Improving Healthcare Accessibility for Patients with Disabilities

For decades, the Americans with Disabilities Act (ADA) has provided a “clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities.” Integral to the law are “strong, consistent, enforceable standards addressing discrimination,” including key public accommodations, like those that facilitate access to medical services and facilities.

The ADA specifically names “professional office of a health care provider, hospital or other service establishment” as entities required to be in compliance with the law (its full text is available here). As such, it’s of utmost importance for medical offices, hospitals and other healthcare facilities to implement the ADA in their physical spaces, policies and practices. (A factsheet from the ADA details what is meant by “providing individuals with disabilities full and equal access to their health care services and facilities.”)

And while ADA compliance improves access to healthcare, there are additional actions physicians, facilities and health systems can take to better serve patients. The need may be greater than you assume.

The World Health Organization (WHO) reports on the need for these broader efforts. It says that persons with disabilities are “three times more likely to be denied health care” and “four times more likely to be treated badly in the health care system.” As a result, it’s incredibly important to evaluate all points of access and all means of communications, including but not limited to in-person and virtual visits, websites and portals, and print communications.

In addition to ensuring that technical accessibility is addressed, a focus on these key principles can build stronger doctor-patient relationships and improve patient satisfaction and have potential to lead to better health outcomes:

• using patient-first language;
• recognizing the importance of preventive care for everyone; and
• viewing each patient as an expert in their own needs.

Removing barriers to healthcare for patients with disabilities

This fact sheet from the Health Aging Rehabilitation Research & Training Center (RRTC) pulls it all together and notes steps you can take to remove barriers and improve access. Specifically, it recommends that providers do the following:

• Obtain accessible office equipment, such as height-adjustable exam tables, scales and X-ray machines.
• Ensure that your office building complies with modern accessibility guidelines, such as having doorways wide enough for wheelchair access, appropriate ramps and elevators, and accessible restrooms.
• Check that your office’s electronic patient portals and online materials comply with modern web accessibility guidelines.
• Provide alternative communication when requested, such as a sign language interpreter or written communication.
• Recognize that patients are permitted to bring their working service animals into clinic waiting rooms, exam rooms and other non-sterile areas. Under current law, it is legal to ask what function the animal performs, but not to ask for ID or documentation.
• Provide ongoing training to your staff on how to interact appropriately with patients who have disabilities. Include topics on respectful communication, disability culture, sexual and reproductive healthcare and the importance of preventive care.
• Connect with local and national disability organizations so your staff can learn more about rare conditions and ask people with disabilities about their preferences for communication and access.
• Recognize that some patients with disabilities may have trouble paying for all of their care, even if they have insurance. Help patients to understand all of their prevention and treatment options, including relative costs. This may include comparing different treatment options or allowing for payment plans.

MLMIC encourages policyholders to address these barriers, stay current with ADA compliance and continue to seek resources that help them improve healthcare access – and healthcare information access –  for all, including individuals with disabilities, including

• “Improving Access to Care for People with Disabilities” from Centers for Medicare & Medicaid Services (CMS) Office of Minority Health;
• MLMIC’s Dateline article* on the ADA and
• MLMIC’s effective communication tips, which offer a great foundation on which to build appropriate accommodations.

* An update of note: The law no longer defines “service animal” as “dog” only as it did when this article was published in 2016. Further, patients diagnosed with post-traumatic stress disorder (PTSD) are now included in those who are permitted to have service animals.