Introduction

The Americans with Disabilities Act (ADA) requires healthcare providers to make their services available in an accessible manner. This means you must provide individuals with disabilities full and equal access to healthcare services and facilities, make reasonable modifications to policies, practices, and procedures, and practice effective communication.

What is a reasonable modification or accommodation?

A reasonable modification or accommodation is a change to a policy, practice, or procedure to make a service fully accessible to an individual with a disability. Often, seemingly neutral policies and practices can exclude people with disabilities. For example, policies that assume everyone communicates in the same way or navigates social spaces in the same way can exclude people with disabilities. By modifying our typical policies and practices, as well as our typical ways of communicating, we can ensure that people with disabilities can access healthcare.

It is important to establish a policy for requesting and receiving accommodation requests on a case-by-case basis and that all staff members understand the request process.

Examples of common accommodations in healthcare:

Policy: “No pets allowed”
Accommodation: Service animals can go wherever the public is permitted (e.g., patient rooms, ambulances).
Learn additional details about service animals under the ADA by visiting ADA Service Animals Guidelines.

Policy: “All appointments are 30 minutes long”
Accommodation: Schedule longer appointments to allow for plain language explanations, extra time for transfers, or to ensure effective communication.

Policy: “Only the patient may attend an appointment”
Accommodation: Allow support people to attend appointments to ensure adequate support for decision-making and treatment.

In rare cases a healthcare provider wouldn’t need to modify their practices because doing so would fundamentally alter the nature of their services.

What is effective communication?

People who have disabilities that affect hearing, seeing, and speaking may use different ways to communicate. Healthcare providers must remove communication barriers by providing auxiliary aids and services to people whose disabilities affect communication. Individuals must be able to receive information from and convey information to their healthcare providers. Barriers to communication should be addressed at all points of contact, including appointment scheduling, reception, paperwork, exam rooms, and the pharmacy.

What are auxiliary aids and services?

Auxiliary aids and services refer to the methods that people with disabilities may use to communicate effectively. You might also call these communication aids and tools. It is important to understand that people with disabilities might communicate in unique ways. Do not assume that a communication aid or services is appropriate for your patient. Instead, ask patients to share their preference with you.

Examples of possible aids and services:

The following list is not comprehensive as auxiliary aids and services may vary based on the individual and the nature of their disability. Instead, this list is meant to give you an idea of potential auxiliary aids and services that may be requested.

For people who are blind, have vision loss, or are deaf-blind:

• A qualified reader (e.g., someone who is able to read effectively, accurately and impartially, using any necessary specialized vocabulary)
• Large print documents
• Braille documents
• Electonic documents compatible with screen-reading programs
• An audio recording of printed information

For people who are deaf, have hearing loss, or are deaf-blind:

• A qualified notetaker
• A qualified sign language interpreter, oral interpreter, cued-speech interpreter, or tactile interpreter
• Real-time captioning, written materials, or printed materials.

For people who have speech disabilities:

• Keeping paper and pencils nearby so the person can write out words that staff cannot understand
• Allowing more appointment time, if needed, to communicate with someone who uses assistive technology to communicate.
• A qualified transliterator.

Who pays for the use of auxiliary aids and services?

You cannot charge people with disabilities the cost of providing an auxiliary aid or service. The healthcare provider should treat the use of auxiliary aids and services as part of the costs of operating a business, as long as the aid or service does not impose an undue burden on the business. The ADA has effective communication guidelines that can provide guidance on what qualifies as an undue burden.

Tips for providing reasonable modifications and effective communication!

• Identify and build relationships with local resources for auxiliary aids and services (e.g., interpreting agencies)
• Provide comprehensive and ongoing staff training on effective communication and reasonable modification policies
• Develop a clear policy and procedure in acquiring auxiliary aids and services to ensure success in implementing policy
• Be prepared to provide documentation in alternative formats as needed
• Remember to be flexible, allow patients with disabilities to share their preferences
• Seek feedback from patients to gain insight on their experiences and use this to improve your services

References