I
This booklet provides guidelines and recommendations to help
health
care professionals ensure equal use
of the facility and services by
all their patients. The information
in this guide gives health care
providers a better understanding of
how to improve not only the
physical environment, but also
their personal interactions with patients
with disabilities. There is also a
review of some of the design
standards established through state
and federal laws, such as the
Americans with Disabilities Act (ADA), that health care
professionals
need to know.
This guide encourages health care professionals to go beyond
the
minimum requirements set by law to
make facilities and services
universally usable to the greatest
extent possible. By meeting
the needs of people with
disabilities, you will also be providing
enhanced facilities and services to all your patients.
How usable are your health care services
and facilities to people with
disabilities?
Can you weigh people who can’t stand on the scale? Can you
communicate with patients with
hearing disabilities? Is it easy for
your patients to move freely
throughout your facility?
UNIVERSAL DESIGN
The concept of designing all products and the built environment to be aesthetic and usable to the greatest extent possible by everyone, regardless of their age, ability, or status in life.
UNIVERSAL ACCESS
People with disabilities represent a large and growing
sector of the
population that needs health care
services. While over 54 million
Americans have been identified as being disabled, the true
number
of people with a disability is
unknown. At some point, almost
everyone experiences a disability as they age.
However, many people with disabilities do not seek out or
obtain
quality health care. Often, health
care facilities are not accessible or
do not have the equipment needed to
serve people with disabilities.
Also, people are often embarrassed because their disability
requires
them to obtain additional
assistance from the staff, requiring them
to surrender some of their
independence. Sometimes, staff may not
know how to assist a person with a
disability, causing frustration for
both the patient and the staff
member. As a result, some people with
disabilities only pursue medical
attention for emergency or acute conditions,
making primary and preventive
health care services low priorities.
From the providers’ perspective, limitations in the physical
environment,
such as the lack of appropriate
equipment, may cause doctors
and other professionals to forgo,
omit, or not recommend procedures
or portions of procedures for
people with disabilities that would
otherwise be commonplace.
Increasing accessibility at health care
facilities will encourage more
people to seek out services, thus
increasing client bases as well as
the general health of individuals
with disabilities.
Universal access or universal design is a concept, that,
when
applied to environments, ensures
that facilities, products, and
services are usable by all people.
Everyone, regardless of ability,
benefits from universal design.
Wide doors make moving equipment
and furniture easier for everyone.
Spacious toilet rooms provide
space for wheelchair users but also
accommodate parents with
strollers or several children. A
place to sit while transacting
Providing Universal Access
Scope of the Problem
3
Removing Barriers to Health Care
business is good for anyone when
they are tired, not feeling well,
or pregnant. Recommended universal
design features, such as power
door operators and
adjustable-height examining and treatment
tables, work well for everyone
including children and older adults.
Some people-accommodating features also add to the value of
the property, create a more
interactive environment, relieve staff
of unnecessary extra work, and help
maintain a comfortable place
to work and visit. Going beyond the
minimum requirements
makes your facility more usable for
all patients. Following is a
checklist of ways to improve
usability and broaden participation
in health care.
✔ weather protection at
entrance doors
✔ power door operators at
interior and
exterior entrances
✔ spaces left open but
dispersed in waiting
areas where wheelchair users can
sit out
of traffic lanes but with other
people
✔ chairs for use by people who cannot
stand while transacting business
✔ chairs that can be set at
different heights for
use by children, adults and older
people,
some equipped with arm rests for
those
who need assistance rising to their
feet
✔ scales that allow people
with difficulty
standing to hold on, and one that
allows
people to be weighed while sitting
in a wheelchair
✔ motorized, adjustable-height treatment
and examining tables and chairs
✔ mammography machines that
can be used
on a woman in a seated position
✔ a portable, amplified
communication system
or device with volume control at
service desks
and treatment spaces for people who
are
hard of hearing
✔ more than one accessible
toilet and dressing
room, some left-handed and some
right-handed
✔ a TTY for use by people
who are deaf to
make phone calls from health care
facilities
✔ staff awareness and
training in using
the National Telephone Relay System
✔ awareness and sensitivity
training for all
staff and professional personnel on
interacting
with people with disabilities
Recommended Universal Design Features
ACCESSIBLE ENVIRONMENTS
Creating accessible health care environments does not have
to be
expensive. In new construction,
accessibility features generally do
not increase costs. In fact, even
in existing facilities, necessary modifications
are not always expensive. And there
may be alternative
devices or services that can be
used as interim solutions when needed
changes may not be readily achievable.
Following are some guidelines for creating and modifying
health
care facilities to be accessible to
people with disabilities. By integrating
these into your buildings and
services, you can provide universally
usable environments beneficial to all your consumers.
Many different local and state building codes, as well as
civil rights
laws, address accessibility. When
building, buying, remodeling or furnishing
facilities, health care providers
are responsible for ensuring their
facilities adhere to all
accessibility requirements. Because there is no
plan review or approval and permit
process for accessibility requirements,
health care practitioners may not
know their obligations and
liability. One must not assume that
contractors are aware of and will
address all required obligations.
Following are some of the laws and
codes you need to become familiar
with to ensure you are in compliance
with accessibility regulations.
The Americans with Disabilities Act (ADA) is a federal law
that
prohibits discrimination against,
or segregation of, people with
disabilities in all activities,
programs, or services. While the
is similar to and patterned after
other civil rights laws, it differs
in that it also has a major impact
on the design, construction, and
operation of buildings and
facilities, transportation vehicles, and many
of the products that go into them.
The Americans with Disabilities Act (
Learn and Adhere to Codes and Laws Regarding Accessibility
Creating Accessible Environments and Services
SECTION 504
5
Removing Barriers to Health Care
The regulations for implementing the
building design specifications for
new construction, additions, and
remodeling called the Americans
with Disabilities Act Standards for
Accessible Design. Due to their
importance in the lives of people
with disabilities, facilities
providing health care are held to an
even higher standard than other
businesses. For example, in new
construction, elevators waived for
very small, two-story office
buildings must be provided in
health care office buildings of any size.
The ADA Standards are being adopted and used as part of
state,
regional, and national building
codes where they are becoming part
of common practice for review,
approval, and construction permits.
Even without local adoption and enforcement, the regulations
are
mandatory and individuals may file
complaints for non-compliance
with owners, managers, and the U.S.
Department of Justice.
Section 504 of the federal Rehabilitation Act of 1973
requires that
any program or service receiving
federal financial assistance, either
directly or indirectly, be
accessible to everyone. Most public services
fall in this category, including
health care facilities. Meeting the
requirements of Section 504 can be
accomplished by changing
policies, providing services such
as sign-language interpreters,
installing text telephones for deaf
clients, or relocating the program
to an accessible facility.
Most states have building codes or other
regulations that specify and
require
accessibility for people with
disabilities
in building design and
construction.
These vary in scope, detail, and
enforcement. Some are local, city
or county codes instead of
statewide.
Some states also have civil rights laws
prohibiting discriminatory
practices.
State and
Rehabilitation Act of 1973
NOTE:
The
for Accessible
Design, state, and/or
local codes contain
technical dimensions
governing the design
of specific features.
Be certain you or
your architect refer
to all applicable compliance
documents.
a reception desk with
a low counter top is
welcoming to all patients
■ accessible parking spaces
close to entrances
■ accessible front entrance
with ramp
and curb cut at appropriate grades
and surfaces
■ interior and exterior doors
that are
wide and easy to open
■ accessible route throughout
the facility
connecting all accessible features
and service areas
■ clear floor space so
people, even those
using wheelchairs, can get close to
and
reach all controls and other
features
■ controls, storage facilities and amenities
such as magazine and literature
racks
wheelchair users
■ low counters, service
windows or
receptionist stations for
transactions
with short or seated people
■ desk-height writing surfaces with knee
space for use by wheelchair users
and
others who cannot stand while
transacting business
■ accessible toilet and
dressing rooms
large enough for a person using
a wheelchair to navigate
■ audible and visual alarm
systems
■ qualified sign language interpreters
for communication with people who
are deaf
■ large printout capability
of key papers
and documents for people with low
vision
■ raised lettering and Braille on selected
signs such as room and elevator
controls
60“ wide access aisle shared by two
parking spaces
sign with the international access
symbol designating
space for accessible parking standard
width parking
space sign with access symbol and
text that
reads “van-accessible” standard
width parking space
96“ wide access aisle for “van-accessible” parking
Selected
The following chart highlights some of the key
should not be overlooked. The
illustrations that follow combine Universal
Design Features with requirements of the
that are safer and easier for all visitors, patients, and staff to use.
Accessible Parking Spaces
Health Care
Facility Entrance
visible and easily
understood signage
to indicate entrance,
parking, etc.
detectable warnings
at curbless
walks that
cross vehicle traffic
lanes cue people with
vision disabilities of
possible hazards
7
Removing Barriers to Health Care entrance incorporates an
accessible passenger
loading zone with adequate room to
get on and off bus and van lifts
accessible parking near entrance smooth
transitions from entrance
to loading areas and walks covered
entrance for weather protection.
Additional Features large furniture pieces combined with
easy-to-move single chairs allow
multiple seating arrangements
Lobby and Reception Area
open floor areas for wheelchair, scooter,
or baby carriages, dispersed
throughout seating adequate space around
door, including pull space to side,
for maneuvering magazine and display
racks within reachable height
TVs and VCRs
Easy to reach and with remote controls refreshment counter with
knee space; all
items placed within easy reach reception
area with multiple height counter and knee
space dual height water fountains
serve standing and seated users public telephones
with convenient shelf space for a
TTY (with an electrical outlet close)
lowered section of closet rod door
with glass window or sidelight
to see others approaching visible
and easily understood directional signage
objects protruding from walls can be detected by canes
Additional Features
9
Removing Barriers to Health Care
flush control on open side of
toilet – automatic preferred
Single User
Patient Toilet Room
loop handle additional counter space
for specimen
cups and similar items within easy reach
pass through
with ample floor space beneath, loop
handle on door
shelf height convenient for standing
and seated users
(36“ to 48“recommended)
full length mirror focused lighting
at lavatory
low, easy-to- reach soap dispenser
paper towel dispenser and trash
receptacle
convenient to lavatory rear and
side grab bars extend
beside and in front of toilet
18“ toilet seat height accommodates
wide range of users
toilet paper within easy reach of
user
(paper dispenser requires only one hand
with continuous
paper flow)
lavatory with knee space and lever faucet
non-skid and slip-resistant floor
surfaces
bottom edge of mirror close to countertop
trash receptacles must not obstruct
clear floor areas at fixtures
reach to seat cover dispenser must
not
be obstructed by toilet
Additional Features
clear floor space for a 5-foot turning
radius
flush or no threshold
Dressing Room
clothes hook 48“ max large dressing
bench, at least 24“ deep by 48“
wide and 17“ to 19“ above floor clear
floor
space for a 5-foot turning radius
because room is small an outswinging
door must be installed full length
mirror benefits standing and seated
users
Recommended Minimum
Sized Toilet Room
at small toilet rooms,
door must swing out
Note:
to provide a 32“ clear
opening, a 36“ wide
door may have to be
installed
6‘-6“
7‘-2“
1‘-6“ 3‘-6“
32“
Minimum recommended 5 feet
minimum clear to one side of
examination
table blood pressure cuff located
on side of table with 5-foot
turning radius so sufficient clear
floor
area is available for wheelchair
maneuvering
cabinet with retractable door and
roll-out
cart provides knee space for a
staff member who may use a
wheelchair loop handle hardware lowered
coat hooks
weight scale accommodates people
who use wheelchairs
Examination Area
3 feet minimum clear between table and wall height
adjustable
and articulating examination table movable
chair and clear floor area
allows access to blood pressure
cuff by people who use wheelchairs or other
mobility devices clear floor space
for 5-foot turning radius
movable chairs with arm rests
11
Removing Barriers to Health Care scale
ACCESSIBLE ENVIRONMENTS
Creating barrier-free health care environments is an ongoing
process
that requires input from many
people. Designers, builders, and
equipment suppliers do not set
policies and are not taught to design
for or accommodate the full range
of human needs and abilities.
Building codes and laws cannot correct for this deficiency, so
it is
important for health care
professionals to become active team members
in planning for any health care facility or program.
Involving people with a variety of disabilities as part of a
team for
assessing accessibility and
recommending additional accommodations
is essential. The lived experience
of disability is an excellent
resource. Since each person’s
experience and knowledge is different,
and also because disabilities vary
so broadly, seek advice from more
than one person. Ask your patients
for their input on how to make
your facility and services more
accessible. Local disability organizations
or advocates can provide
information on a broad range of disabilities
including mobility, cognitive,
vision, and hearing and are excellent
sources for planning advice.
Not all barriers to health care are physical ones. Often,
interactions
between health care providers and
people with disabilities can
be awkward and frustrating.
Observing some basic rules of disability
etiquette will yield greater
results and more positive interactions
between health care professionals and patients with disabilities.
■ Treat all persons with respect. Call a person by his
or her first
name only when you’re extending
this familiarity to everyone present.
■ Offer assistance to a person with a disability if
you feel like it,
but wait until your offer is
accepted before you help, and
listen to any instructions the
person may want to give about
the best way to assist them.
Provide Customer-based Services
In General
Create a Team of People to Help
Determine and Meet Accessibility Requirements
Creating Accessible Environments and Services
13
■ Any aid or equipment a
person may use, such as a wheelchair,
guide cane, walker, crutch or
assistance animal is part of that
person’s personal space. Do not
touch, push, pull or otherwise
physically interact with an
individual’s body or equipment
unless requested to do so. If it is
necessary to move a person’s
mobility device, never do so
without asking first.
■ Always ask before you move a person in a wheelchair , out of
courtesy, but also to prevent
disturbing the person’s balance.
■ If a person transfers from
a wheelchair to an examining table,
bathtub, toilet, etc., be sure not
to move the chair beyond easy
reach. If the person uses some
other aid, such as crutches or a
walker, make sure they remain
accessible to the patient.
■ Always make sure the wheelchair is locked before
helping a person transfer.
Removing Barriers to Health Care
■ When talking with someone
who has a disability, speak directly
to that person rather than through
a companion who may be
with them.
■ Be considerate of the extra
time it may take for a person with a
disability to get things done or
said. Let the person set the pace in
walking and talking.
■ Relax. Don’t be embarrassed if you happen to use
accepted, common
expressions, such as “See you
later” or “Got to be running
along” that seem to relate to the person’s disability.
examining table lowers to
wheelchair seat height, making transfers safer
and easier
People with Mobility Disabilities
■ To get the attention of a
person who has a hearing disability,
tap the person on the shoulder or
wave your hand.
■ Look directly at the person and speak clearly,
slowly and
expressively to establish if the
person can read your lips. Not
all persons with hearing
impairments can lip read. Those who
can rely on facial expressions and
other body language to help
in understanding.
■ When you offer to assist
someone with a vision impairment,
allow the person to take your arm.
This will help you guide
rather than propel or lead them.
■ When greeting a person with
a severe loss of vision, always
identify yourself and others who
may be with you. Speak in a
normal tone of voice, indicate when
you move from one place to
another, and let it be known when
the conversation is at an end.
■ When conversing at length with a person in a
wheelchair, sit or
place yourself at that person’s eye
level, but do not kneel.
■ Don’t patronize people who
use wheelchairs by patting them
on the head.
People with Vision Disabilities
People with Hearing Disabilities a roster of certified sign language
interpreters
should be maintained at each office
15
Removing Barriers to Health Care
■ Show consideration by placing yourself facing the
light source
and keeping your hands and food
away from your mouth when
speaking. Keep mustaches
well-trimmed.
■ While shouting won’t help,
written notes can.
■ Give whole, unhurried attention when you’re talking
to a person
who has difficulty speaking. Keep
your manner encouraging
rather than correcting, be patient
rather than speak for
the person. When necessary, ask
short questions that require
short answers or a nod or shake of
the head.
■ Never pretend to understand if you are having
difficulty doing
so. Repeat what you understand. The
person’s reaction will
assist you and guide you to
understanding.
■ Take the time necessary to assure clear
understanding. Use
simpler words and add gestures
while you talk. Use precise
language and try to employ words
that relate to things you
both can see. You may need to write
down information or draw a
simple picture.
■ Be prepared to give the
person the same information more than
once in different ways.
Conclusion
Creating more universally usable health care environments
and services benefits all your
customers, including those
patients with disabilities.
Knowledge of existing codes and
standards serves as a starting
point in meeting accessibility
guidelines. Going beyond
accessibility requires a partnership
with your patients with
disabilities. By creating a team, you
can meet the intent of the law and
foster an atmosphere that
welcomes everyone into your health care facility.
People with Speech Disabilities
People with Cognitive Disabilities
RESOURCES
Resources For More Information
Copies of the
Title II and Title III Technical Assistance Manuals are
available from the
Disability and Business Technical Assistance Center (DBTAC)
or the
Department of Justice at:
Disability and
(800) 949-4232 V/TTY
Website: www.adata.org/index-dbtac.html
Public Access Section
Civil Rights Division
(800) 514-0301; (800) 514-0383 (TTY)
Website: www.usdoj.gov/
For Design or Product Information, contact:
The Center for Universal Design
Campus
(800) 647-6777 (V/TTY)
(919) 515-3023 (fax)
Website: www.design.ncsu.edu/cud
Copies of Removing Barriers to Health Care may be ordered
from The Center for Universal
Design or the
Office on Disability and Health.
Alternate formats are available
upon request. When ordering large
quantities, please
contact the North Carolina Office
on Disability and Health.
The
The
Campus
(919) 966-2932
(919) 966-0862 (fax)
Website: www.fpg.unc.edu/~ncodh
For a more detailed discussion of the
for medical care facilities, you
may order the 17
page technical assistance document
titled Medical Care
Facilities from the Center for Universal Design.