People with significant disabilities account for 12% of the population. Adults with disabilities are four times as likely as peers without disabilities to report fair or poor health1. It is well known that people with disabilities experience significant barriers to accessing needed health services.
Peacock, et al in a 2015 commentary in the New England Journal of Medicine2 describe these barriers: “Many factors may contribute …, including physical barriers to care (e.g., inaccessible medical diagnostic equipment such as examination tables, weight scales, and imaging technologies); non-inclusive health or wellness programs designed for people without disabilities; transportation problems, especially in areas with poor public transportation; inaccurate or inadequate knowledge or stigmatizing attitudes of clinicians about disabling conditions; competing priorities in the health care system; prior difficult or unpleasant experiences getting health care; and communication barriers, such as failure to accommodate deaf patients who require sign-language interpreters. The effects vary depending on the disability type: stigma, for instance, is especially problematic for people with mental health or intellectual disabilities, whereas inaccessible equipment can prevent someone with significant mobility disability from obtaining even basic services (e.g., getting weighed).”
The Disabilities Rights Education and Defense Fund has complied healthcare stories told by people with disabilities (http://www.dredf.org/healthcare-stories/videos/) that are “dispatches from the front lines of health care, [and] add an essential human dimension to a large body of research showing that people with disabilities experience both health and healthcare disparities and face specific, persistent barriers to care.” These stories are powerful reminders of how much is yet to be done to assure equal access to health services.
Reporting the results of a 2012 office accessibility survey, Mudrick et al concluded that physical barriers in exam rooms and bathrooms and in availability of accessible equipment were quite prevalent3.
The following lengthy quote is from “Americans with Disabilities Act : access to Medical Care for Individuals with Mobility Disabilities” (http://www.ada.gov/medcare_mobility_ta/medcare_ta.htm):
“Accessibility of doctors’ offices, clinics, and other health care providers is essential in providing medical care to people with disabilities. Due to barriers, individuals with disabilities are less likely to get routine preventative medical care than people without disabilities. Accessibility is not only legally required, it is important medically so that minor problems can be detected and treated before turning into major and possibly life-threatening problems. The Americans with Disabilities Act of 1990 (ADA) is a federal civil rights law that prohibits discrimination against individuals with disabilities in everyday activities, including accessing medical services. Section 504 of the Rehabilitation Act of 1973 (Section 504) is a civil rights law that prohibits discrimination against individuals with disabilities on the basis of their disability in programs or activities that receive federal financial assistance, including health programs and services. These statutes require medical care providers to make their services available in an accessible manner. This technical assistance publication provides guidance for medical care providers on the requirements of the ADA in medical settings with respect to people with mobility disabilities, which include, for example, those who use wheelchairs, scooters, walkers, crutches, or no mobility devices at all.
The ADA requires access to medical care services and the facilities where the services are provided. Private hospitals or medical offices are covered by Title III of the ADA as places of public accommodation. Public hospitals and clinics and medical offices operated by state and local governments are covered by Title II of the ADA as programs of the public entities. Section 504 covers any of these that receive federal financial assistance, which can include Medicare and Medicaid reimbursements. The standards adopted under the ADA to ensure equal access to individuals with disabilities are generally the same as those required under Section 504.
Both Title II and Title III of the ADA and Section 504 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 to individuals with disabilities, unless the modifications would fundamentally alter the nature of the services (i.e. alter the essential nature of the services).”
Resources for health care providers on accessibility of practice environments:
- ADA Information Line:
- Your Rights Under Section 504 of the Rehabilitation Act https://www.hhs.gov/sites/default/files/ocr/civilrights/resources/factsheets/504.pdf
- Disability Rights Education and Defense Fund. Training Module 4: Physical Access to Health Care. (https://dredf.org/wp-content/uploads/2014/11/Module-4-Physical-Access-to-Healthcare-10-14.pdf)
- Office of Minority Health of the Federal government, Increasing the physical accessibility of health care facilities, provides detailed guidance for health care facilities to improve accessibility4.
- This article describes the findings of a study on accessibility of medical services5. A summary of the article’s findings is available at Disability Scoop http://www.disabilityscoop.com/2013/03/19/doctors-turning-away/17518/) and a plain language summary is available at the Annals of Internal Medicine Website (http://annals.org/article.aspx?articleid=1666710)
- Accessible Health Care Series from the Center for Disability Issues and the Health Professions:
- Choosing and Negotiating an Accessible Facility Location: https://webhost.westernu.edu/hfcdhp/wp-content/uploads/2-Brief-Choosing-Location.pdf
- Health Care Facilities Access – Clinic and Out-patient: https://webhost.westernu.edu/hfcdhp/wp-content/uploads/4-Brief-Health-Care-Outpatient-Clincs.pdf
- Importance of Accessible Examination Tables, Chairs, and Weight Scales: https://hfcdhp.org/wp-content/uploads/1-Brief-Tables-Scales.pdf
- Improving Accessibility with Limited Resources: https://webhost.westernu.edu/hfcdhp/wp-content/uploads/3-Brief-Access-Limited.pdf
- Krahn, G. L., Walker, D. K., & Correa-De-Araujo, R. (2015). Persons with disabilities as an unrecognized health disparity population. American Journal of Public Health, 105(S2), S198-S206
- Peacock, G., Iezzoni, L. I., & Harkin, T. R. (2015). Health care for Americans with disabilities—25 years after the ADA. New England Journal of Medicine, 373(10), 892-893. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617620/)
- [Mudrick, N. R., Breslin, M. L., Liang, M., & Yee, S. (2012). Physical accessibility in primary health care settings: results from California on-site reviews. Disability and Health journal, 5(3), 159-167. Retrieved from https://dredf.org/wp-content/uploads/2015/02/Mudrick-Breslin-Liang-Yee-DHJO-article-V5-No3-2012.pdf.
- Singer, R.F., Dickman, I., Rosenfield, A. (2017). Increasing the Physical Accessibility of Health Care Facilities. Centers for Medicare & Medicaid Services, Office of Minority Health. Retrieved from cms.gov/About-CMS/Agency-Information/OMH/Downloads/Issue-Brief-Physical-AccessibilityBrief.pdf
- Lagu, T., Hannon, N. S., Rothberg, M. B., Wells, A. S., Green, K. L., Windom, M. O., & Lindenauer, P. K. (2013). Access to subspecialty care for patients with mobility impairment: a survey. Annals of internal medicine, 158(6), 441-446.
A medical assistant comes out from behind the counter, sees Ms. Schaeffer, and asks her very loudly and slowly for some information. Ms. Schaeffer is distressed at being addressed this way and at being asked to private information in the middle of the waiting room. She requests that they move the conversation to another room.
What should Ms. Shaeffer be able to expect concerning how medical practice staff communicate with her?