Today, I want to share with you Part One of an Accessible Healthcare Series. I recently participated in a webinar, hosted by the ADA National Network, entitled “The Basics of Health Care and the Americans with Disabilities Act (ADA).” In partnership with three other ADA Centers, I presented the portion on the physical accessibility of buildings and facilitates. While most people are familiar with the concept that buildings must be ADA compliant, there is still confusion around what needs to be compliant.
The ADA ensures access to the built environment for people with disabilities, while the Department of Justice enforces accessibility standards. When the law was first passed in 1990, the ADA included Standards for Accessible Design, which were amended in 2010. These new standards are referred to as the 2010 Standards for Accessible Design. The 2010 Standards became enforceable in 2012 – for all new construction, alterations, program accessibility, and barrier removal.
The ADA does not outline the specifications for different facilities. Rather, they rely on the US Access Board to develop and update design guidelines, which are used by the DOJ for enforcement. These standards apply to places of public accommodation, commercial facilities, and state and local governments.
Titles II and III of the ADA require that medical care providers provide individuals with disabilities full and equal access to their health care services and facilities and reasonable modifications to policies, practices, and procedures when necessary to make health care services fully available.
When reviewing a medical facility, it’s important to first look at how a person with a disability would arrive to the facility. Do they use public transportation, will be they have a person drop them off, or are they driving their own vehicle and may need accessible parking? The 2010 Standards define “parking facility” to be inclusive of both parking lots and parking structures. The number of spaces required to be accessible is calculated separately for each facility.
While the 2010 standards give a calculation for the number of accessible parking required, there are different standards for specific medical facilities. In Hospital Outpatient facilities, which are within a hospital and provide regular and continuing medical treatment without an overnight stay, 10% of patient and visitor parking compliant with the standards.
Rehabilitation Facilities and Outpatient Physical Therapy Facilities should have 20% of their parking compliant when they specialize in treating conditions that affect mobility. Doctors’ offices, independent clinics, and other facilities not located in hospitals are not considered outpatient facilities. These facilities are subject to the standard scoping as outlined in Chapter 2 of the 2010 Standards.
Once you have reviewed parking, you want to be sure that there is an accessible route to the entrance of the building. Once a person has parked, they need to have at one accessible route within the site from the accessible parking spaces and accessible passenger loading zones; public streets and sidewalks; and public transportation stops to the accessible building for facility entrance. At least 60% of all public entrances must comply. This means that entrance doors, doorways, and gates must have clear width of 32 inches min., with a clear opening of 90 degrees.
Exam rooms should have features that make it possible for patients with mobility disabilities to receive appropriate medical care. This includes an accessible route to and through the room; an entry door with adequate clear width, maneuvering clearance, and accessible hardware. Also, you need appropriate models and placement of accessible exam equipment and adequate clear floor space inside the room for side transfers and use of lift equipment.
The number of accessible exam rooms with accessible equipment varies based on the size of the practice, patient population, and other factors. However, regardless of the size of the practice, an accessible restroom is required. Chapter 6 of the 2010 Standards outlines accessible restroom requirements. You will want to be mindful of the maneuvering space, the height of the toilet, grab bars, as well as the knee and toe clearance at the sink. These are just a few of the requirements.
It’s also important to remember if you have added furniture to the restroom, such as shelving for urine specimen containers, or moveable trashcans, these need to stay out of the clear maneuvering space. My father was recently in the hospital and the public restrooms on his floor were all single-user and marked accessible. I found that each time I used the restroom, the housekeeping staff had moved the trashcan adjacent to the toilet, making a side transfer for a wheelchair user impossible. I moved the trashcan out of the clear maneuvering space every time but found that it was always moved back. This is an example of where the restroom was constructed properly, yet human error caused the restroom to be inaccessible.
There is so much detail in ensuring that facilities are compliant. It’s no exception in the world of health care. In fact, it can be much more confusing. If you have questions about the ADA accessibility of your facility, please reach out to us at 1-800-949-4232.