December 24, 2025
By Yona Lunsky
When I was a kid and things went missing at school or at summer camp, there was a Lost and Found. It was a place, a system, a belief that when something was lost, it could be found and returned. Just before the holidays in December, classrooms or sometimes the entire school would hold up lost objects so people could claim them. I was often one of those people as I was not great at keeping track of my things, a problem that continues to this day. But the two words—Lost and Found—are very big words with profound implications.
A few weeks ago, the Ontario Ombudsman released a report after nearly three years of investigation: Lost in Transition. It examines in great depth what happens when adults with developmental disabilities in our province are living in hospital beds, sometimes for years, and can’t find their way out to a proper home. This is the second report on our population (the first was Nowhere to Turn in 2016), and includes 24 recommendations targeted toward the Ministry of Children, Community and Social Services and the Ministry of Health to address this awful situation. In addition to capital planning and proper funding for the needed community infrastructure, several of the recommendations focus on the two ministries working together to identify the population and fully support them in partnership; there are recommendations focused on establishing guidelines, shared protocols, communication and information sharing; there are some specific recommendations on French-speaking services, and recommendations about education and staffing.
Reading this latest report felt very heavy for me. It focused on seven individuals: Jordan, Luc, Noah, Sean, and Kevin – all age 30 and under, together spending 16 years in hospital. And Jack and Anne, in their late 50s, together spending over 10 years in hospital but not connected with developmental services for most of their lives (Jack not until his lengthy hospital admission, and dying in the months following hospital discharge). After waiting almost three years for this report, I had imagined sweeping changes or solutions, the way lost objects at school were eventually reclaimed. But the truth is, this group of individuals is not lost like my hats or mittens—they are hidden in plain sight, waiting for a home to be found within a broken system.
As noted in the report, hospitals may not even recognize that someone has a developmental disability (like Jack), and if they suspect it, they may not know what to do. Based on my experience with this exact topic for the past twenty years, it is often the case that people are acting (or not acting, as the case may be) out of ignorance—there are simply things they don’t know or can’t find. It is not just the people who are lost. It is also the relevant information, the go-to person who can help, and a clear way to navigate the system. Failing to act is also a kind of giving up or hopelessness about problems that seem too complex and impossible to solve—problems that must be someone else’s responsibility.
But these problems are our responsibility as a society. It is important that we read this report carefully and pay attention to the stories being told. Solutions do not rest solely in hospitals or with government; they also lie in our communities and in the systems we commit to building together across sectors.
Pathways Forward – Learning and Doing
One reason people remain hidden in plain sight is that our systems weren’t built with them in mind. We know that education is one important piece of the puzzle. Many of the people responsible for healthcare curricula were themselves trained in an era where this group was cared for in institutions, outside of the community, and not seen as part of our collective responsibility. Indeed, the Ombudsman report recommends additional education “to develop and implement an ongoing education and training program for the health sector, focused on providing information about developmental services and dual diagnosis resources, programs and processes, to assist with discharge planning for patients with developmental disabilities.” (Recommendation 10, p. 59). Of course, education, if done right, should not only assist with discharge planning, but also improve care while in hospital and even before people get hospitalized, sometimes preventing the need for hospitalization. This is a good direction—we have seen capacity building efforts work in other jurisdictions—but we also need to think about how that education happens. Many healthcare providers hold ableist attitudes toward people with disabilities, and if we are not thoughtful about what we teach, how we teach, and who teaches, we can further entrench ableist ways of thinking.
Our colleagues in the UK, the US, and Australia have made sure that education is developed together with people with lived experience of disability and with families. I am proud to say that we have also embraced these ideas in our education efforts at H-CARDD, and have seen that when we teach together, offering applied learning, building community, and integrating patient and family perspectives, we can shift attitudes and behaviours. We just wrapped up our sixth year of Project ECHO focused on adults with developmental disabilities, where patients, clinicians, and families teach side-by-side, sometimes across our province and sometimes across the country. Our online videos educate hospital providers on how to recognize this population and adapt care approaches. These videos were co-designed with people with disabilities and focus on common healthcare scenarios. And we have evidence-informed point-of-care tools that help providers deliver the care this population needs and deserves.
What will it take to advance education and build capacity so that all providers in Ontario and across Canada are comfortable and skilled at working with our population? How can we apply the lessons learned here and elsewhere to make sure that we educate people in ways that work? And how do we make sure that the much-needed emphasis on equity and diversity in health education considers people with a range of disabilities including developmental disabilities?
Building Systems That Help People
A few years ago, after an extensive review of the literature and discussions with over 100 clinicians, policymakers, patients and families, we proposed 10 essential steps to support transitions out of hospital for our population. We wrote a full report, an easy read, an executive summary, and a brief placemat version. Similar to the Ombudsman’s report, we highlighted six stories based on real people, and we showed how they got stuck in hospital and, importantly, how they found their way home. We then published a guide with a range of examples from right here in Ontario illustrating how different groups are implementing these various steps successfully.
If you work in healthcare or a community disability agency, what would it take to make sure your team could find and act on this guidance? What sort of education would you need? What additional infrastructure? Simply writing that this should happen is not enough. As part of our commitment to equity and inclusion, we have to ensure that this population gets equitable care and we must invest in how we embed resources and train people to make that possible.