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8/27/2015 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 1

8/27/2015 N.C. Office on Disability and Health Vision: A state where people with disabilities have the opportunity, 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 one or more major life activities or bodily functions • Have a record of such impairment • Are regarded as having an impairment 2

8/27/2015 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 Universal 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/ 3

8/27/2015 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 2 nd 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 • Treatment room • Parking • Medical equipment • Entrances/paths of • Communication travel approaches/devices • Doors/elevators • Clinical forms • Intake/waiting room • Health education literature • Restrooms/dressing rooms • Policies and training 4

8/27/2015 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 5

8/27/2015 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 or 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 Wheelchair Accessible Wheelchair-accessible scale Scale, front view Height-adjustable exam (with fold-down ramp) and table with clear floor space ambulatory scale for surrounding it patients who can stand with assistance/handrails Photo Credit: Rowan County Health Department. Used with permission 6

8/27/2015 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 7