CNIB welcomes the long-anticipated review of the Assistive Devices Program, under the Ministry of Health and Long-Term Care (the Ministry), as part of the Auditor General's 2018 Annual Report. The program was last reviewed by the Auditor General in 2009. In the 2018 Annual Report, the Auditor General concludes that:
Overall, the Program under the Ministry does not have fully effective systems and procedures in place to meet the needs of Ontarians with long-term physical disabilities in an efficient and cost-effective manner, and in compliance with applicable Program policies.
Summary Findings and Analysis
1. Currently, the paper-based application process is inaccessible and inefficient.
Auditor General: "The Ministry still only accepts hardcopy claims from vendors, resulting in unnecessary delays for clients and potential errors. The Ministry’s information system, implemented almost eight years ago at a cost of about $7 million, can be updated to allow Program staff to accept claim submissions electronically. However, at the time of our audit, the Ministry still only accepted claims through the mail."
Analysis: The ADP started to update their computer systems to accept electronic submissions in 2018, but this not expected to be finished until mid-2020, if it is delivered on time. This will be nine years after the system was put in place. Both authorizers and vendors must print the forms, which means is not accessible to the authorizer, vendor, or ADP client who is blind, partially sighted or Deafblind.
2. Current process causes unnecessary delays
Auditor General: Forty-six per cent of ADP claims take longer to process than the 8-week target set by the Ministry. The process is deemed to begin when ADP receives a claim from the vendor. For the person making the claim, the entire process is much longer than eight weeks.
Analysis: According to the report, 10 of the 49 FTE staff who work in the ADP department are Data Entry Operators – their primary job function is to enter hardcopy claims into the system. This is an unnecessarily labour-intensive process that creates accessibility barriers for clients, vendors and authorizers who are blind, partially sighted or Deafblind. We support the electronic process that's proposed by the Auditor General - it will reduce wait times and alleviate the administrative burden.
3. Inflexible and Outdated Technology
Auditor General: "Device pricing of some visual aids has not kept pace with advancements in assistive technology (such as electronic devices, including computerized equipment). Therefore, the Ministry should review device pricing regularly."
"The Ministry did not conduct a pricing review of all devices within its three-year review cycle, as its guideline requires. Instead, the Ministry told us it mainly focused on com¬monly claimed devices because its list of Program-approved devices is long — over 8,000 specific devices, many of which are older models. The Ministry informed us that it did not remove older models from its device list so as to provide more choices for clients, specifically those clients who may be comfort¬able with older models they have been using for a long time."
Analysis: In addition to pricing reviews, the Ministry should undertake regular reviews of devices available through the ADP, involving key stakeholders, end users and subject matter experts for each device category. Devices under the visual aids category have not been significantly updated since 2001. Often, these outdated lists include devices that are no longer manufactured. To learn more, read CNIB's Re-Vision ADP Report.
4. Affordability for Seniors
Auditor General: Sixty per cent of ADP clients in 2017/18 were over the age of 65.
Analysis: Applicants who aren't Ontario Disability Support Program (ODSP) recipients must pay 25 per cent of the costs, including seniors. This presents significant financial challenges for seniors with sight loss. It's imperative that we investigate other means-testing methods to address the affordability gap for seniors who aren't eligible for ODSP.
Auditor General: "Some vendors are able to benefit significantly from lower manufacturer costs, likely because the high volume of their purchases lead to volume discounts from the manufacturers. These benefits are not subsequently passed on to the Ministry and clients."
Analysis: The Auditor General reports that approximately 1,200 vendors registered with the Ministry, operating in 1,900 locations, in 2017/18. Given that most of the approved vendors are based in urban areas, Ontarians living in rural and remote areas often purchase devices from vendors who aren't approved by the ADP and submit a claim. These out-of-pocket expenses place unnecessary financial burdens on individuals. The government should consider upfront funding for individuals who wish to purchase their devices from mainstream retailers – these devices are often sold at lower prices, which would result in cost savings for the ADP and empower consumer choice. Additional regulatory burdens will create barriers for more vendors, manufacturers and distributors from entering the market, which will limit consumer choice, slow innovation and inflate the costs.
Facts about the Assistive Devices Program:
- The Program funds approximately 8,000 assistive devices within 19 device categories, such as mobil¬ity devices, hearing aids, home oxygen, respiratory devices, insulin pumps and supplies, prostheses, orthotics and visual and communication aids.
- In 2017/18, the Ministry provided approximately $514 million through the Program to help purchase devices for over 400,000 Ontarians residents, 48 per cent more than 2007/08.
- In 2017/18, visual aids accounted for $3.2 million, approximately 0.6 per cent of the overall program expenditure.
Technology fosters inclusion, and it reduces feelings of isolation and depression for people who are blind, partially sighted or Deafblind – but only when it's accessible, available and affordable.
The Government of Ontario should be proud of its Assistive Devices Program (ADP) – it is a lifeline for many Ontarians living with disabilities. Without the ADP, many would be unable to afford an assistive device.
Modernizing the ADP will enhance service delivery and ensure Ontarians who are blind, partially sighted or Deafblind have access to high-quality, timely and essential equipment. Thanks to technological advances, assistive devices can do more than ever before. This means modern devices such as a smartphone or tablet can perform multiple functions (e.g. reading, writing, indoor/outdoor navigation apps, etc.).
CNIB Advocates across Ontario are meeting with their MPPs to raise this issue and request that the government meet with disability stakeholders to modernize the program.
If you would like to join us or to learn more, please email firstname.lastname@example.org.