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The Americans with Disabilities Act (ADA) is a federal civil rights law that prohibits discrimination against people with disabilities. Health care organizations that provide services to the public are covered by the ADA.
The ADA requires that health care entities provide full and equal access for people with disabilities.
This can be done through:
Covered health care facilities include, but are not limited to: hospitals, doctors’ offices, pharmacies, dentists’ offices, acupuncturists’ offices, etc.
Health care agencies run by state and local governments are covered under Title II of the ADA. Health care organizations run by private businesses or nonprofit organizations are covered under Title III of the ADA. All places covered by the ADA must provide access to their facilities and programs for people with disabilities.
A person with a disability can be a person with a mobility or physical disability, sensory (vision or hearing), intellectual, psychiatric, or other mental disability. People with medical conditions such as HIV/AIDS, epilepsy, rheumatoid arthritis, and cancer may also covered under the ADA.
One in five people in the United States is a person with a disability.
Access to health care programs and services can be met in different ways. The way a place meets its access to health care obligations will depend on who operates it - 1) a state or local government or 2) a business or nonprofit organization.
State and local governments meet access requirements to programs through “program accessibility.” This means that the program must be accessible across the system as a whole. If individual programs
within the health care system are not physically accessible, the goods and services can be relocated to an accessible location or a facility can be retrofitted to make it accessible.
Businesses and nonprofit organizations meet access requirements to programs and services by engaging in “readily achievable barrier removal” at their facilities.
Example: A private health care provider has barriers such as steps at their entrance or examination rooms that are too small to accommodate a person who uses a wheelchair. To meet their access requirements, the provider must develop a plan to remove those barriers to make the site accessible unless it is technically infeasible.
As a best practice, the provider should review its plans for barrier removal on a regular basis as it moves toward more complete accessibility of its facilities.
If a provider can demonstrate that making a reasonable modification or providing effective communication would be overly expensive (“undue financial burden”) or would completely change
the care or service provided (“fundamentally alter the nature of the service, program, or activity”) they would not be required to comply with the ADA requirements. There are a number of factors to consider before a facility can claim an undue burden or fundamental alteration of service such as the nature and cost of the action in relation to the size, resources, nature, and structure of the facility’s operation.
Example: A doctors’ office is in an existing building with 4 small exam rooms. Making all of the exam rooms accessible may not be readily achievable because load bearing walls cannot be removed or the cost of the full project may be too high. Instead, the doctor could make two of the rooms accessible and ensure they only schedule two patients who would benefit from an accessible room at the same time.
Example: A parent of a child with a disability requests to see a primary care doctor she knows. She is comfortable with this doctor and wants her to treat her child. However, this doctor specializes in care for older adults. Because the doctor is not a pediatrician, this could be a fundamental alteration of the health care service and would not be required.
Myth - A doctor who does not specialize in a patient’s disability does not have to provide care to that person.
Fact - Generally, a health care provider cannot refuse to see a patient due to their disability.
Health care providers are required to make reasonable modifications (or changes) to policies, practices, and procedures to provide equal access to facilities and services to people with disabilities. The term “reasonable modification” is a broad concept that covers every type of disability.
Granting reasonable modifications is a key piece to ensuring that persons with disabilities have equal access to the goods and services just like patients without disabilities.
Examples:
Myth - A health care facility cannot charge a patient with a disability a fee for parking.
Fact - A health care facility can charge for parking if it is a charge that all patients pay. However, if a parking pay machine is not accessible, a reasonable modification would be waiving parking fees for people with disabilities who cannot access the parking machine.
Health care providers must ensure that communication with patients with hearing, vision, and speech disabilities are as effective as communication with other patients. The aid or service provided depends on the method of communication used by the patient, how long and how complex it will be, and the setting where the communication will take place.
Effective communication can be met through the use of a device or method or a service.
Examples:
Myth - A patient’s husband is Deaf and uses sign language. The wife, who is in a coma, is hearing (is not deaf). The doctor needs to communicate the health issues of the patient with the husband. Because the wife, who is hearing, is the patient, the hospital does not need to provide a sign language interpreter to her husband.
Fact - Because communication with the family benefits the patient, the hospital must provide a sign language interpreter for the husband. In some environments and situations, such as in an emergency room or urgent care, due to the immediate need effective communication may be provided via Video Remote Interpreting (VRI).
Health care facilities must ensure that their facilities are accessible to people with disabilities. When possible, medical equipment should also be accessible. Examples: accessible examination tables, accessible imaging machines, accessible scales, and patient lifts. Health care providers must have an accessible facility that meets the 2010 ADA Standards for Accessible Design and have accessible exam/ treatment/procedure rooms available.
A facility that was constructed before the ADA is not “grandfathered.”
Examples of features of accessible facilities, as defined by the 2010 ADA Standards for Accessible Design, include:
Accessible examination rooms include, for example:
Myth - A private practice specialist doctor sees patients at two offices. Although the doctor has an adjustable height exam table at each of the offices and accessible bathrooms, both offices have one step at the entry way. The doctor has to remove the barrier of the front step at only one of the offices, regardless of how much it will cost.
Fact - Unless the doctor can show that removing the barrier by installing a ramp at both offices would cause an undue financial burden, the doctor must install a ramp at both offices. For budgetary reasons and as part of a barrier removal plan, the doctor may remove the steps at each location in different years.
If you have questions about your rights or responsibilities under the ADA, contact your local ADA Center. Each center has ADA specialists who provide information and guidance to anyone requesting ADA information. You can call toll-free at 1-800-949-4232. You can also email your local center by completing the ADA National Network’s Email Us Form (adata.org/email). All calls and emails are treated confidentially.
Content was developed by the Pacific ADA Center and is based on professional consensus of ADA experts and the ADA National Network.
1-800-949-4232
adatech@adapacific.org
https://www.adapacific.org/
The contents of this factsheet were developed under grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant numbers 90DP0081 and 90DP0086). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this factsheet do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.
