increasingly, technology is used in the health care system. For example, a patient can be asked to use a tablet computer or iPad to answer questions on their medical history, before seeing a health care professional. Yet the information and communication accessibility requirements in the Integrated Accessibility Standards Regulation do not address mobile apps such as those used on this technology. Tablets are capable of delivering accessibility. However, the apps used on them must be designed to incorporate accessibility requirements.
g) Barriers in Provision of Support Services Needed in the Health Care System
i) To make use of health care services, some people with disabilities require support services. For example, some need attendant care or other like personal support services, to get to a place where health care services are provided, and/or on arrival, to be able to use the washroom, or to undertake other basic life needs. A patient in an acute care ward in a hospital may need help to be fed at mealtime. These needs are not consistently met in the health care system.
ii) Healthcare support workers may not have the training to work with people with complex disabilities or the time to provide the attendant services to support people in these settings; e.g. to regularly to turn them when in a bed, to assist with feeding, bathroom needs, or to help with the use of adaptive equipment, such as communicating using a letter board, or other communication aid.
iii) A person’s personal attendant services can be tied to the person’s place of residence and are not transferrable to another setting.
iv) Service animals may not be allowed into health care settings (including in psychiatric intensive care).
h) Health Care Barriers Identified in the Ontario Ombudsman’s “Nowhere to Turn” Report
On August 24,2016, the Ontario Ombudsman made public a blistering report on the state of development services in Ontario, particularly for people with intellectual disabilities. The Report, entitled “Nowhere to Turn”, is available at https://www.ombudsman.on.ca/Resources/Reports/Nowhere-to-Turn.aspx#HTML
The AODA Alliance has not had the time needed to fully study that powerful report. However, its Executive Summary reveals that among other findings, it found significant barriers facing people with intellectual and other like disabilities in the health care system. For example, its Executive Summary includes:
* “Most hospitals typically lack the specialty training and programming necessary to serve those with developmental disabilities.”
* “Our investigation also revealed that there are adults with both developmental disabilities and complex medical conditions who are unable to access necessary community supports and services.”
* “I believe that the Ministry is well intentioned and earnest, but recognize that systemic flaws persist.”
The Health Care Standards Development Committee should ensure that recommendations for the Health Care Accessibility Standard address the accessibility barriers that the Ombudsman’s Report identified.
i) Other Barriers
Other accessibility barriers can include such things as:
* Renewing a health card can be difficult for people with limited mobility who are required to report to a Ministry office to update their card.
8. Other Important Considerations for the Health Care Accessibility Standard
The Health Care Accessibility Standard must set detailed requirements for specific accessibility action. It is not sufficient for this accessibility standard to impose requirements for health care providers to merely make plans and policies on accessibility. To some extent, the Integrated Accessibility Standards Regulation already does that, though insufficiently.
As well, from 2001 to 2015, the Ontarians with Disabilities Act, which preceded the stronger AODA, required public sector organizations like hospitals to make annual accessibility plans. This accomplished little. Obligated organizations understandably get frustrated. Each must waste money duplicating effort to figure out what to do.
Ontario’s 2007 Customer Service Accessibility Standard is another example that the Health Care Standards Development Committee should strive to avoid at all costs. It tells obligated organizations to develop a policy on accessible Customer Service, to train staff on it, and to have a customer feedback mechanism. With few exceptions it doesn’t list the barriers to Customer Service that need to be addressed, nor does it say what to do about them.
As well, it is not enough for the Health Care Accessibility Standard to vaguely require an organization to consider accessibility or to include accessibility features in their services and facilities. Ontario accessibility standards commendably require the goal of accessible electronic kiosks, accessible counter heights in public service areas for getting customer service, and accessible playground equipment (all when new kiosks, counters or playgrounds are created. However, the accessibility standards wrongly don’t spell out what accessibility features should be incorporated in new electronic kiosks, or how high to make a new public service counter, or what accessibility features to include in new playground equipment.
Those are grossly inadequate requirements. They don’t serve people with disabilities or obligated organizations very well. Each organization must wastefully hire consultants, and hope they get it right. The Moran AODA Independent Review Report found:
“One of the most common pieces of feedback received by the Review focussed on the difficulty of interpreting the meaning of the standards under the AODA. Both the public and private sectors said they had problems understanding their obligations because the standards are often not clear enough or specific enough about what is required. Public sector organizations, while doing their best to comply, are often uncertain about what exactly compliance with the standards requires. The fact that the standards have been framed very generally means that it is hard to know when they have been met. For example, the standards do not offer reference points for several general obligations, such as what it means to provide accessible formats or incorporate accessibility features into procurement. This leaves organizations to depend on guesswork or expensive consultants and lawyers to determine what compliance entails.”
Some Ontario accessibility standards commendably provide needed specificity. For example, one specifies the detailed rule for website accessibility.
Finally, the Health Care Accessibility Standard should impose requirements that are at least as stringent as the Ontario Human Rights Code, the Charter of Rights, or both. Otherwise, obligated organizations will be frustrated to find that they did what the Health Care Accessibility Standard required, only to learn that they have further Charter and/or human rights accessibility duties. It frustrates the AODA’s goal of relieving people with disabilities of the burden to battle barriers, one at a time, if an accessibility standard directs obligated organizations to do less, or take longer, than the Charter and human rights laws allow.
The Health Care Standards Development Committee should conclude that, among other things, health care providers will need substantially improved training on disability and accessibility. This should take place as part of the education of health care professionals, as well as within health care providers.
It is critically important that this be live training, not online e-learning. Wherever possible, it should involve direct contact with people with disabilities. To date, the Ontario Government has heavily relied on online training for meeting training requirements in other accessibility standards. Online training and e-learning are extremely unreliable and ineffective for conveying the knowledge and concepts pertaining to accessibility.