In today’s healthcare landscape, ensuring compliance with the Americans with Disabilities Act (ADA) is crucial to providing inclusive and accessible services for all patients. Individuals with disabilities continue to lack equal access to routine preventative medical care and this disparity is projected to increase because of the current lack of education for physicians and staff, in addition to a growing population of Americans with disabilities – which is already estimated to be 1 in 5 people in the U.S.
All individuals are legally entitled to equitable healthcare and accessibility to medical services for people with disabilities, which is federally mandated under The Americans with Disabilities Act of 1990 (ADA) and Section 504 of the Rehabilitation Act of 1973. Unfortunately, studies have found that there is a lack of education to assist physicians and other healthcare organizations in understanding how to meet these requirements and how to maintain proper accessibility. In January 2022, HealthAffairs published a study[1] that found out of 714 U.S. outpatient-practice physicians, 35.8% reported knowing little or nothing about their responsibilities under the ADA. Additionally, 71.2% answered incorrectly about who determines reasonable accommodations, while concurrently, 68.4% felt they were at risk of ADA lawsuits.
While the commitment to inclusivity in healthcare practices is unwavering, the practical implementation of accessibility measures can pose challenges, especially when the facility is landlord-owned rather than practice-owned. In such instances, healthcare providers must navigate the complexities of ensuring accessibility in compliance with the 2010 ADA Standards for Accessible Design, even in facilities constructed before the ADA. A common misconception is that facilities constructed prior to the ADA are exempt, however there is actually no “grandfathering” provision. All facilities must adhere to a “reasonable accommodation” standard.
In the service-oriented landscape of healthcare, it’s commendable that many practices actively assist patients with accessibility needs, especially those in wheelchairs. However, our ADA site evaluations reveal that relying solely on proactive assistance can inadvertently mask underlying accessibility challenges and potentially expose staff to unnecessary risks. While immediate assistance for patients facing obstacles like high door thresholds is valuable, an in-depth evaluation of your facility can uncover areas where unassisted wheelchair navigation is not only feasible but also indicative of meeting accessibility requirements.
Navigating the intricate details and measurements outlined in ADA laws and requirements may seem overwhelming, but integrating accessibility into your standards of care doesn’t have to be complex. A straightforward and efficient approach is to include an accessibility training course as part of the annual compliance training already mandated for your staff. This ensures that your entire organization is well-versed in ADA laws and requirements.
Accessibility should cover the approach and entrance, the access to goods and services, public toilets, as well as other amenities like water fountains and public phones. A practice needs to have the ability to exam, weigh and measure the patient the same as any other patient. Accommodation goes beyond mobility needs and includes not only auditory and sight accommodation but also needs such as accommodation for patients with HIV. In fact, in the past few years there have been a several lawsuits brought against practices for denial of treatment. For the purpose of this article, the following areas are highlights of what we’ve found during our site visits that specifically address mobility accommodation:
- main entrance thresholds are often too high and difficult for a wheelchair, walker or scooter to clear, especially when the main door is heavy or closes quickly.
- the waiting room must have chairs without arms or bariatric chairs.
- depending on patient needs, at least one exam room must have an accessible exam table that can lower to 17”-19”, and an accessible scale.
- hallways and door openings must be wide enough for a wheelchair to self-navigate through.
- there must be appropriate clearance in the exam room. There should be a 60” diameter area to allow for 180° wheelchair rotation, a 30”x48” clear space adjacent to the table for transfer, and ample space on the opposite side of the table for transfer assistance.
By adopting a proactive and comprehensive approach to ADA compliance, healthcare practices can create an inclusive environment that prioritizes the needs of all patients. This not only meets legal obligations but also demonstrates a commitment to providing equitable healthcare services for everyone.
[1]Iezzoni, Lisa I., Rao, Sowmya R., Ressalam, Julie, Bolcic-Jankovic, Dragana, Agaronnik, Nicole D., Lagu, Tara, Pendo, Elizabeth, Campbell, Eric G. “US Physicians’ Knowledge About The Americans With Disabilities Act And Accommodation Of Patients With Disability.” Health Affairs, January 2022, https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.01136?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed. Accessed November 30, 2023.
