Support for Patients and Healthcare Workers with Mental Health Challenges


The COVID-19 pandemic shows us how important healthcare is for every person in Ontario and around the world. In addition, the pandemic has emphasized the many barriers that already exist in the Ontario healthcare system for patients with disabilities. AODA healthcare standards could prevent and remove these barriers, and ensure that all Ontarians access the care they need. For instance, support for patients and healthcare workers with mental health challenges could prevent or remove some of the barriers Ontario patients face.

Support for Patients and Healthcare Workers with Mental Health Challenges

As a result of COVID-19, more people may develop physical disabilities, such as:

Therefore, more guidelines governing the healthcare system would better support the growing number of patients with these disabilities. Likewise, many people may develop Mental health disabilities as a result of the pandemic. For instance, some mental health challenges people experience happen after upsetting life events, or constant stress. As the pandemic progresses, more people may experience increased stress because they:

  • Worry about contracting COVID-19
  • Are isolated from family, friends, neighbours, or colleagues
  • Feel constantly saddened by news about the pandemic
  • Have difficulty coping with changes, such as:
    • Safety protocols for every-day tasks, such as shopping
    • Supervising children during online learning
    • Adapting to remote work
    • Caring for older or immunocompromised loved ones, in person or at a distance
    • Mourning loved ones who have passed away, while distanced from other loved ones

Constant stress from all these factors may lead to mental health challenges. For example, some of the mental illnesses people may experience are:

Anxiety Disorders:

Conditions in which people’s experience of anxiety becomes overwhelming and often affects other aspects of their lives.

Persistent feelings of sadness that can impact people’s:

  • Thoughts
  • Moods
  • Behaviour
  • Energy levels
  • Activities
  • Physical health

Posttraumatic Stress Disorder (PTSD):

A condition in which some people who have experienced a traumatic event, such as an accident, assault, military combat or natural disaster, may have repeated, involuntary memories or flashbacks of the event, sometimes triggered by sights, sounds or smells that recall the event.

Furthermore, some healthcare workers may also develop mental health challenges, after treating patients with COVID-19 under intensely stressful conditions. As a result, the healthcare system must be prepared to meet the needs of many more people with these conditions.

More Support for Patients and Healthcare Workers with Mental Health Challenges

AODA healthcare standards could require healthcare providers to make information about mental health supports available to patients. Healthcare workers could post contact information about services such as:

  • Help lines, by:
    • Phone
    • Text
    • Live web chat
    • Email
  • Mental health community resources
  • Programs providing supports such as cognitive behavioural therapy (CBT)
  • Peer support programs

In addition, healthcare providers could post pamphlets explaining the process for:

  • Referral to a professional counsellor, such as a psychologist or psychiatrist
  • Finding mental health support at school or work

 Furthermore, healthcare providers could post notifications in different places and formats. Healthcare providers could post signs outside their doors and in other prominent places. In addition, healthcare providers could train all staff so that they can offer patients information in person. Staff can take better advantage of these services if they are fully aware of them. Finally, healthcare providers could also post notifications on their websites and on phone-answering services, such as answering machines or automated answering systems.

Moreover, AODA healthcare standards could also include requirements to remedy the shortage of mental health professionals. Government could partner with other sectors to develop more training programs for psychologists, psychiatrists, and other professional mental health counsellors. Campaigns could increase public awareness about the need for these professionals, so that more people would follow these career paths. Likewise, standards could mandate more training on mental health for family doctors and nurse practitioners. Thorough training could help these healthcare workers interact with patients who have mental health challenges, and refer them to specialists when needed.

Finally, all these improvements to the healthcare system would also benefit healthcare workers with disabilities, including mental health challenges. It is vital that Ontario should develop a healthcare system equipped to support patients and healthcare workers who have mental health challenges.




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Support for Patients and Healthcare Workers with Brain Injuries


The COVID-19 pandemic shows us how important healthcare is for every person in Ontario and around the world. In addition, the pandemic has emphasized the many barriers that already exist in the Ontario healthcare system for patients with disabilities. AODA healthcare standards could prevent and remove these barriers, and ensure that all Ontarians access the care they need. For instance, support for patients and healthcare workers with brain injuries could prevent or remove some of the barriers Ontario patients face.

Support for Patients and Healthcare Workers with Brain Injuries

More people may develop disabilities as a result of COVID-19, including Brain injuries. For instance, people may acquire brain injuries that impact different skills and abilities, such as:

  • Mobility
  • Information processing, such as textual or verbal information
  • Speech
  • Focus
  • Memory, organization, and time management
  • Behavioural regulation and stress management

Therefore, more AODA guidelines governing the healthcare system would better support the growing number of patients with these disabilities.

For instance, people with some forms of brain injury need training in which they learn tools to maintain and regulate emotions or behaviours impacted by changes in brain function, such as:

  • Responsibility
  • Self-awareness
  • Personal and social boundaries
  • Safety

AODA healthcare standards could include requirements to increase the number of professionals qualified to teach patients about these tools and techniques. Government could partner with other sectors to develop more training programs for neuropsychologists and mental health counsellors. Campaigns could increase public awareness about the need for these professionals, so that more people would follow these career paths.

Similarly, more patients with brain injuries may also need more professionals who can support them in learning new forms of mobility, information processing, and other daily living skills. For example, some of these professionals include:

  • Physiotherapists
  • Occupational therapists
  • Speech therapists

Likewise, people who have newly acquired brain injuries could also benefit from peer support programs. These programs could connect newly diagnosed patients with other people living with similar injuries, for practical and emotional support.

More Support for Patients and Healthcare Workers with Brain Injuries

In addition, AODA healthcare standards could require more training about brain injuries for healthcare workers, such as:

  • Family doctors
  • Nurses
  • Staff of walk-in clinics
  • Lab technicians
  • Pharmacists

This basic training would prepare these workers to interact with and support patients with different types of brain injuries. For instance, workers could become familiar with different ways that people may:

  • Communicate
  • Process information
  • Move
  • Behave

Detailed training on how to interact with patients who have a variety of abilities could help healthcare workers meet these patients’ needs.

Furthermore, more accessible healthcare spaces would better serve patients who have gained physical disabilities as a result of their brain injuries.

Finally, all these improvements to the healthcare system would also benefit healthcare workers with disabilities, including brain injuries. It is vital that Ontario should develop a healthcare system equipped to support both patients and healthcare workers who have brain injuries.




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Support for Patients and Healthcare Workers with Breathing Disorders


The COVID-19 pandemic shows us how important healthcare is for every person in Ontario and around the world. In addition, the pandemic has emphasized the many barriers that already exist in the Ontario healthcare system for patients with disabilities. AODA healthcare standards could prevent and remove these barriers, and ensure that all Ontarians access the care they need. For instance, support for patients and healthcare workers with breathing disorders could prevent or remove some of the barriers Ontario patients face.

Support for Patients and Healthcare Workers with Breathing Disorders

More people may develop disabilities as a result of COVID-19, including breathing disorders. Therefore, more AODA guidelines governing the healthcare system would better support the growing number of patients with these disabilities.

For instance, AODA healthcare standards could include requirements to increase the number of professionals qualified to support patients in managing their conditions. For example, some of these professionals include:

  • Respiratory therapists
  • Physiotherapists
  • Occupational therapists
  • Nutritionists
  • Psychologists
  • Nurses
  • Technologists

Government could partner with other sectors to develop more training programs in these fields. Campaigns could increase public awareness about the need for these professionals, so that more people would follow these career paths.

Likewise, people who have newly acquired breathing disorders could also benefit from peer support programs. These programs could connect newly diagnosed patients with other people living with similar disorders, for practical and emotional support.

More Support for Patients and Healthcare Workers with Breathing Disorders

In addition, AODA healthcare standards could require more training about breathing disorders for healthcare workers, such as:

  • Family doctors
  • Nurses
  • Staff of walk-in clinics
  • Lab technicians
  • Pharmacists

This basic training would prepare these workers to interact with a variety of patients and meet their needs. For example, some patients with breathing disorders may use assistive devices, such as oxygen tanks or wheelchairs. Alternatively, other patients may not use any assistive devices, but have difficulty walking long distances. In other words, these patients’ disabilities are invisible. Moreover, training could prepare staff to make oxygen available throughout the hospital for patients who need it.

Furthermore, more accessible healthcare spaces would better serve patients who have gained physical disabilities, including breathing disorders. For instance, accessible parking spaces should be as close as possible to hospital entrances. In this way, people who cannot walk long distances can easily enter hospitals. Likewise, wards treating out-patients with these disorders should also be near entrances. As a result, patients could access their treatments without fatigue or breathlessness. Similarly, smoking areas should be farther away from these entrances, so that patients will not breathe in smoke.

Finally, all these improvements to the healthcare system would also benefit healthcare workers with disabilities, including breathing disorders. It is vital that Ontario should develop a healthcare system equipped to support both patients and healthcare workers who have breathing disorders.




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Accessible Transportation in Healthcare


The COVID-19 pandemic shows us how important healthcare is for every person in Ontario and around the world. In addition, the pandemic has emphasized the many barriers that already exist in the Ontario healthcare system for patients with disabilities. AODA healthcare standards could prevent and remove these barriers, and ensure that all Ontarians access the care they need. For instance, AODA guidelines for accessible transportation in healthcare could prevent or remove some of the barriers Ontario patients face.

Accessible Transportation in Healthcare

AODA healthcare standards should remove the barriers in specialized transit that limit patient access to healthcare. In addition, guidelines in these standards should ensure that programs providing patient transport do not contain barriers.

For example, a recent article describes a program to transport Waterloo seniors and adults with disabilities to receive COVID-19 vaccines. This program could help many people who have limited access to this vital healthcare service. However, the program did not use accessible vehicles, and required passengers to enter and exit vehicles without assistance. As a result, passengers using assistive devices, or passengers needing support, could not benefit from this program.

The article explains that the city of Waterloo is developing solutions to remove this accessibility barrier. For instance, the city may partner with accessible cab or specialized transit companies. This partnership would remove the physical barrier of inaccessible vehicles. However, an organizational barrier remains.

Organizational barriers happen because program creators have not thought about how clients with disabilities would access their services. In this case, the city of Waterloo did not recognize that their transport program would exclude many people with physical disabilities. Moreover, these excluded people may be most at risk of contracting COVID-19. Therefore, it is crucial to ensure that programs designed to protect people’s health also meet their accessibility needs.

Healthcare standards under the AODA could include guidelines that prevent organizational barriers in transportation. For instance, standards could require that organizational programs to transport patients must take those patients’ accessibility needs into account. As a result, organizations planning patient transit programs would consider accessibility at the beginning of the planning process. In this way, patients of all abilities could have the same chance to travel and receive critical forms of care.




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Accessible Remote Healthcare


The COVID-19 pandemic shows us how important healthcare is for every person in Ontario and around the world. In addition, the pandemic has emphasized the many barriers that already exist in the Ontario healthcare system for patients with disabilities. AODA healthcare standards could prevent and remove these barriers, and ensure that all Ontarians access the care they need. For instance, AODA guidelines for accessible remote healthcare could prevent or remove some of the barriers Ontario patients face.

Accessible Remote Healthcare

During the COVID-19 pandemic, more patients are accessing healthcare remotely, to reduce close contact with others. For instance, doctors may consult with patients by phone or video-conference. Likewise, patients may consult a doctor or nurse remotely to determine whether they should seek in-person care. Similarly, pharmacies can deliver prescriptions, and offer any important information about them, in a physically distanced way.

Before the pandemic, many people with disabilities may have used these remote options for accessing their healthcare. For instance, someone may opt for remote healthcare if:

Now, more healthcare organizations may offer remote options, to meet the increased demands for these services from patients of all abilities. Therefore, as these organizations begin or continue offering care at a distance, they should ensure that this care is accessible.

Guidelines to Ensure Accessibility of Remote Healthcare

AODA healthcare standards could include many guidelines to support healthcare workers in meeting patients’ accessibility needs remotely. For example, standards could require that healthcare organizations offer multiple ways to communicate with patients. For instance, patients may need to contact their doctor, nurse, or pharmacist:

  • By phone, including:
    • With speech-to-speech relay service
  • By video-conference, using:
  • By email or text

Guidelines could require healthcare organizations to notify the public about which appointment options they could offer. Then, patients could choose the appointment option that would work best for them.

In addition, AODA guidelines could require all online platforms for remote appointments to be compatible with assistive technologies. For instance, patients may access video-conferences or secure email systems for their healthcare using accessible hardware or software such as:

  • Large monitors and/or screen magnification
  • Screen readers and Braille displays
  • Speech recognition
  • Input devices other than traditional mice, including:
    • Keyboard commands
    • Trackballs
    • Touch pads or touch screens
    • Light pens
    • Joysticks
    • Head pointers
    • Mouth sticks

If healthcare organizations use accessible web platforms for their remote appointments and consultations, more patients can benefit from remote healthcare.




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Accessible Healthcare Reviews After States of Emergency


Currently, there are still no AODA healthcare standards. However, an AODA standards development committee drafted recommendations of guidelines that AODA healthcare standards should include. These guidelines include accessible healthcare reviews after states of emergency.

The committee’s mandate from the Ontario government requires recommendations focused on the hospital setting. However, patients and healthcare workers with disabilities also face barriers in other parts of the healthcare system, including:

  • Doctors’ offices
  • Walk-in clinics
  • Wellness centres
  • Pharmacies
  • Labs
  • Nursing homes
  • Outpatient rehabilitation centres
  • Health regulatory colleges

Therefore, all these settings should have accessible healthcare reviews after states of emergency.

Accessible Healthcare Reviews After States of Emergency

When a state of emergency is over, the government should research how well they maintained accessibility for patients with disabilities during the emergency. The government should conduct this research in partnership with the advisory panel formed at the beginning of the state of emergency, in keeping with the committee’s recommendation for accessible healthcare during states of emergency. In addition, the government should also consult with members of the public who have disabilities. This expanded research will give the government information about how the emergency impacted people from a variety of backgrounds.

Likewise, the government should also review how its emergency management policies and procedures impacted people with accessibility needs during the state of emergency. For instance, the government should review how well it:

The government should then update policies and procedures that do not comply with these principles.

All these reviewing and updating processes will help the government respond to future emergencies with policies and supports that benefit all citizens.




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Accessible Healthcare During States of Emergency


Currently, there are still no AODA healthcare standards. However, an AODA standards development committee drafted recommendations of guidelines that AODA healthcare standards should include. These guidelines include accessible healthcare during states of emergency.

The committee’s mandate from the Ontario government requires recommendations focused on the hospital setting. However, patients and healthcare workers with disabilities also face barriers in other parts of the healthcare system, including:

  • Doctors’ offices
  • Walk-in clinics
  • Wellness centres
  • Pharmacies
  • Labs
  • Nursing homes
  • Outpatient rehabilitation centres
  • Health regulatory colleges

Therefore, all these settings should have accessible healthcare during states of emergency.

Accessible Healthcare During States of Emergency

At the beginning of a state of emergency, the committee recommends that the government should create an advisory panel. This panel would offer suggestions about how to ensure accessible healthcare during the emergency. At least fifty percent (50) percent of panel members should be people with disabilities.

Gathering Data

Furthermore, the government should be gathering data throughout the emergency about how it is impacting people with disabilities from diverse backgrounds. For instance, public health units, and other public-sector organizations, should help gather data about people:

  • Of colour, including Black people and Indigenous peoples
  • Who are Francophone
  • Who are LGBTQ2S+
  • From low-income communities
  • Who live in group settings, such as nursing homes or group homes for people with disabilities

This data could reduce intersectional discrimination and systemic discrimination for these groups during a later state of emergency.

Guidelines for Hospitals

Moreover, the government should work with hospitals and other public-sector organizations to ensure that emergency situations are managed in accessible ways. For instance, potential protocols for triaging patients receiving emergency care must:

  • Respect human rights
  • Include testing principles that are scientifically valid and reliable

Likewise, healthcare providers should avoid delaying or canceling in-person appointments for people with disabilities, when possible. While virtual appointments are a valuable option, they do not work for all people. As a result, healthcare providers should have processes to ensure that in-person care is available for people who need it. Moreover, patients should have accessible, affordable modes of transportation to these appointments. Similarly, hospitals should also ensure access to communication supports and support persons during appointments, triage, and hospital stays. Likewise, hospitals should recognize that people may gain communication disabilities during an emergency. For instance, people may need speech language pathology services in hospital because they:

  • Are intubated
  • Develop difficulty swallowing

In addition, the government should develop an infection-control framework that accommodates service animals, and allows visitors for people with disabilities in hospitals. These visitors may provide essential supports, such as assistance in decision-making for people with cognitive or intellectual disabilities. Likewise, visitors for residents in group settings, such as group homes or nursing homes, should also be considered essential.

Finally, programs that meet people’s basic accessibility needs should continue to operate, even during emergency situations. For example, some of these programs are:

  • Programs to support people who have recently gained disabilities
  • Discharge programs from hospitals to patients’ homes, or to other healthcare settings
  • Services for home care or other needed supports
  • The Assistive Devices Program (ADP)

Guidelines for Other Organizations

Moreover, the government should also create a resource with guidelines about how mandatory masking impacts people with disabilities. For instance, cities and other public organizations can use this guide to find out:

  • When people with disabilities may be exempt from the requirement to wear masks
  • How masking affects communication for people who:
    • Are Deaf, deafened, or hard of hearing
    • Have speech or language disabilities
  • How accessible masks or face shields allow more people to communicate

Similarly, the government should develop a guide for pharmacies, and other vendors of healthcare products and services, on how to serve customers with disabilities in ways that are accessible and protect their health. For example, these guides might recommend that vendors provide:

Not every option will be suitable for all customers. Therefore, when vendors offer multiple options, each customer can meet their healthcare needs in a way accessible to them.

Likewise, the government should also provide accessibility guidelines for testing centres. For instance, these guidelines might include:

When the government develops all these guidelines, they should be posted online, in English and French, and in accessible formats.

Our next article will outline the committee’s recommendations for reviewing accessible healthcare after states of emergency.




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Enforcement Framework for Accessibility in Healthcare


Currently, there are still no AODA healthcare standards. However, an AODA standards development committee drafted recommendations of guidelines that AODA healthcare standards should include. These guidelines include an enforcement framework for accessibility in healthcare.

The committee’s mandate from the Ontario government requires recommendations focused on the hospital setting. However, patients and healthcare workers with disabilities also face barriers in other parts of the healthcare system, including:

  • Doctors’ offices
  • Walk-in clinics
  • Wellness centres
  • Pharmacies
  • Labs
  • Nursing homes
  • Outpatient rehabilitation centres
  • Health regulatory colleges

Therefore, enforcement frameworks to ensure accessibility should also apply to all these settings.

Enforcement Framework for Accessibility in Healthcare

The committee reports that many hospitals are not complying with accessibility requirements under the Integrated Accessibility Standards Regulation (IASR). Therefore, the committee recommends that the government should strengthen its existing enforcement framework, and create an additional framework to enforce accessibility in healthcare.

Under the current framework, the government assesses compliance based on reports that organizations submit about their own accessibility. In other words, organizations assess themselves. The committee recommends that the reporting process should include more incentives for organizations to complete these reports accurately, such as:

  • More examples of compliance and non-compliance, to support staff in understanding the report
  • Reminders of fines for organizations that do not comply

In addition, the committee recommends mandated on-site inspections, so that the government can verify that hospitals are complying with the law. Both the report and inspection should assess hospitals’ patient relation processes, to verify that they are:

Furthermore, hospitals should also create plans to remove or prevent the accessibility barriers that are documented within their complaint processes, feedback processes, or independent evaluations. Hospitals should post their plans within the Ministry for Seniors and Accessibility’s publicly searchable database. As a result, patients and visitors can know which hospitals are most committed to compliance. Moreover, funding that hospitals receive from the government should be based on whether they have created and followed such accessibility plans. Similarly, funding should also depend on how well hospitals make improvements recommended during the reporting or inspection processes.

Finally, hospitals should have accessible websites, as required under the Information and Communications Standards. These websites should include information about the hospital’s accessible services, such as:

New Enforcement Framework for Hospitals

In addition to enhancing existing frameworks under the IASR, the government should also create a new enforcement framework specifically supporting the healthcare standards. The government should create and establish this framework over the next three (3) years. Moreover, the government should develop the framework while consulting with:

Under this framework, hospitals would work with the Ministry for Seniors and Accessibility to set accessibility goals. These goals would help hospitals decide which accessibility issues to address first. Goals would also include timelines and penalties for non-compliance with the IASR or with a hospital’s own accessibility plan, under the existing framework. Penalties could be fines, or other consequences. However, each hospital would receive clear guidance about what constitutes compliance, and the consequences of non-compliance.

The government should post the framework online, in English and French, and in accessible formats. Furthermore, the government should review and update the framework every three to six (3-6) years. The results of the review should also be publicly available online. In addition, hospitals should post their accessibility plans on the Ministry of Seniors and Accessibility’s publicly searchable database. After every government review of the framework, hospitals should also post their progress toward achieving their goals. In this way, the public can assess how well each hospital is identifying and removing barriers to accessibility.




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Accessibility Awareness in Healthcare


Currently, there are still no AODA healthcare standards. However, an AODA standards development committee drafted recommendations of guidelines that AODA healthcare standards should include. These guidelines include accessibility awareness in healthcare.

The committee’s mandate from the Ontario government requires recommendations focused on the hospital setting. However, patients and healthcare workers with disabilities also face barriers in other parts of the healthcare system, including:

  • Doctors’ offices
  • Walk-in clinics
  • Wellness centres
  • Pharmacies
  • Labs
  • Nursing homes
  • Outpatient rehabilitation centres
  • Health regulatory colleges

Therefore, outreach programs to spread awareness about the importance of accessible healthcare should support all these settings.

Accessibility Awareness in Healthcare

Members of the public are often unaware of how hospitals accommodate patients with disabilities, including:

As a result, patients may not request or receive accommodations they need. Therefore, the committee recommends that the government should create an outreach campaign to raise awareness about the accessible services in hospitals. For example, the campaign should include public service announcements appearing in different forms of media, such as:

  • TV
  • Radio
  • Podcasts
  • Print media
  • Virtual or Internet ads
  • Social media

The outreach campaign should be available in English, French, and additional languages. Similarly, the ads should include communication supports, such as Sign language interpretation and Real-Time Captioning. Likewise, outreach materials should be available in accessible formats.

Moreover, the government should work with each hospital to develop announcements specific to its services. For instance, one announcement should describe a local hospital’s process for receiving and responding to accessibility complaints, including:

  • How to file a complaint about inaccessible goods, services, or facilities
  • The timeline for the complaint process
  • How to ensure accessible communication during the process

Likewise, the government should also consult people with disabilities to develop the announcements.

Announcements should inform the public about how each hospital:

Announcements should show hospitals accommodating patients with a variety of disabilities. In addition, announcements should reveal how lack of accommodation can lead to poor health outcomes. Finally, the campaign should emphasize that all hospitals must be fully accessible by 2025, to comply with the AODA.

This campaign should help Ontarians learn about and advocate for more accessible ways to receive healthcare.




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Accreditation Processes for Accessibility in Healthcare


Currently, there are still no AODA healthcare standards. However, an AODA standards development committee drafted recommendations of guidelines that AODA healthcare standards should include. These guidelines include creating accreditation processes for accessibility in healthcare.

The committee’s mandate from the Ontario government requires recommendations focused on the hospital setting. However, patients and healthcare workers with disabilities also face barriers in other parts of the healthcare system, including:

  • Doctors’ offices
  • Walk-in clinics
  • Wellness centres
  • Pharmacies
  • Labs
  • Nursing homes
  • Outpatient rehabilitation centres
  • Health regulatory colleges

Therefore, all these settings should have accreditation processes.

Accreditation Processes for Accessibility in Healthcare

Under the Integrated Accessibility Standards Regulation (IASR), hospitals must provide accessible services, including:

However, hospitals may not be providing these services. As a result, the committee recommends that the government should create processes to accredit hospitals that do obey provincial accessibility laws. For instance, Accreditation Canada should change its Leadership and Governance Standards, to address the need for accessible service in healthcare. These changed standards should include:

  • A statement about the need to provide accessible services
  • Guidelines for providing these services
  • Assessments to verify whether hospitals are complying with IASR requirements

The government should consult people with disabilities, or organizations representing them, during the creation of these guidelines.

Moreover, the accreditation process should involve observing families during their interactions with hospital services and staff. Accreditors can use these observations to determine if a hospital is providing all required accommodations and following accessibility best practices. Likewise, accreditors should also view hospitals’ documentation, to ensure that it accurately reflects the services a hospital is providing. For example, a hospital’s customer service policy might express welcome for support persons. However, in practice, the hospital might separate patients from their support persons.

In addition, the government should create a toolkit to help hospitals recognize and comply with the AODA. Likewise, a resource containing best practices would also support hospitals in complying with current and future AODA standards.




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