Health Care

The issue

Deaf people are being denied Sign language interpreters for medical appointments and treatments. Deaf people are still being misdiagnosed as having other disabilities, including mental incompetence, when in fact they are merely Deaf. The Supreme Court decision in the Eldridge case is not being implemented.

Our position

The Eldridge decision must be implemented universally. Deaf people should not be diagnosed on their competence without being provided with appropriate communication services and without being assessed by Deaf experts sensitive to Deaf culture and norms. The Canadian health care system must be protected and upheld in order to ensure the best health care for all Canadians.

The Canadian health care system is one of the best in the world. For the most part, it succeeds in providing the best possible medical attention for all people regardless of their social or financial circumstances. However, funding cutbacks and the decentralization of health care have placed the principles of the system in jeopardy.

Eldridge Decision

The Canadian Charter of Rights and Freedoms prohibits discrimination in the provision of services such as health care on the basis of disability. The decision of the Supreme Court in 1997 in the case of Eldridge v. B.C. confirmed that any health care service, facility, or good that receives federal funding, whether directly or indirectly, must provide accessibility to those services, facilities, and goods for people who are deaf, hard of hearing, or otherwise disabled or handicapped.

The implementation of this decision has been, for the most part, disappointing. While some provincial governments have contracted with agencies to ensure the provision of Sign language interpreters in most health care situations, other provinces and territories have not followed suit.

The Supreme Court’s decision is limited to government-funded health care. The potential spread of private and/or for-profit health care services into this country is a terrifying prospect for Canadians who are deaf or hard of hearing. By definition, such services could be exempt from the Court’s ruling. Our rights to equal access to health care might not even be upheld by the Canadian Human Rights Commission, since the CHRC and its provincial counterparts seem to accede to the argument that private institutions and services (such as private educational and training schools) need not comply with the Charter in the matter of accessibility.

Health Information

The Canadian Association of the Deaf – Association des Sourds du Canada has a program called “Open Up!” in which we partner with other organizations to make fully accessible versions of their important health information, such as cancer, diabetes, heart and stroke, and mental health. We make this information accessible to hearing, hard of hearing, and Deaf people, anglophones and francophones, people with disabilities that are intellectual, developmental, language or literacy related, etc.

As long as we were able to secure government funding to underwrite this program, the other organizations were happy to be partners with us. If we could not supply government funding, however, those organizations were not interested in making sure their valuable information is accessible to people with disabilities. Group after group – more than thirty of them – told us that reaching disabled people was “not a priority” for them and that their budgets allocate absolutely no resources towards that goal. This is a staggering admission of failure and discrimination on their part. Their own constituencies are people who generally end up seriously and permanently disabled in some way through the diseases they experience. Blatantly discriminating against people with hearing or intellectual disabilities sends the message that these supposedly compassionate and caring organizations really don’t care if we end up with the preventable illnesses they are allegedly determined to eradicate or to manage proactively.

Deaf Children and Youth

Early recognition of deafness is essential for every child. Therefore, the Canadian Association of the Deaf-Association des Sourds du Canada supports the early identification of deaf and hard of hearing children and infants.

Once the child has been identified as deaf or hard of hearing, the priority must be to ensure he/she is given a language immediately. A child who cannot hear will naturally resort to learning through his/her eyes. The child therefore needs a visual language. Sign language meets this need. Therefore, the CAD-ASC advocates the introduction of Sign language as a first language upon which to build the communication tools that will enable the child to acquire the spoken/heard language as a second language.

Unfortunately, the health care system as presently constituted is geared towards the “sickness” model that identifies a rigorous oralist training program as the only option for deaf and hard of hearing children. The result for the child is enormous cultural confusion, poor literacy skills, and poor employment prospects. This is an extremely important fact for health care. It is well-known that people place more demands on the health care system when they are unemployed, illiterate, or psychologically distressed. Is it worth it to persist in an approach to deafness that leads to such results? The CAD-ASC does not believe so.

Hospice and Palliative Care

Hospice and palliative care addresses the needs of people with terminal illness. Treatment of their physical, emotional, psycho-social, and spiritual needs cannot be effective if their communication needs are not also handled in a sensitive and informed manner.

More Deaf people need to be trained to become nursing staff, support workers, and volunteers. They are experts about, and sensitive to, the social and cultural issues of Deaf patients. The ideal is for each major city (at a minimum) to have a Deaf palliative team, i.e., a group of Deaf or Sign language users/volunteers with expertise in Sign languages, Deaf/non-Deaf family relationships, and how to support/educate non-Deaf doctors and health care professionals.

The CAD-ASC works in partnership with professionals such as the Canadian Hospice and Palliative Care Association to develop programs to train and provide Deaf support workers for Deaf clients in hospice and palliative care situations. Our mission is to remove communication, cultural, and institutional barriers that limit access to end-of-life care and information. This is something that might best be achieved through the establishment of Deaf senior citizen residences and nursing homes. The need is clear and urgent.

Medical Expenses

Deafness is expensive – to the deaf person. A hearing-aid can cost $1,000. Many Deaf and hard of hearing people require two hearing-aids, and replacement parts can be required as frequently as every three months. Moreover, as the level of hearing loss and the inner shape of the ear change over time, new aids must be purchased frequently. Yet medicare in most provinces currently covers only a portion of the total costs of a hearing-aid, and even then it only covers these costs once every two or three years. Such an arrangement smacks of, at best, ignorance of the nature of deafness, and at worst, economic exploitation of a disability. If the un- and under-employment rate of Deaf people is 80%, how are the majority of Deaf people supposed to afford the hearing instruments that might help them to function in society and achieve satisfactory employment?

Deaf With Other Disabilities

Canadians who are “deaf plus” – i.e., who have other disabilities or special needs in addition to their deafness – face even greater difficulties in securing appropriate health care. For example, those who are deaf and blind may require their medical or prescription instructions to be provided in Braille, and they will likely require the services of an intervenor for any medical appointment or hospitalization; qualified professional intervenors are even less readily available than Sign interpreters. Diagnosis of additional problems can be vague or misunderstood and/or downplayed, as the health care professionals tend to focus obsessively on the deafness and treat other concerns as incidental or less important. Since deafness, unlike many of its companion disabilities, is not fatal or life-threatening, this kind of approach is not only misguided but dangerous to the health of the patient.

Deaf Aboriginals

One Ontario Government research project conducted in the 1990s discovered that roughly half of the province’s Aboriginal populace have varying degrees of hearing loss, and virtually no services to help them cope.

In addition, the medical expenses of registered Aboriginals are paid through the Department of Aboriginal Affairs and Northern Development rather than through the Ministry of Health ; the medicare regulations at DAAND are even more punitive than those of the provincial health ministries as far as deaf needs are concerned. For example, DAAND will cover the cost of one hearing-aid every five years for a Native child. It is unbelievable that anyone could think that a child’s ear shape and size are the same at age six as at age one, and the same at age eleven as at age six. And with the worst employment record and the highest poverty levels in Canada, how are the Aboriginal peoples supposed to pay for $1,000 hearing-aids four years out of five?

Mental Health

Mental health services for Deaf persons have increased over the past ten years, but there are still far too few of them, and they are still clustered into the largest cities. People in rural areas and small towns cannot obtain such services.

Deaf people are still routinely misdiagnosed as mentally disabled, autistic, exhibiting behavioural problems, or “lacking in language skills”, when in fact they have not been provided with appropriate means through which to communicate with medical personnel. When a Deaf person is assessed as incompetent, s/he is very unlikely to be consulted as to treatment, and equally unlikely to be provided with treatment and information in a format s/he can understand, i.e. with the assistance of certified Sign language interpreters, or in written English or French appropriate to their level of skill in that language.

It is extremely difficult for Deaf people to enter the training programs that lead to careers in the mental health field, due to lack of accessibility and support services. At the other end of the scale, non-Deaf people can get into the training programs but then find the programs do not include training to meet the specific needs of Deaf clients. Even if the non-Deaf professionals do manage to obtain specialized training, nearly all of them do not Sign themselves, at least not at a level of fluency that allows them to use it in clinical situations ; they end up employing interpreters, which instantly inhibits all participants by introducing a third-party into a confidential consultation, even though the interpreter may be bound by a Code of Ethics.

Employee Assistance Programs

Employee assistance programs (e.g., for substance abuse) are routinely inaccessible for Deaf persons. Because of the confidential nature of the concerns that bring clients into such programs, there is a reluctance or refusal to provide interpreter services, and a near-complete ignorance of the special stresses that can motivate a Deaf person towards abusive or self-destructive behaviour. How can a non-Deaf consultant with no training or experience of deafness understand the linguistic, emotional, cultural, and physical pressures that beset a Deaf person who is being forced to function as a “fake-hearing” person in the workplace?

Hospital Accessibility

Few hospitals have assistive devices for deaf or hard of hearing clients or visitors. Even the audiology and otolaryngology departments of major hospitals do not have TTY devices for deaf or hard of hearing callers to book appointments. No hospital in the country has an interpreter on staff ; at best, they may have interpreters available “on call”.

To the best of our knowledge, no hospital makes it a practice to provide patients with TV sets that include caption decoder chips; without such chips, deaf and hard of hearing people cannot follow the dialogue and sound effects of anything broadcast on the TV. Few if any hospitals have visual alarm systems or visual communication and safety systems.

In short, there is probably not a single hospital in the country that is truly accessible for deaf and hard of hearing people.

Deaf Doctors

We know of exactly two deaf doctors and one deaf psychologist in all of Canada. We know of no Deaf dentists or surgeons. There are two or three deaf nursing assistants. We know there are Deaf people employed in the health care field, but theirs are supportive or menial positions, such as data entry clerks, janitors, cafeteria workers, rehabilitation assistants, and the like.

The United States, to cite but one country, has proven that Deaf people can handle the most demanding of health care positions – there are even operating-room surgeons in the U.S. who are Deaf. No obstacle is insurmountable. One deaf Canadian doctor invented his own stethoscope to enable him to “listen” to heartbeats and the respiratory system. It can be done. But where are the incentives to encourage medical schools and health care training programs to recruit Deaf students? Where are the support services to enable Deaf students to accept the invitations to enroll?

Recommendations

The Canadian Association of the Deaf-Association des Sourds du Canada makes several recommendations that are based on the overall goal of moving the system delivery and management closer to the community – indeed, by putting it into the hands of the grassroots community itself. A community-based approach with a national mandate would save health care funds in the long run by providing community members with the training and resources to look after their fellow members.

The Canadian Association of the Deaf-Association des Sourds du Canada recommends that:

1. The Supreme Court of Canada decision in Eldridge v. British Columbia must be affirmed in clear and uncompromising terms as a basic legal principle governing all health care in Canada, including any and all private and/or for-profit health care services, goods, or facilities. Moreover, this principle must be implemented to the full letter of the law.
2. A federal-provincial multi-disciplinary task force, consisting 50% of Deaf consumers, should be established with the goal of developing new early diagnosis and intervention standards and guidelines that will ensure balanced information and health care services in relation to childhood deafness.
3. Provincial health authorities should establish multi-disciplinary partnerships, which shall include Deaf organizations, with the goal of transferring early intervention and early childhood development services to the community in order to reduce the tendency to “medicalize” deafness and in order to encourage cross-sectoral support and development for deaf and hard of hearing children.
4. The Canadian Association of the Deaf-Association des Sourds du Canada rejects the current “one size fits all” approach to hearing health care. All deaf children have unique abilities, thus individualized programs are the only good option.
5. Sufficient funding must be made available to provide the necessary supports and training services for deaf and hard of hearing children. Such funding must not be predicated upon the parents of the deaf child accepting a specified approach or “treatment” favoured by “the government of the moment”; rather, the funding must be provided for the services determined by the community stakeholder partnerships to be the best suited for the individual child’s needs and abilities.
6. All assistive devices for deaf and hard of hearing persons must be covered by medicare, with no restrictions. Any concerns about potential rip-offs can be circumvented by a requirement that purchases must be confirmed through documentation provided by certified professionals such as audiologists.
7. Contracts with agencies to provide services to deaf and hard of hearing people must be based on the principle of client need, not on the basis of number of clients served.
8. The federal, provincial, and municipal governments must combine efforts and resources to create at least one large senior citizens residence for Deaf people in every major city in the country.
9. It must be made mandatory that a Sign language interpreter be provided at a competency assessment for any Deaf person.
10. Hospice and palliative care must be designated as a core service and provided with appropriate funding. This funding must include monies for the provision of support services and assistive devices dedicated to the needs of deaf and hard of hearing clients.
11. The provision and funding of support services and accessibility measures must include the services and measures needed by Canadians who are deaf-plus, i.e., deaf and have other disabilities as well.
12. The Department of Aboriginal Affairs and Northern Development, and its provincial counterparts, must overhaul the funding of health care for aboriginals in order to reflect their actual needs and their current lack of services.
13. Mental health services for deaf and hard of hearing people, including employee assistance programs, must be increased, expanded, and directed to take a pro-active approach towards the recruitment, training, and placement of professionals and caregivers who are themselves deaf.
14. All hospitals, nursing homes, and retirement residences must be required to provide full accessibility for deaf and hard of hearing patients. Two-way light-switches, permanently activated TV caption decoders, visual alarms everywhere, and free Sign language lessons for all hospital staff are minimal requirements.
15. Federal and provincial health-care authorities, as well as medical schools, must work together with deaf consumer organizations to establish an infrastructure designed to take down barriers and make it possible for deaf students to enter the health care field.
16. Government funding, at all levels, towards charitable health organizations must be contingent upon those organizations making all of their information fully accessible to D/deaf and hard of hearing people, deaf-blind people, those with intellectual or developmental disabilities, and those with low language or literacy skills.

APPROVED: 3 JULY 2015

FOR FURTHER INFORMATION CONTACT:

The Canadian Association of the Deaf-Association des Sourds du Canada
606 – 251 Bank Street
Ottawa, Ontario K2P 1X3
(613) 565-2882
www.cad.ca