Introduction

The Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act require that health care providers provide individuals with disabilities full and equal access to their health care services and facilities.  Title II of the ADA applies to public hospitals, clinics and health care services operated by state and local governments and Title III of the ADA applies to privately-owned and operated hospitals, clinics and health care providers.  Section 504 of the Rehabilitation Act applies to recipients of federal financial assistance such as Medicaid and federally conducted programs.

Who is affected by inaccessible medical facilities and services?

All people with disabilities can be affected by inaccessible medical facilities and services. Barriers may vary based on the individual and the nature of their disability. In general, compared to individuals without disabilities, individuals with disabilities are less likely to receive comprehensive preventative care, annual dental visits, diagnostic imaging, and/or recommended cancer screenings. It is important to meet all ADA building requirements and to check the accessibility of your medical facility and digital spaces to ensure that people with disabilities receive medical services equal to those received by a person without a disability.

Where do barriers occur?

Barriers can occur in any space the public is interacting with your facility or service. This could include:

• Parking lots and pathways to the building or provider’s office
• Patient check-in areas (waiting rooms, check-in counters, or kiosks)
• Clinical examination rooms
• Restroom facilities
• Websites, Patient Portals, and Mobile Apps

What are some examples of barriers to entering or navigating a health care facility?

The following list is not comprehensive as barriers may vary based on the individual and the nature of their disability. Instead, this list is meant to give you an idea of what barriers might be present and where they might occur. It is important to listen to the people with disabilities who are using your facilities and services to learn about specific barriers that may be popping up in or around your practice.

Parking lots/pathways to the building or provider’s office

• Obstructed pathways causing an inaccessible route in the parking lot and entry way of the facility
• Poorly maintained or uneven surfaces
• Inadequate lighting
• Unclear or unmarked navigation within the building or provider’s office (i.e. information desks and hallways)

Patient check-in areas

• Lack of accessible seating (i.e. no space for a mobility device user)
• Inaccessible check-in counters/kiosks (i.e. too high or too low)
• Inadequate signage or lack of tactile indicators
• Unfriendly sensory environments (i.e. bright lighting, strong odors/fragrances, loud noises)

Clinical examination rooms

• Inaccessible medical equipment (e.g., non-adjustable scales, blood pressure cuffs, or diagnostic tools)
• Lack of clear space for a mobility device user
• Lack of transfer aids
• Inaccessible examination tables (e.g., lacking adjustable height features)

Restroom facilities

• Inadequate turning space for mobility devices (e.g., narrow doors, protruding objects)
• Inadequate grab bars or support rails
• Lack of accessible sinks and amenities (e.g., soap dispensers, paper towels, hand dryers)
• Inadequate signage or lack of tactile indicators

Websites, patient portals, and mobile apps

• Lack of compatibility with assistive technologies (e.g., screen readers)
• Inaccessible forms or input fields
• Lack of captions, transcripts, or audio descriptions for video content
• Missing “alternative text” or “alt text” on images

Telehealth and web accessibility

It is equally important to ensure that your digital spaces are also fully accessible for people with disabilities. When websites, apps, and patient portals are not accessible as mentioned above, they can create barriers for people with disabilities.

The ADA has guidelines on accessibility for web content and mobile apps.

Resources for examining the accessibility of your healthcare practice

Luckily there are some great resources out there to help you examine the accessibility of your healthcare practice!

The Northwest ADA Center has an Oregon Healthcare facilities checklist. You can also use the ADA checklist for existing facilities.

The Access Board has published standards for Medical Diagnostic Equipment (MDE). Accessible MDE includes adjustable-height exam tables and chairs, wheelchair-accessible scales, adjustable-height radiologic equipment, portable floor and overhead track lifts, gurneys and stretchers.

Here are some questions to consider when thinking about accessibility:

1. Do you have a system in place for patients to provide feedback on the accessibility of your practice?
2. Are staff members aware of accessible routes, resources, and services available for patients with disabilities?
3. Do you have a relief space for service animals?
4. Is your website and online patient portal accessible to people with disabilities, including those who use screen readers or voice recognition software?
5. Does your telehealth platform allow interpreters and/or support people to join the service session?
6. Is the building wheelchair accessible?
7. Are stretchers or other equipment available for assisted transfer of patients with mobility disabilities onto the surface of your radiology equipment?
8. Are your patient scales capable of weighing a person using a wheelchair?
9. Can your mammography equipment be used with patients who may be seated in a wheelchair?
10. Can people using mobility aids transfer safely and easily to and from your exam tables and chairs?
11. Do your examination rooms provide clear floor space for a person to turn in their wheelchair or scooter?

References