What Must Be Done to Make Ontario’s Health Care System Fully Accessible to Patients with Disabilities? Check Out the AODA Alliance’s Finalized Framework for the Promised Health Care Accessibility Standard


Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

Web: www.aodaalliance.org Email: [email protected] Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

What Must Be Done to Make Ontario’s Health Care System Fully Accessible to Patients with Disabilities? Check Out the AODA Alliance’s Finalized Framework for the Promised Health Care Accessibility Standard

February 25, 2020

          SUMMARY

What must be done to make Ontario’s health care system accessible to patients with disabilities and to any patients’ support people with disabilities? What should be included in the Health Care Accessibility Standard that the Ontario Government is now developing under the Accessibility for Ontarians with Disabilities Act?

Here we unveil our most thorough and comprehensive brief on this topic. Below please find the AODA Alliance’s finalized Framework on what the Health Care Accessibility Standard should include.

We have submitted this new Framework to the Ford Government. We have also submitted it to the Health Care Standards Development Committee. The Government appointed that Committee under the AODA. That Standards Development Committee has the job of developing recommendations on what the Government should include in the promised Health Care Accessibility Standard to make Ontario’s health care system disability-accessible. This Framework sets out what we urge that Standards Development Committee to recommend to the Ford Government.

Last December we made public a draft of this Framework and invited your feedback. We thank all those who sent us feedback. We’ve done our best to use that feedback as we finalized this Framework. This final brief includes everything that was in our December draft. It has added recommendations, drawing on the excellent feedback we received from our supporters.

So what’s next? The Health Care Standards Development Committee is now writing a set of draft recommendations for the Government on what the Health Care Accessibility Standard should include. Later this year, that Committee is expected to make its draft recommendations public, and to invite public feedback on it. After that, the Health Care Standards Development Committee is required to consider that public feedback as it finalizes its recommendations to the Government.

The Health Care Standards Development Committee certainly knows about our efforts on this issue. Last December, we sent our earlier draft of this Framework to that Committee. On January 16, 2020, AODA Alliance Chair David Lepofsky made a 15 minute presentation to the Health Care Standards Development Committee on our recommendations. As noted above, we have now provided this finalized Framework to the Standards Development Committee.

We have asked the Health Care Standards Development Committee to adopt all of our recommendations. At the very least, we have asked that Committee to append this framework to its draft recommendations and to invite public feedback on it.

Once the Health Care Standards Development Committee makes its draft recommendations public for our feedback, we will circulate it to you. We will prepare a submission to the Standards Development Committee, using this Framework as our foundation.

Please share this Framework with people you know who work in the health care system. It would be great if Ontario’s health care system starts taking action on our recommendations now, because they are good ideas!

In addition to this Framework, you may wish to check out the captioned 1-hour talk on barriers in the health care system by AODA Alliance Chair David Lepofsky. For all our efforts in recent years, leading the campaign to get Ontario to enact a much-needed Health Care Accessibility Standard to make the health care system accessible to patients with disabilities, check out the AODA Alliance’s health care page on our website.

A grand total of 390 days have now gone by since the Ford Government received the final report on the AODA’s implementation and enforcement that was prepared by former Lieutenant Governor David Onley. We are still waiting for the Ford Government to come up with an effective plan to implement the Onley Report’s recommendations to strengthen the AODA’s implementation and enforcement.

          A Framework for the Health Care Accessibility Standard

February 25, 2020

Proposed by the Accessibility for Ontarians with Disabilities Act Alliance

www.aodaalliance.org [email protected] Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

Introduction — What is This Framework?

The Ontario Government has committed to develop a Health Care Accessibility Standard under the Accessibility for Ontarians with Disabilities Act (AODA). In 2017, the Ontario Government appointed a Health Care Standards Development Committee to make recommendations on what the Health Care Accessibility Standard should include. On March 7, 2019, the Doug Ford Government committed to resume this Committee’s work.

The AODA requires the Ontario Government to lead Ontario to become accessible to people with disabilities by 2025. The Government is required to do so by enacting and effectively enforcing accessibility standards, which are enforceable regulations. Under the AODA, an accessibility standard is required to specifically spell out the barriers that are to be removed or prevented, what specifically must be done to remove or prevent them, and the timelines required for these actions.

In this Framework, the AODA Alliance proposes key ingredients and aims that should be included in the Health Care Accessibility Standard. We hope this will assist the Health Care Standards Development Committee.

The Health Care Accessibility Standard should set detailed requirements for specific actions that health care providers and organizations shall take. It is not sufficient for this accessibility standard to vaguely require health care facilities or providers to simply make plans and policies on accessibility, or to vaguely require obligated organizations to consider or include accessibility features in their health care facilities or services. The details of what this accessibility standard will require are vital to its success.

Some needed actions will have to be taken by each health care facility and/or health care provider. Some will need to be taken by the self-governing bodies that regulate each of the health professions in Ontario. Some of the needed actions will have to be taken by the Ontario Government. The Government funds, centrally plans and oversees Ontario’s health care system.

It is especially pressing to now effectively address disability barriers in Ontario’s health care system. In 2020, Ontario’s health care system is still replete with serious accessibility barriers, even fully 15 years after the AODA was enacted. Too often, it has been designed and operated on the unspoken or unarticulated premise that it is largely if not totally meant for patients without disabilities. Yet disproportionately, those who use and need the health care system are people with disabilities.

We each make the greatest use of health care services towards the end of our lives. Disabilities are far more prevalent among seniors. Disability most often is caused by aging.

Twenty-three years ago, in Eldridge v. British Columbia [1997] 3 SCR 624, the Supreme Court of Canada established the broad principle that patients with disabilities have a constitutional right to accessible health care services in Canada. Yet since then, the Ontario Government has not undertaken a comprehensive effort or strategy to identify the recurring disability barriers in the health care system. It has not implemented a comprehensive plan to remove and prevent those barriers. In the meantime, old barriers remain while new ones keep being created.

Even the very barrier that the Supreme Court ordered provincial governments to fix almost a quarter century ago too often remains in place. In the Eldridge case, the Supreme Court ruled that the Charter of Rights makes provincial governments responsible to ensure the provision of Sign Language interpreter services for deaf patients in hospitals that need them to effectively communicate with health care providers. This is a constitutional right of those patients. Yet in its December 26, 2019 edition, the Hamilton Spectator reported on recent incidents where this vital service was not assured in a Hamilton, Ontario hospital.

Ontario needs a strong, comprehensive and enforceable Health Care Accessibility Standard enacted under the AODA so that patients with disabilities don’t have to fight an endless number of legal cases under the Canadian Charter of Rights and Freedoms and the Ontario Human Rights Code to tear down these many barriers, one at a time. Health care facilities and providers should not have to each separately re-invent the accessibility wheel, trying to figure out how to address the known and recurring disability barriers in Ontario’s health care system.

In her case, it took Ms. Eldridge up to seven years to win the right to a sign language interpreter in a hospital’s emergency room where she gave birth to twins. A pregnant woman about to give birth in a hospital emergency room cannot be expected to wait seven years for such a needed accessibility service.

Achieving accessibility in Ontario’s health care system should be doable for several compelling reasons. The system receives enormous public funding. Health funding is always a high priority for government after government. There is substantial centralized government planning of the health care system. This issue bears on the lives and health of everyone in Ontario. This is because everyone is bound to eventually get a disability as they age.

Moreover, Ontario’s health care system is undergoing ongoing and substantial reforms and innovation. Every year, new health care facilities are established or built. Change is always in the wind. That makes changes in favour of accessibility easier to implement.

We hope the Health Care Standards Development Committee finds this Framework helpful. We ask the Health Care Standards Development Committee to vote separately on each of these recommendations. In any event, we encourage the Standards Development Committee to attach this Framework to its forthcoming package draft recommendations that it will be required to circulate and post for public comment. That would enable the Health Care Standards Development Committee to get public input on this Framework to guide its development of its final recommendations.

This Framework reflects our years of efforts at gathering input from the grassroots of Ontario’s disability community and consulting experts here and abroad. Last December, we made public a draft of this Framework for public comment. We are indebted to those who read it so carefully and offered suggested improvements. We’ve done our best to incorporate the excellent feedback that we received.

It has taken our substantial multi-year grassroots effort to reach the point of having a Health Care Standards Development Committee appointed and now working on developing recommendations on what the promised Health Care Accessibility Standard should include. Since 2009, the AODA Alliance has led the campaign to get the Ontario Government to develop a Health Care Accessibility Standard. This is documented on our website’s Health Care page. It took the previous Ontario Government up to six years just to decide in 2015 to develop a Health Care Accessibility Standard. It took another two years to get the previous Government to take the first step of appointing this Health Care Standards Development Committee. We then had to fight for up to a year to get the current Government to lift the freeze on the work of the Health Care Standards Development Committee.

The AODA Alliance spearheaded all of these grassroots efforts. At the same time, we have had to campaign against the Ontario Government’s efforts to substantially narrow the range of disability accessibility barriers that the Health Care Standards Development Committee would be free to consider.

In this Framework, the term “health care facility” means any organization that provides any kind of health care service, from a major hospital to a local physician’s office. It includes an organization whose primary purpose is not provision of health care, but which includes a health care service within it. For example, a university may include a health clinic, which, for the purpose of this Framework, is treated as a health care facility. The term “major health care facility” refers to larger health care facilities and centres, not smaller operations like an office for a single physician, dentist or other health care professional.

In this Framework, “health care provider” means anyone who helps provide any kind of health care service, including any health care professional (whether or not their profession is regulated), any support staff or volunteers that assist them and any drug store staff that assist a patient with getting and using medications.

In this Framework, we address barriers in the health care system that can impede patients with disabilities, and/or any patients’ support people (whether family members, friends or others) where the support person or care giver has a disability. Whether or not a patient has a disability, some of their care givers or support people (such as family members) may have disabilities. The disability barriers in the health care system that impede patients with disabilities can also often impede a care giver or support person who has disabilities.

This framework sets out recommendations for actions that the Health Care Accessibility Standard should require. In this Framework, when we state that a health care provider or facility or other organization “should” do something, we mean that the Health Care Accessibility Standard should require this action. We do not propose these actions as guidelines or best practices. “Best practices” or guidelines are not mandatory or enforceable. This Framework proposes actions which need to be mandatory and enforceable.

We acknowledge with thanks the tremendous help provided to us by the ARCH Disability Law Centre and by an amazing team of volunteer law students at the Osgoode Hall Law School who made a huge difference in the preparation of this Framework.

The following are the headings in this Framework:

  1. What Should the Long-Term Objectives of the Health Care Accessibility Standard Be?
  1. A Vision of An Accessible Health Care System
  1. General Provisions that the Health Care Accessibility Standard Should Include
  1. The Right of Patients with Disabilities and of Any Patients’ Support People with Disabilities to Know About Available Health Care Services, about Available Disability-Related Supports and Accommodations, about Important Information Regarding Their Diagnosis and Treatment and about How to Access Them
  1. The Right of Patients with Disabilities and of Any Patients’ Support People with Disabilities to Physically Get to Health Care Services
  1. The Right of Patients with Disabilities and of Any Patients’ Support People with Disabilities to Get into and Around Facilities Where Health Care Services are Provided
  1. The Right of Patients with Disabilities and of Any Patients’ Support People with Disabilities to Accessible Furniture and Floor Plans in Health Care Facilities
  1. The Right of Patients with Disabilities to Identify their Disability-Related Accessibility Needs in Advance and to Request Accessibility/Accommodation from a Health Care Provider or Facility
  1. The Right of Patients with Disabilities to Accessible Diagnostic and Treatment Equipment
  1. The Right of Patients with Disabilities to the Privacy of Their Health Care Information
  1. The Right of Patients with Disabilities and of Any Patients’ Support People with Disabilities to Accessible Information and Communication in Connection with Health Care Services and Products
  1. The Right of Patients with Disabilities to the Support Services They Need to Access Health Care Services
  1. The Right of Patients with Disabilities and of Any Patients’ Support People with Disabilities to Health Care Providers Free from Knowledge and Attitude Barriers Regarding Disabilities
  1. The Right of Patients with Disabilities and of Any Patients’ Support People with Disabilities to Accessible Complaint Processes at Health Care Providers’ Self-Governing Colleges and to Have Those Colleges Ensure that the Profession They Regulate Are Trained to Meet the Needs of Patients with Disabilities
  1. The Right of Patients with Disabilities and of Any Patients’ Support People with Disabilities to Systemic Action and Safeguards to Remove and Prevent Barriers in Ontario’s Health Care System
  1. The Need to Harness the Experience and Expertise of People with Disabilities Working in the Health Care System to Expedite the Removal and Prevention of Barriers Facing Patients with Disabilities and Any Patients’ Support People with Disabilities

1. What Should the Long-term Objectives of the Health Care Accessibility Standard Be?

#1-1. The 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 disabilities and to any support people with disabilities for any patient, by 2025, the AODA’s deadline, by requiring the removal and prevention of 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.

This is what the AODA requires this accessibility standard to achieve. This goal also lives up to the Charter of Rights’ and Ontario Human Rights Code’s accessibility requirements. Some incorrectly think that the AODA imposes new requirements for accessibility. In fact, it seeks to get obligated organizations to do what the Ontario Human Rights Code and the Charter of Rights have required them to do for well over three decades.

It would be grossly inadequate 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. It would fulfil that weaker goal to simply remove only one barrier somewhere in Ontario’s huge health care system. It would leave our health care system with far too many accessibility barriers.

2. A Vision of An Accessible Health Care System

To begin, the Health Care Accessibility Standard should set out a vision of what an accessible health care system should include. An accessible health care system should include the following:

#2-1. The health care system will be designed and operated from top to bottom for all its patients, including patients with all kinds of disabilities, as disability is defined in the Ontario Human Rights Code and/or 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 imagined as having no disabilities.

#2-2. Patients with disabilities, and where needed, any patients’ support people with disabilities will be able to easily find out what health care services are available and how and where to get them.

#2-3. Places where health care services are offered will be reachable by accessible public transit routes and will have sufficient accessible parking immediately adjacent to them.

#2-4. 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.

#2-5. Patients with disabilities will be able to seek, receive and fully benefit from the health care services and products that are available in the health care system and which they require.

#2-6. Health care providers will consistently and reliably know how to meet the needs of patients with disabilities and where needed, any patients’ support people with disabilities, to ensure that patients with disabilities fully benefit from their health care services.

#2-7. 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.

#2-8. Patients with disabilities, and where needed, any patients’ support persons with disabilities, will have prompt, effective and easy access to user-friendly information in accessible formats and in multiple languages on the health care options, programs, services, supports and accommodations available for their disability, and on the process for seeking these. As well, printed, online and other written information about available health care services, diagnoses, prognosis, treatments, exercises, medications, and other information provided to or available to patients with disabilities and, where needed, any patients’ support people with disabilities in connection with health care services and products, will be readily and easily available in an accessible format. This includes, for example, a patient’s health care records and labels/instructions for prescription drugs.

#2-9. 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.

#2-10. 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 any 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.

#2-11. 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.

#2-12. Diagnostic and treatment equipment and furniture will be designed based on principles of universal design and will be fully accessible to patients with disabilities.

#2-13. 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.

#2-14. Publicly funded appointments for receiving health care services will be sufficiently long to enable a patient with a disability, who needs 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 measure whenever possible for remote appointments or home visits.

#2-15. Where patients with disabilities or any patients’ support people with disabilities need a disability-related accommodation in connection with health care services, there will be a prompt, user-friendly process for requesting and obtaining the needed accommodations.

#2-16. Patients will be free to use their own accommodation supports, such as service animals, when seeking or obtaining health care services and products.

#2-17. Where patients with disabilities or where needed, any patients’ support people with disabilities, believe that a health care provider is not effectively meeting the patient’s disability-related needs, they will have access to a prompt, fair, open and arms-length review process, including an offer of a voluntary Alternative Resolution Process if needed, conducted by someone who was not involved in the original decision or activity and who does not oversee the work of those involved in the patient’s health care services.

#2-18. There will be no bureaucratic, procedural or policy barriers that impede the effective accommodation of individual patients with disabilities or, where needed, any patients’ support people with disabilities, at any levels of Ontario’s health care system.

#2-19. 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 ongoing and 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.

#2-20. An accessible health care system is 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 caregivers often also impede health care providers and workers with disabilities.

3. General Provisions that the Health Care Accessibility Standard Should Include

The intent or rationale of the following recommendations is for the Health Care Accessibility Standard to include general requirements across the health care system that will ensure that its specific accessibility requirements are effective.

#3-1. 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 disability within the meaning of the AODA or the Ontario Human Rights Code.

#3-2. 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 they are offered in a hospital and 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 physicians, dentists, physiotherapists, psychologists, occupational therapists, speech language pathologists, and all other health care professions and providers. 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.

#3-3. The Health Care Accessibility Standard should not be limited to hospitals and the hospital sector. Most people get most health care services outside of hospitals. If the Health Care Accessibility Standard were limited to barriers in hospitals, it would leave out most of the health care system and most of the barriers in the health care system. It would force people with disabilities to go to overcrowded hospitals to get their health care services, since hospitals would be the only place where accessible services would be assured to them.

The fact that the Government’s terms of reference for the Health Care Standards Development Committee focus on the hospital sector does not prevent this Standards Development Committee from making recommendations that go beyond the hospital sector. A number of earlier AODA Standards Development Committees have made recommendations beyond their terms of reference. We ask the Health Care Standards Development Committee to do the same.

Most if not all of the barriers identified in this Framework occur both in hospitals and in other places where health care services and products are provided. At the very least, the Health Care Standards Development Committee should make recommendations about all of these barriers proposed in this Framework as they relate to hospitals, and then should recommend that the Health Care Accessibility Standard require the same action on the same barriers where they occur anywhere else in the health care system where health care services or products are provided to patients.

#3-4. The Health Care Accessibility Standard should cover ambulances and other vehicles that transport patients in connection with the receipt of health care services.

#3-5. The Health Care Accessibility Standard 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, indigenized or other communities within Ontario.

#3-6. The Health Care Accessibility Standard should require the removal of existing barriers, and not only the prevention of new barriers.

#3-7. If the Health Care Standards Development Committee identifies a recurring accessibility barrier in Ontario’s health care system, it should make recommendations on how to remove or prevent that barrier, even if there is a less effective or comprehensive existing health care regulation or statute that may already apply to it in whole or in part.

The Health Care Accessibility Standard will take precedence and prevail over any other laws, if those other laws either create or permit health care accessibility barriers, or if they do not effectively remedy those barriers, or if they provide less accessibility than the Health Care Accessibility Standard. If an existing law, such as a statute or regulation governing the health care system, creates an accessibility barrier or impedes the removal or prevention of a health care barrier, the Health Care Standards Development Committee should recommend measures to be included in the Health Care Accessibility Standard that would remove or prevent those barriers. It should recommend the modification or repeal of any law that itself creates or permits health care barriers. Any provincial legislation or regulations that create accessibility barriers against patients with disabilities are contrary to the guarantees of equality to people with disabilities in the Ontario Human Rights Code and the Charter of Rights.

#3-8. 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.

#3-9. 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.

#3-10. 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.

#3-11. 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.

4. The Right of Patients with Disabilities and of Any Patients’ Support People with Disabilities to Know About the Health Care Services Available to Them, About Available Disability-Related Supports and Accommodations, About Important Information Regarding Their Diagnosis and Treatment and About How to Access Them

Barriers: Patients with disabilities and support people with disabilities too often find it difficult to get accessible information to find out from their health care facility from their health care provider, from the health care system at large and/or from the Ontario Government about the health care services that are available, or about where and how to get them.

The intent/rationale of the following recommendations is to ensure that patients with disabilities and any patients’ support people with disabilities can find out what health care services are available to them and where to obtain them.

#4-1. Each health care provider or facility should be required to make readily available, in an accessible format, information about the health care services or products they offer and about where and how to arrange to get them. If the health care provider or facility has a website, this information should be accessibly posted prominently on that facility or provider’s website in plain language. Where communication supports or assistance is needed to access this information, those supports should be made available (See below regarding communication supports).

#4-2. The Ontario Government or any provincial organization mandated to oversee or deliver health care services should be required to make readily available to the public in accessible formats, including on the internet, detailed information on the menu of health care services available in Ontario, and on how and where to arrange to get those services.

5. The Right of Patients with Disabilities and of Any Patients’ Support People with Disabilities to Physically Get to Health Care Services

Barriers: Obstacles that impede people with disabilities from physically getting to places where they need to go to receive health care services and products, include, such things as:

  1. a) The many public transit barriers that the Transportation Accessibility Standard has not removed or prevented. This results in such things as health care facilities and providers that are not on an accessible public transit route, and restrictions on para-transit services being able to cross over municipal boundaries to get to them. The Transportation Standards Development Committee’s spring 2018 final report to the Ontario Government left out many important revisions needed to the 2011 Transportation Accessibility Standard (part of the 2011 Integrated Accessibility Standards Regulation), that were identified in the July 31, 2017 joint brief by the AODA Alliance and the ARCH Disability Law Centre.
  1. b) Health care funding conditions that require that a patient must attend a physician’s office to receive health care services can impede access to health care services for whose disability prevents them from travelling to that office.
  1. c) “One issue per visit” policies in physicians’ offices can prevent those with multiple disabilities, or disabilities plus illness/ailment from receiving adequate treatment. This discourages them from seeking treatment.
  1. d) The new ‘mega hospitals’ that replace smaller, 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.
  1. e) Limited accessible parking lots and spaces near hospitals i.e. which cannot accommodate modified vans with raised roof or side lift for wheelchair.
  1. f) 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.
  1. g) Reductions or elimination of funding for house visits by a health care provider preclude the possibility of home visits for patients who are physically incapable of going to the health care provider’s office or facility to get treatment. For 2019 provincial cuts to OHIP coverage for a physician’s house visit to a patient, see http://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/11000/bul11214.aspx

The intent/rationale of the following recommendations is to ensure that patients with disabilities and any patients’ support persons with disabilities can get to the places where health care services and products are provided.

We ask the Health Care Standards Development Committee to make the following recommendations. These could be incorporated either or both into the promised Health Care Accessibility Standard or into the Transportation Accessibility Standard, to address those transportation barriers in the health care context. In 2011, the Ontario Government enacted the Transportation Accessibility Standard, as part of the 2011 Integrated Accessibility Standards Regulation.

In 2016, the Ontario Government appointed the Transportation Standards Development Committee to review the 2011 Transportation Accessibility Standard and to make recommendations where needed, to strengthen it. In 2018, the Transportation Standards Development Committee made very weak recommendations for revisions to the 2011 Transportation Accessibility Standard. The Transportation Standards Development Committee did not recommend many if not most of the improvements that the AODA Alliance and the ARCH Disability Law Centre called for, in their joint July 31, 2017 brief to the Transportation Standards Development Committee. In over two years since then, the Ontario Government has announced no plans to implement any improvements to strengthen the 2011 Transportation Accessibility Standard.

The Transportation Standards Development Committee’s 2018 recommendations to revise the 2011 Transportation Accessibility Standard, if adopted, would not fix any of the deficiencies in the 2011 Transportation Accessibility Standard. Since receiving the final recommendation of the Transportation Standards Development Committee over one and a half years ago, the Ontario Government has not announced any revisions to the 2011 AODA Transportation Accessibility Standard. It is therefore still open to the Ontario Government to make improvements under the AODA to the 2011 Transportation Accessibility Standard beyond the weak ones that the Transportation Standards Development Committee recommended in 2018.

#5-1. 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.

#5-2. 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.

#5-3. 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.

#5-4. 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).

#5-5. 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.

#5-6. 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.

#5-7. 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 in those vehicles equipment for communication with patients with communication-related disabilities.

6. The Right of Patients with Disabilities and Any Patients’ Support People with Disabilities to Get into and Around Facilities Where Health Care Services are Provided

Barriers: Barriers in the built environment where health care services are provided that impede people with disabilities from getting into places where health care services and products are offered, or from safely and independently getting around these places, such as:

  1. a) Older hospitals and other facilities where health care services are provided that lack obvious and basic accessibility features like ramps, accessibility features in washrooms like transfer spaces at toilets, grab bars, accessible signage to departments or elevators, etc.
  1. b) New hospitals, such as Toronto’s Women’s College Hospital, that have obvious accessibility problems despite being opened eleven years after the AODA was passed.
  1. c) Parking facilities with automated parking payment kiosks that are inaccessible to wheelchair users.
  1. d) Health care facilities with inaccessible doors to the check-in/waiting areas.
  1. e) Health care facilities including reception areas that use print signs to communicate important information or directions to patients and which offer no accessible means for people with vision loss or dyslexia to obtain this information, e.g. dim signage lighting making it hard to read the sign for people with low vision, signage that does not use plain language for those with intellectual or cognitive disabilities.
  1. f) Facilities where health care services are provided that are obstacle courses, e.g. with chairs, tables, signs or other obstacles blocking parts of hallways or other paths of travel.
  1. g) Diagnostic, isolation, consultation, waiting and/or treatment rooms that are too small to accommodate wheelchairs or other mobility devices or support people or service animals.
  1. h) Reception desks behind windows with “speakers”, making it hard to communicate for those with hearing loss, and which are placed too high for those in wheelchairs or those having smaller stature. These also can cause privacy issues.
  1. i) Reception desks, where access to them is blocked, or where knee space is blocked, preventing face to face access.
  1. j) Doorways within a health care facility that are too tight to allow a wheelchair or other mobility device to pass through.
  1. k) Elevators lacking audio floor announcements and elevator buttons that lack braille and colour-contrasted large print for use by persons with vision loss.
  1. l) The absence of way-finding guidance such as tactile floor strips or signage to direct people with vision loss or cognitive or intellectual disabilities through a health care facility, e.g. through large open areas like hospital lobbies.
  1. m) Health care facilities that have fragrances or other substances affecting those with environmental sensitivities.
  1. n) Equipment e.g. commode, alternating mattresses, nurse call switches, etc., that are not accessible for use by a person with a motor disability.
  1. o) Children’s play areas in a health care facility that lack furniture that accommodates children using a mobility device like a wheelchair.

The Ontario Building Code and current AODA accessibility standards are 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, can still have serious accessibility barriers. See generally https://www.aodaalliance.org/category/built-environment/

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, in places where health care services and products are provided to patients. As far as we can tell, the Ontario Government has in place no mandatory accessibility standard, required for the design of a new health care facility such as a hospital or long-term care facility, beyond the inadequate Ontario Building Code, to ensure that it is fully accessible. Similarly, the Government has no such accessibility standard, beyond the inadequate Ontario Building Code, for retrofitting an existing health care facility which is undergoing a major renovation. As well, the Government has in place no detailed accessibility standard whatsoever for a health facility to be retrofitted for accessibility, if that facility has no major renovation underway.

The Ontario Government has announced no plan to develop a comprehensive Built Environment Accessibility Standard under the AODA. Yet the Ontario Human Rights Code, and in some cases, the Charter of Rights, require these facilities to become disability-accessible.

As a result, each time a new hospital or other health care facility is built, or a renovation to one is undertaken, the organization needs to individually hire consultants to reinvent the accessibility wheel. Their advice need not be followed, or even disclosed to the public. This wastes public money. It leads to patchworks of varying levels of accessibility from organization to organization.

The 2019 final report of David Onley’s Independent Review of the AODA concluded that Ontario’s laws on the accessibility of the built environment are inadequate and that design professionals such as architects are not trained to ensure that they design buildings that everyone can access. However, the Ontario Government has announced no plans to upgrade the Ontario Building Code ‘s accessibility provisions, or to enact an AODA Built Environment Accessibility Standard, despite our repeated requests.

The Health Care Standards Development Committee should get direct input for technical requirements on these issues from qualified accessibility consultants, preferably ones who have experience giving advice regarding the accessibility of health care facilities.

The intent/rationale of the following recommendations is to ensure that patients and their support people with disabilities can get into and around facilities or other built environment where health care services and products are provided. The following lists examples of needed requirements but is not exhaustive.

#6-1. The Health Care Accessibility Standard should set specific and detailed accessibility requirements to ensure the accessibility of the built environment where health care services and products are provided, beyond the weak Ontario Building Code and the existing AODA accessibility standards. These should include accessibility requirements in new construction and major renovations. These should also include readily achievable retrofit requirements for existing facilities that are not undergoing a major renovation. Here is a sample of requirements for which detailed standards should be set:

#6-2. 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.

#6-3. Inside the health care facility, major public areas such as emergency room doors should always be fully accessible and have automatic power door openers.

#6-4. 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.

#6-5. 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.

#6-6. 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.

#6-7. 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.

#6-8. 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.

#6-9. 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:

  1. a) specifying their required end-user functionality that effectively address recurring known needs arising from specific disabilities, and,
  1. b) 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.

#6-10. 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.

#6-11. 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.

#6-12. 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.

#6-13. 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.

#6-14. 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.

#6-15. 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.

#6-16. Major health care facilities should include sensory rooms for people with sensory overload issues, such as in hospital emergency rooms.

#6-17. 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.

#6-18. Health care facilities should provide charging areas for electric mobility devices.

#6-19. 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.

#6-20. In a health care facility, waiting areas, isolation areas, breastfeeding rooms, staff areas and volunteer areas should be designed to be accessible.

#6-21. Accessible and bariatric paths of travel should be provided in health care facilities.

#6-22. 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:

  1. a) requiring a greater number of accessible parking spots for the facility, where possible.
  1. b) requiring that the accessible parking spots be located as close as possible to the doors of the health care facility.
  1. c) 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
  1. d) requiring that there be accessible curb cuts and an accessible path of travel from the accessible parking spots to the health care facilities’ entrances.

#6-23. Health Care facilities should have designated snow-piling areas outside, to prevent snow from being shoveled onto accessible paths of travel.

#6-24. 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.

#6-25. 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.

7. The Right of Patients with Disabilities and Any Patients’ Support People with Disabilities to Accessible Furniture and Floor Plans in Health Care Facilities

Barrier: Furniture, related equipment and floor plan layouts in health care facilities too often were chosen or designed without taking into account the accessibility needs of patients with disabilities and any patients’ support people with disabilities.

The intent/rationale of the following recommendations is to ensure that health care facilities create barrier-free spaces for patients and support people with disabilities. The following list of examples of needed requirements is not exhaustive.

#7-1. 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.

#7-2. 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.

#7-3. 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.

#7-4. 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.

#7-5. 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.

#7-6. 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.

#7-7. 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.

#7-8. The Ontario Government should make available to health care facilities and providers:

  1. a) guides on accessible procurement including procurement of accessible furniture
  1. b) lists of venders of accessible furniture

#7-9. The Ontario Government should provide a hub for procuring accessible furniture to help health care facilities and providers reduce the cost of their acquisition.

8. The Right of Patients with Disabilities to Identify their Disability-Related Accessibility Needs in Advance and to Request Accessibility/Accommodation from a Health Care Provider or Facility

Barrier: Health care providers, and especially large facilities, too often do not provide an easy-to-access way for a patient with disabilities or for any patients’ support people to notify the health care provider of their need for a disability accommodation or accessibility, so that these can be provided in a timely fashion.

The intent/rationale of the following recommendations is to ensure that patients with disabilities and their support people can easily alert a health care facility or provider, in advance, of any disability-related accessibility or accommodation needs, and can arrange to have these met in connection with their receiving health care services and products.

#8-1. 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.

#8-2. 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.

#8-3. 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.

#8-4. The Chief Executive Officer of any hospital or large health care facility should 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.

9. The Right of Patients with Disabilities to Accessible Diagnostic and
Treatment Equipment

Barrier: Too often, diagnostic and treatment equipment used by health care facilities or health care providers are not designed based on principles of universal design. Too often they are instead designed without sufficient regard to the needs of patients with disabilities.

The intent/rationale of the following recommendations is to systematically replace inaccessible diagnostic and treatment equipment over time with accessible equipment, while maximizing patient access to accessible equipment in the meantime.

#9-1. 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.

#9-2. 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.

#9-3. 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.

#9-4. 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.

#9-5. 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.

#9-6. 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:

  1. 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.
  1. 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.
  1. c) Develop plans to purchase, rent or otherwise acquire accessible diagnostic or treatment equipment over a period of up to five years.

#9-7. These accessibility/universal design requirements should also apply to consumer health care products, such as for example, pill bottles.

10. The Right of Patients with Disabilities to the Privacy of Their Health Care Information

Barrier: Too often, patients with disabilities are not assured a chance to give and receive information regarding their health care needs in private, when dealing with health care providers or facilities. This can include e.g. having a health professional’s assistant assist a patient with disabilities to fill out a printed medical history form in the office’s open reception area rather than in private. Another common example is a pharmacy giving private information about medications to a patient over the counter in a pharmacy, where others can easily overhear this.

The intent/rationale of the following recommendations is to ensure that the privacy of patients with disabilities is fully respected in connection with health care services.

#10-1. 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.

#10-2. 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.

11. The Right of Patients with Disabilities and of Any Patients’ Support People with Disabilities to Accessible Information and Communication in Connection with Health Care

Barrier: Too often, critical health care information in the health care system is provided in inaccessible formats, or via inaccessible websites or other technology, or without the communication supports that people with communication-related disabilities need.

The 2011 Information and Communication Accessibility Standard, enacted as part of the 2011 Integrated Accessibility Standards Regulation, has not ensured that these barriers to health care-related information are removed and prevented. The July 24, 2019 draft recommendations of the Information and Communication Standards Development Committee, while helpful, would not fully address all the concerns identified here. See further the AODA Alliance’s November 26, 2019 brief to the Information and Communication Standards Development Committee.

The intent/rationale of the following recommendations is to ensure that patients with disabilities and their support people with disabilities can effectively communicate with health care providers in connection with receiving health care services and products and will get accessible information needed for that purpose.

Beyond the following recommendations, we strongly encourage the Health Care Standards Development Committee to get input on detailed requirements to include regarding accessible information and communication in connection with health care from Communication Disabilities Access Canada. CDAC is a widely respected and leading national expert in this area.

#11-1. Without limiting the information and communications to which this part of the Health Care Accessibility Standard should apply, it should address:

  1. a) Information or communications needed to provide a health care provider with the patient’s history, needs, symptoms or other health problems.
  1. b) Information and communications regarding the patient’s diagnosis, prognosis or treatment, including any risks, follow-up or other health care services to secure.
  1. c) A health care facility’s discharge instructions.

#11-2. 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.

#11-3. 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.

#11-4. 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.

#11-5. 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.

#11-6. The Health Care Accessibility Standard should set more specific and detailed requirements than the Information and Communication Accessibility Standard, to require hospitals, other health care facilities and other health care providers to ensure that patients with communication-related disabilities get the communication supports they need in a timely fashion to ensure that they can effectively communicate with their health care provider in connection with their health care services and products.

#11-7. 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.

#11-8. 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.

#11-9. 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:

  1. 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;
  1. b) In the case of existing information technology now being used, retrofit to be accessible except where this would pose an undue hardship and,
  1. c) As an alternative, 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.

#11-10. 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 in Ontario 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. The same requirement as above should apply regarding the use of PDF format.

#11-11. 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.

#11-12. 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:

  1. a) All advertisements for health care promotion should have captioning and audio description.
  1. 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.

Barrier: Healthcare providers:

  1. a) may not recognize a patient who has an invisible communication disability;
  1. b) may not know how to communicate with a patient if the patient uses ways other than speech to communicate;
  1. c) may overestimate or underestimate a patient’s comprehension and ability to give informed consent;
  1. d) may erroneously assume the patient’s incapacity based on their communication disability;
  1. e) may not know how and/or when to provide communication accommodations and supports for effective communication.

The intent/rationale of the following recommendations is to ensure that patients who have disabilities that affect their communication have timely accommodations and supports for their effective two-way communication at all times with healthcare providers and throughout the healthcare process.

#11-13. The Healthcare Accessibility Standards should require:

  1. a) Intake procedures that identify, document and share a patient’s communication profile with their healthcare team. For example, the patient’s preferred communication method, home language and authorized communication assistant.
  1. b) Procedures to ensure privacy and confidentiality of information if third parties are present to assist with communication.
  1. c) Provision of required communication accommodations and supports. Accommodations include items that patients need to communicate, such as pen, paper, boogie board, picture, letter board and communication devices. Supports include strategies that healthcare providers can use to facilitate communication with a patient as well as assistance from people who know the patient well, a sign language interpreter, a language translator, a speech language pathologist.
  1. d) Engagement when needed of Speech-Language Pathology services to provide appropriate accommodations and supports, in situations where a patient has no means to communicate or to ensure authenticity of communication in high stake consent situations.
  1. e) Access to generic, commercial picture/word displays for emergency, ICU and inpatient use.

#11-14. To facilitate the provision of these communication supports and accommodations to patients with communication disabilities and to reduce or eliminate wasteful duplication of efforts, the Ontario Government should be required to:

  1. a) Ensure in any education program for health care providers or professionals (including first responders and emergency care staff), training on core competencies on communicating with patients who may have unclear speech, reduced comprehension of spoken language or who may use sign language, writing, picture, letter boards, communication devices and/or someone else to assist a patient with communication.
  1. b) Establish and fund a central hub for rapid provision of communication supports referred to here, which health care facilities and providers can use.
  1. c) Create, widely distribute and publicize readily available and easy-to-use kits and guides for health care facilities and providers, including first responders, on how to arrange for effective communication with a patient with communication disabilities.

12. The Right of Patients with Disabilities to the Support Services They Need to Access Health Care Services

Barrier: Too often, health care facilities can lack the essential support services that patients with disabilities need to be able to access the health care services that the facility offers. Examples include hospital patients with disabilities who need help with eating, patients who need attendant care, or patients with vision loss who need to be guided to and from their destinations within a health care facility.

The intent/rationale of the following recommendations is to ensure that patients with disabilities get the support services they need to be able to make use of and fully benefit from the health care services and facilities that are offered to the public in Ontario’s health care system.

#12-1. 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, such as:

  1. a) Attendant care.
  1. b) Assistance with meals.
  1. c) Assistance being guided to and getting around the health care facility e.g. for patients with vision loss or cognitive disabilities.

#12-2. 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.

#12-3. No health care facility or provider will refuse to allow a patient with disabilities or any patients’ support people with disabilities to use their own needed accommodations, such as a service animal, when seeking or obtaining health care services or products.

13. The Right of Patients with Disabilities and Any Patients’ Support People with Disabilities to Health Care Providers Free from Knowledge and Attitude Barriers Regarding Disabilities

Barrier: Too often, front-line workers in Ontario’s health care system including professional health care providers and their staff and volunteers have knowledge and attitude gaps regarding patients with disabilities that create barriers to equal services, due to the lack of sufficient training on this.

The intent/rationale of the following recommendations is to ensure that those who work directly with patients with disabilities and with any patients’ support people with disabilities have proper training on how to meet the needs of people with disabilities so that people with disabilities are freed from stereotypes, patronization and paternalism.

#13-1. Each of the self-governing colleges that regulates a health care profession in Ontario should set detailed requirements for specific and sufficient training that must be obtained before a person can qualify to get a license to practice in Ontario in that profession, such as for physicians, nurses, dentists, etc. For those who already have a license to practice, those colleges should be required to set mandatory specific training to be obtained in this area, with time lines for doing so, as part of their licensees’ continuing professional development requirements. This training should include requirements for the health care professional to train their staff who interact with patients and the public.

#13-2. 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 must include a sufficient designated and mandatory curriculum on meeting the needs of patients with disabilities.

#13-3. The training requirements under the 2011 Integrated Accessibility Standards Regulation should be revised to provide that the training for any employees or volunteers in an organization of any size that provides any health care services or products must include training specific to the barriers facing patients with disabilities and any patients’ support people with disabilities in the health care system.

14. The Right of Patients with Disabilities and of Any Patients’ Support People with Disabilities to Accessible Complaint Processes at Health Care Providers’ Self-Governing Colleges, and to Have Those Colleges Ensure that the Profession They Regulate Are Trained to Meet the Needs of Patients with Disabilities

Barrier: The self-governing colleges that govern some 26 kinds of health care professionals in Ontario are not assured to have in place sufficient ways to ensure that their members are providing accessible health care services to patients with disabilities.

The intent/rationale of the following recommendations is to ensure that health care professionals’ self-governing colleges effectively oversee the profession that they govern to ensure that they are providing accessible services to patients with disabilities, and have a fully accessible complaint process for the public to use.

#14-1. Each health care profession’s self-governing college should be required to:

  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. e) Regularly 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.
  1. f) As provided in Recommendation #13-1 above, set specific curriculum requirements that a person must complete on providing accessible services to patients with disabilities, in order to qualify to get a license to practice in the profession they regulate.
  1. g) As required by Recommendation #13-1 above, for those already licensed to practice in the profession they regulate, set continuing professional development training requirements on providing accessible services to patients with disabilities that a licensed professional must complete.

15. The Right of Patients with Disabilities to Systemic Action and Safeguards to Remove and Prevent Barriers in Ontario’s Health Care System, and to the Removal of Existing Systemic Barriers to Accessible Health Care

Barrier: Too often, the Ontario Government and individual health care facilities go about their business planning for and operating Ontario’s health care system without taking into account the needs of patients with disabilities. This results in systemic barriers being left in place and new ones being created.

The intent/rationale of the following recommendations is to ensure that each health care facility and the Ontario Government effectively take into account the needs of patients with disabilities when designing and planning for Ontario’s health care system and when operating it on a day-to-day basis, and have safeguards in place to catch recurring accessibility gaps. The Supreme Court’s Eldridge decision requires the Government to do this.

#15-1. 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.

#15-2. 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.

#15-3. 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.

#15-4. 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.

Barrier: OHIP fee schedules for medical services that assume a patient has no disability and requires no additional time for the health appointment. For example, some patients with disabilities need more time to undress, get on the assessment table, and then get dressed again. Communication disabilities may lead to needing more time to discuss a patient’s condition with them, including such things as their medical history, diagnosis, and treatment options. Patients with complex disabilities can require more time for their condition to be medically assessed and treatment to be provided or discussed. The individual physician should not be required to personally finance all of this. The current OHIP funding model creates a harmful economic incentive for physicians to avoid taking on patients with significant or complex disabilities as their patient.

#15-5. The OHIP fee schedule should be revised 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.

16. The Need to Harness the Experience and Expertise of People with Disabilities Working in the Health Care System to Expedite the Removal and Prevention of Barriers Facing Patients and Their Support People with Disabilities

Barrier: People with disabilities working or volunteering in the health care system too often face accessibility barriers in the workplace that also hurt people with disabilities who seek health care services.

The intent/rationale of the following recommendations is to ensure that the experience and expertise of people with disabilities working for pay or as volunteers in the health care system is effectively harnessed to help root out the accessibility barriers that impede patients with disabilities and any patients’ support people with disabilities. This is because workplace disability barriers and health care service disability barriers often are the same or substantially overlap.

#16-1. 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.



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