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A Pan-Canadian Approach in Providing Accessibility Devices

Editor's Note: The following brief article describes the mandates of the National Coalition on Vision Health (NCVH). Robert Fenton, NFB:AE President, has been asked to represent the interests of blind and vision-impaired consumers through his involvement with the Coalition.

The effort to ameliorate the living conditions of persons with disabilities, including those who are visually impaired, has been, broadly speaking, carried on at three interdependent levels: attitudinal change (both at the individual and societal level), the acquisition of skills, and the development and provision of accessibility devices to compensate for whatever functional barriers impairments may cause.

The degree to which accessibility devices are available to visually impaired Canadians was examined recently in a paper entitled "Toward Implementing In Unison". (The term "visually impaired" includes totally blind persons, persons who experience a significant degree of vision loss, and persons who are deaf blind.)

Notwithstanding considerable efforts by various jurisdictions in Canada to provide accessibility devices to visually impaired persons, the research data indicate that significant gaps remain. These gaps concern adequacy within existing programs, inconsistency and inequity across programs and jurisdictions, and the absence of programs in some jurisdictions altogether.

Visually impaired Canadians obtain accessibility devices in various ways. The particular way depends on the type of device, the purpose for which it is intended (for example, school, work, or leisure), the part of the country wherein the person resides, etc. Some visually impaired Canadians, as shown by the data, may be completely unable to obtain certain devices, unless they are in a position to cover the entire cost themselves. In addition to government programs, the charitable sector provides some assistance.

People who are blind face difficulty in accessing visually presented information, such as the printed word without the assistance of another person or a device. Over the years, various devices have been developed that enable people with visual impairments to read and write. These devices range from Braille typewriters and magnifying aids to sophisticated voice equipped computers and optical character recognition machines.

The importance of accessibility devices for persons who are blind or visually impaired cannot be overstated. Simply put, accessibility devices that enhance or substitute for vision are to blind people what ramps are to people who use wheelchairs. In the United States, the National Council on Disability investigated the role and potential of accessibility technology for persons with disabilities. They concluded, quoting Radabaugh (1988) that "For Americans without disabilities, technology makes things easier. For Americans with disabilities, technology makes things possible."

Notwithstanding the occasional Luddite ostrich, individuals with disabilities have long recognised that assistive technology is as cost-effective as it is necessary. The National Council on Disability found that, as a result of technology, 62% of working-age persons with disabilities were able to reduce dependence on family members, 58% were able to reduce dependence on paid assistance, and 37% were able to increase earnings.

When asked to estimate the impact of equipment on their quality of life, assistive technology users reported that without the equipment, their quality of life on a scale from 1 to 10 was around 3; as a result of the equipment, it jumped to approximately 8.4. Clearly, for independence and quality of life, accessibility devices are essential, and the increased independence for the individual results in lowered costs to society as a whole. People who are visually impaired become more independent, productive members of society, who in turn contribute to the economy, rather than being dependent on social assistance in the long term.

As already indicated above, the current approach of providing accessibility devices in Canada is seriously inadequate. (These inadequacies are documented in greater detail than can be accommodated in this short article in "Toward Implementing in Unison", which can be obtained in every format and in both official languages by contacting Dawnelee Klomp at 613-562-0000 ext. 158) or by e-mail at klompd@cnib.ca.

Only four provinces (Alberta, Saskatchewan, Ontario and Quebec) provide public coverage for accessibility devices, and none of these provide full access for visually impaired persons to affordable low vision, low technical and high technical accessibility devices. In other provinces, and for those who do not qualify for existing provincial programs, blind Canadians often do without the equipment that could assist them in their lives. The mobility of Canadians between provinces, a fundamental Canadian principle, is restricted, by reason of inequitable services, for persons who are visually impaired.

This situation clearly goes against numerous recent government reports on "disability supports" that have encouraged the establishment of programs to assist Canadians with disabilities in obtaining needed supports, including accessibility devices. At the federal level, support for accessibility devices has been demonstrated in various ways, including some compensation for the costs of disability provided through income tax relief. As well, through Human Resources Development Canada programs (and related, cost-shared provincial programs), funding for devices to be used in employment is often provided. The need, however, is greater than existing funding.

Aside from the provincial programs, there is some assistance available for children and for working age adults. However, seniors, who are the fastest growing segment of the population, and the group most likely to be visually impaired, have very few options for obtaining accessibility devices. First Nations Peoples (who have an extremely high rate of disability in general, and of vision impairment in particular), are even more disadvantaged than their fellow Canadians. For them, each funding source tends to see itself only as a last resort, with the result that a person can be shuffled back and forth for long periods of time without receiving services.

My research has revealed a patchwork of services. A consistent funding program for accessibility devices/technology does not currently exist in Canada. The programs that do exist vary widely. Depending upon the jurisdiction, there are variations in eligibility criteria, type of device covered, permitted uses of provided devices, ownership of the device, and cost to the client. None of the programs or jurisdictions provides a comprehensive service for all visually impaired persons of all ages, who require devices for a variety of purposes. These inconsistencies, inadequacies and gaps affect adversely the quality of life of many visually impaired Canadians. They thus undermine their efforts to contribute fully and independently to Canadian society.

Existing programs are extremely complex, and people have difficulty understanding the systems. Visually impaired Canadians are often unaware of the options available to them, and the variation in coverage between jurisdictions. Many seem to have given up attempting to navigate this complex system.

Part of the complexity stems from jurisdictional confusion. Particularly in the case of First Nations Peoples, but evident elsewhere as well, multiple, uncoordinated programs claim to be the provider of last resort. The result is that required services are not provided in a timely manner.

While there is clearly no pan-Canadian program for accessibility devices, the Canadian government has already indicated that provision of such services can be part of the federal mandate, as there is currently a federal funding presence. There is clearly a commitment to ensuring that visually impaired Canadians, whose well-being and fulfilment of citizenship is a shared responsibility, be provided with some devices. (This, of course, applies equally to persons with other disabilities. While I examined accessibility devices in relation to visually impaired Canadians, I recognise that any systemic response must take into account the needs of people who require accessibility devices due to other disabilities.)

Seniors receive the most inadequate services. As the fastest growing group of persons with visual impairments, seniors have an incredible need for accessibility devices that is, at present, unmet, and that will continue to grow with the senior population.

Children's service provision, particularly for educational purposes, is more advanced than that for other age groups. This shows the investment by many levels of government in ensuring that visually impaired children are able to learn along with their peers. Still, however, there are gaps, especially for post-secondary education.

Much of the criticism directed at the current approach focuses on the fact that persons and their needs are served through inflexible systems, creating, thereby, the impression that systems do not serve but rather constrain. There is a need for a functional approach, focusing on improved quality of life and independence. Through some of the systems, devices are provided under such inflexible conditions that the positive impact of the device is lessened; for example, by restricting its use to work or home, or requiring that it be "medically necessary".

"Toward Implementing In Unison" suggests that the current approach has serious negative implications for visually impaired Canadians, especially those who reside in provinces without an accessibility device program. A consistent Canadian approach would recognise the value of these devices in the life of an individual with a disability. Access to such devices is often a necessity for inclusion and independence, and thus for full citizenship.

Achieving a coherent and equitable Canadian system presupposes a number of political factors, not all of which can be addressed here. At the inter-governmental level, two recently concluded Agreements, the Social Union and In Unison, contain the public policy instruments and modalities by which this issue can be handled. In my view, undoubtedly, the most important factor in bringing change are the actions or inactions of those of us who are concerned about our future well-being, as well as that of our brothers and sisters. The critical question is: can concerned organisations and individuals act in concert in response to this challenge? Our future actions will tell. Let this be a beginning.

A national vision. A national dream.

Who are we?

A group of stakeholders that includes ophthalmic professionals, educators, researchers, consumers and associations that are interested in improving communication and co-ordination of efforts between partners.

Mission

The National Coalition on Vision Health is a coalition of Canadian organisations and service providers of vision care, research, education, rehabilitation and consumers. The Coalition will provide leadership for the improvement of vision health and eye care. They will provide this leadership through research and public awareness, by supporting public and professional education and information, vision-loss prevention initiatives, vision health, and related advocacy.

History

The National Consultation on the Crisis in Vision Loss, held in Toronto in 1998, was a momentous opportunity for diverse groups of Canadian stakeholders to come together and do something remarkable. They agreed that there is a current crisis in vision loss and they decided that they needed to form a National Coalition to identify priorities and take a multi-disciplinary approach to addressing these priorities. They agreed that action must be taken immediately. In the closing address the Assistant Deputy Minister of the Health and Programs Branch of Health Canada, Ian Potter, said "Health Canada understands the need for collaboration and is prepared to make a contribution to support the collaborative efforts of this meeting."

The Result

With support from Health Canada, the National Coalition on Vision Health has financial support for three years to establish themselves and develop a national eye care program that will be recognised at all levels. The Coalition committee has met on two occasions and several subcommittees have been established. We are in the process of developing an extensive database of information sources and contacts within the field of vision health.

If you would like to receive additional information regarding the Coalition's activities, please contact: Dr. Don Farrell, Chair, National Coalition on Vision Health, E-mail:drdoom@nbnet.nb.ca Phone: (506) 634-8484

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