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8/27/2015 1

Accessibility Basics for Medical Practices: 10 Opportunities for Improvement

North Carolina Office on Disability and Health North Carolina Division of Public Health

Disclaimer

NC DHHS does not endorse any product shown in this presentation.

Objectives

• Explain the importance of addressing

accessibility in providing care to children and youth with disabilities

• Understand how to use and teach

“Accessibility Basics for Medical Practices”

• Identify additional opportunities for

conducting accessibility surveys or other collaboration with NCODH

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N.C. Office on Disability and Health

Vision: A state where people with disabilities have the

• pportunity, every day and in all places, to be healthy and

participate in all aspects of community life Mission: To promote the health and well-being of North Carolinians with disabilities across the life span by:

• Improving access to services and opportunities
• Decreasing health disparities

Social Model of Disability

• Disability is not just the health condition of a

person

• It is a limitation experienced in the context of

the community and society in which the individual lives

• Societal and environmental accommodations

are critical for people with disabilities of any age to be healthy

World Health Organization. Health Topics: Disabilities. Online at http://www.who.int/topics/disabilities/en/

Americans with Disabilities Act (ADA), Public Law 101-336

The ADA is a civil rights law that prohibits discrimination on the basis of disability in employment, state and local government programs, public accommodations, commercial facilities, transportation and telecommunications Protects people of all ages who:

• Have a physical or mental impairment that substantially limits
• ne or more major life activities or bodily functions
• Have a record of such impairment
• Are regarded as having an impairment

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ADA Title II State and Local Government Programs

• Title II covers health departments, academic medical centers at

state institutions or state or locally funded school-based health centers

• Barrier removal is required when:

– No administrative or financial burden exists – Removal of the barrier does not fundamentally alter the services offered – Removal of the barrier does not pose a danger to others

• Barrier removal is determined on a case-by-case basis
• Title II entities must consider all available funding sources

“Americans with Disabilities Act Questions and Answers.” United States Equal Employment Opportunity Commission and the Civil Rights Division, United States Department of Justice. Online http://www.ada.gov/q&aeng02.htm

Some ADA Requirements

• Accessible parking
• Accessible path of travel
• Doors do not require more than 5 lbs. of force to open
• Accessible signage
• Accessible restrooms
• Providing interpreters or other forms of effective

communication at no cost to the patient

P.L. 101-336 and the Americans with Disabilities Act 2010 Standards for Accessible Design

“The design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design.”

– Ron Mace, The Center for Universal Design, NC State University

A focus on Universal Design helps your practice go beyond the basic requirements of the ADA, building codes, local ordinances and makes environments safer and easier to use by people with varying abilities

The Center for Universal Design, College of Design, NC State University. Online at http://www.ncsu.edu/www/ncsu/design/sod5/cud/

Universal Design

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Universal Design Features

• Power doors and weather protection at

entrances

• Automatic flushing toilets
• Unisex/family restrooms
• Adjustable-height examination tables
• Scales that allow people to be weighed while

sitting in a wheelchair

“Accessibility Basics for Medical Practices”

• A “top 10” list for improving accessibility of medical

practices.

– Not a full accessibility survey – Does not guarantee any kind of legal compliance

• Designed to allow you to examine accessibility issues

through observation or with little measurement.

– Further explanation provided on back or 2nd page

• Helps you hone in on issues that need further

examination.

– May have multiple items unchecked

• Preliminary step to conducting an accessibility review

with NCODH and local disability partners

Look at the Whole Environment: Place, People, Policies and Procedures

• Scheduling
• Parking
• Entrances/paths of

travel

• Doors/elevators
• Intake/waiting room
• Restrooms/dressing

rooms

• Treatment room
• Medical equipment
• Communication

approaches/devices

• Clinical forms
• Health education

literature

• Policies and training

8/27/2015 5 Look at Your Waiting Areas

• Clear 36 inch high counter tops with knee space

underneath

• Moveable furniture
• Objects are cane detectable
• Staff trained to communicate in accessible way (e.g.

holding up sign with patient’s name if they’re deaf)

• Easily understood and visible directional signage

Look At Your Restrooms:

• Toilet 17-19 inches high
• Grab bars on back and side
• Clear floor space for

transferring

• 5 feet diameter circle for

turning around

• 32 inch wide doorway
• Sink no higher than 34 inches
• 29 inch clearance under sink

with insulated pipes

“Access To Medical Care For Individuals With Mobility Disabilities” United States Department of Justice

Look At Exam Room Features

• At least 30 x 48 inches clear floor

space next to exam table for side transfer

• Height adjustable exam table
• Space between table and wall

for examiner

• Space at end of bed for

transferring or lift

• Accessible route (36 inch width

to all patient areas)

• Doorways at least 32 inch wide

with maneuvering clearance (door can’t be in the path of travel)

“Access To Medical Care For Individuals With Mobility Disabilities” United States Department of

• Justice. http://www.ada.gov/medcare_ta.htm

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Access to Examinations

• For pediatric patients, transfer onto an exam table may be

easier, but all patients grow up

• Deaf patients or caregivers are not required to bring an

interpreter

• Extra time should be offered and built into appointment if

needed

• Transfer onto accessible table must be provided

– Adjustable height table is best – Use of portable (e.g. Hoyer) lift is next safest – Training staff in safe transferring techniques (this is the least safe option)

“Access To Medical Care For Individuals With Mobility Disabilities” United States Department of Justice. Online at http://www.ada.gov/medcare_ta.htm

Use of A Height Adjustable Exam Table

Minimum requirements for accessible exam tables:

• Lower to wheelchair

height (17-19 inches)

• Stabilization, such as rails,

straps, cushions, wedges

• r rolled up towels
• 30 x 48 inch clear floor

space and 36 inch path to table also required

“Access To Medical Care For Individuals With Mobility Disabilities” United States Department of Justice. Online at http://www.ada.gov/medcare_ta.htm

Use of Accessible Equipment in a Local Health Department

Height-adjustable exam table with clear floor space surrounding it Wheelchair-accessible scale (with fold-down ramp) and ambulatory scale for patients who can stand with assistance/handrails Wheelchair Accessible Scale, front view

Photo Credit: Rowan County Health Department. Used with permission

8/27/2015 7 Use of A Wheelchair Accessible Scale

• 1. Sloped surface provides

access to scale platform and no abrupt level changes at floor or platform

• 2. Edge protection at drop off
• 3. Large platform

accommodates various wheelchair sizes

• 4. Provide maneuvering space

to pull on and off the scale

“Access To Medical Care For Individuals With Mobility Disabilities” United States Department of Justice. Online at http://www.ada.gov/medcare_ta.htm

Service Animals

• Service animals must be allowed in all areas of the practice

accessible to the general public or other patients

• Service animals are not pets
• Service animals may only be dogs or in some cases specially-

trained miniature horses

• They must be housebroken, and under control by using a

leash, voice commands or other controls

“Revised ADA Requirements: Service Animals,” United States Department of Justice, http://www.ada.gov/service_animals_2010.htm

Service Animals (cont.)

• To determine if an animal is a service animal, you may only ask:

– Is that a service animal? – What tasks does it perform?

• You may not ask about a person’s disability or require documentation
• Staff may prohibit a service animal only if

– It is out of control – It is not housebroken – There is a legitimate reason (e.g. animal will affect sterility)

• Patients should be assisted when their service animal is not present

“Revised ADA Requirements: Service Animals,” US Department of Justice, http://www.ada.gov/service_animals_2010.htm

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General Tips and Strategies for Staff and Providers

• Gather information about assistance or accommodations

needed prior to appointment from youth, parents, caregivers, etc.

• Promote a realistic schedule – longer time slots, less busy part
• f day or multiple visits, etc.
• Never assume, always ask –family/caregivers know their child

the best or ask the youth directly

• Remember, the caregiver may have the disability
• Comply with accessibility laws and incorporate Universal Design

into your practice – Budget for accessible equipment – Provide health education and other materials in alternate formats

Effective Communication Strategies

• Using auxiliary aids and/or services such as:

– Sign language interpreters – Written notes – Large print (at least 16-18 point font) – Braille – Information provided with clear visuals and little text

• Without aids and services, there is a risk of

misdiagnosis, inappropriate treatment and lack of patient comprehension

After the “Top 10:” How Can NCODH Help You?

• NCODH can assist you in improving access and

the delivery of quality health care with: –On-site accessibility surveys –Trainings/Presentations –Partnerships with local disability groups –Review of documents and policies to increase accessibility and inclusivity

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On-site Accessibility Surveys

• Time required for a survey will depend on size of the facility.

Plan for a minimum of 2 hours.

• Examines access issues in greater depth than the “Top 10”

– The accessibility survey is conducted with a variety of staff (e.g. medical/dental, administrative and

• perations/maintenance)

– NCODH will assist you in creating a plan for removing barriers This will be your internal document – Disability advocates will participate and are a local resource

Additional Opportunities: Creating Accessible Dental Practices

• NCODH has a similar community training model and tool to

improve accessibility of dental practices

• Like the medical clinic surveys, the process involves local

disability organizations or advocates as partners

• Questions on the dental survey (which is also abbreviated)

cover:

– Customer Service – Operatory – X-ray room – Tooth brushing area – Patient consultation spaces

Resources

• “Removing Barriers to Health Care: A Guide for Health

Professionals”, 1998. NCODH and The Center for Universal

• Design. http://fpg.unc.edu/resources/removing-barriers-

health-care-guide-health-professionals. Also available in hard

• copy. Call 919 707-5607
• Americans with Disabilities Act: Access to Medical Care for

Individuals with Mobility Disabilities.” Online. US Department of

• Justice. www.ada.gov/medcare_mobility_ta/medcare_ta.pdf
• June Issacson-Kailes, www.jik.com Nationally recognized

Disability Policy Consultant, Center for Disability and the Health Policy, Western University of Health Sciences, Pomona, CA

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“Accessibility Basics for Medical Practices”

• A “top 10” list for improving accessibility of medical

practices.

– Not a full accessibility survey – Does not guarantee any kind of legal compliance

• Designed to allow you to examine accessibility issues

through observation or with little measurement.

– Further explanation provided on back or 2nd page

• Helps you hone in on issues that need further

examination.

– May have multiple items unchecked

• Preliminary step to conducting an accessibility review

with NCODH and local disability partners

Thank You

Chris Mackey chris.mackey@dhhs.nc.gov 919-707-5607 Jacquie Simmons Jacquie.simmons@dhhs.nc.gov 919-707-5672 NC Office on Disability and Health www.ncdhhs.gov/dph/wch/aboutus/disability.htm