How can a health care facility
determine whether its premises are accessible to people who use
wheelchairs or other mobility devices? What steps must they take
to provide access?
These are some common sense approaches medical and health care facilities
can use to determine whether their premises are accessible.
After determining whether "getting through the door" is possible,
facilities should determine whether aisles between office furniture
and equipment are wide enough for a person using wheelchair or other
mobility devices to pass. Examination, treatment, and dressing room
doorways must also be wide enough for individuals using wheelchairs
or other mobility devices. (See earlier question for information
about doorway widths.)
Widening doors and rearranging furniture and storage items are examples
of methods to provide access that will be readily achievable for
most health care facilities.
Registration and patient interview areas with built-in counters
should be evaluated to determine whether individuals using wheelchairs
can use them. If readily achievable, accessible counters (28 to 34
inches high with knee spaces at least 27 inches high, 30 inches wide,
and 19 inches deep) must be made available. If it is not readily
achievable to provide accessible counters, then alternative measures
must be taken to provide access, such as providing a table or a clipboard
that patients and clients can use while filling out forms.
Facilities should also evaluate whether there are level changes
between treatment and service areas. For most health care facilities,
providing a ramp for one or even several steps is a readily achievable
measures to provide access. If it is not readily achievable to install
a permanent ramp, then a facility must use a portable ramp if it
is safe and readily achievable.
What assistance must health care facilities provide for
patients and clients who use wheelchairs or other mobility devices
to ensure equal and effective treatment and services?
Individuals with mobility impairments often find it difficult or
impossible to use certain standard equipment found in medical and
health care facilities. For example, people who are not ambulatory
cannot use standard-height examining tables.
Therefore, health care providers cannot conduct certain examinations
that require patients to lie prone or supine unless the individual
is lifted onto the table. Such measures can be unsafe, embarrassing,
and undignified for many patients. Although people who use wheelchairs
or other mobility devices area not often affected by this particular
barrier to treatment, older patients and others who are semi-ambulatory
also can experience difficulty.
An adjustable-height examining table is an ideal solution if it
is readily achievable to obtain one. Such tables can be lowered to
the height of a wheelchair seat, thus enabling some patients who
use wheelchairs to move independently or with minimum assistance
from their wheelchairs to the table and back again. The adjustable
feature also allows medical or health care personnel to elevate the
table to a comfortable height to conduct an examination. A group
of physicians could purchase such a table and make arrangements to
share its use.
If it is not readily achievable to obtain such a table, facilities
must obtain an inexpensive, padded table the height of a wheelchair
seat for use by patients who cannot use the conventional tables.
This type of low table can be used for some examinations of patients
who do not have disabilities.
If neither of these options is readily achievable, then medical
and health care facilities must provide assistance to help patients
onto the high tables, including lifting them if necessary. Such measures
must be undertaken in a safe manner to avoid injury to both the health
care personnel and the patient and to preserve the dignity of the
patient as much as possible.
Similarly, health care facilities must provide such assistance to
patients with mobility impairments who are having radiology exams
or other tests conducted on surfaces that cannot be adjusted for
height or that are inaccessible in some other way.
In all of these situations, medical and health care personnel should
follow the instructions and preferences of the patient with regard
to lifting or providing other assistance.
Modifications to the manner in which certain examinations are conducted
are also required. For example, some X-ray equipment used to take
mammograms is built so the patients must stand to have the X-ray
taken. Other mammogram equipment requires the patients to sit on
a wheeled stool with a swivel seat. In both, situations, a woman
with a disability that prevents her from standing or sitting safely
on such a stool would not be able to undergo the X-ray examination.
Replacing the stool with a stable chair or allowing the patient
to undergo the examination from her wheelchair are appropriate methods
of providing access. Medical and health care facilities must provide
assistance to undress and dress as needed or requested by patients
with disabilities unless doing so fundamentally alters the services
provided.
If they have a blanket policy prohibiting individuals other than
patients in examination or treatment facilities, medical and health
care facilities must modify the policy to allow a family member,
friend, or personal care assistant to accompany a patient or client
when necessary during the examination or treatment. |
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