The ADA: What is right and wrong with healthcare access

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The ADA What is right and wrong with healthcare
access

• Jacqueline Webel, OTD OTR/L
• October 27, 2009
• Washington University School of Medicine
• Program in Occupational Therapy
• Region 7 DBTAC

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Community Receptivity Enhancement Study

• Region 7 Missouri, Kansas, Nebraska, Iowa
• University of Missouri/Columbia PI Jim de
  Jong
• Information, Training, Technical Assistance
• Washington University Research PI David Gray
• Research projects to address to address community
  receptivity and increase participation of people
  with disabilities

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Objectives

• Determine the features that are most important to
  persons with disabilities for their participation
  in healthcare.
• Evaluate the relationship between the features
  important to people with disabilities and the
  features included in the ADA Accessibility
  Guidelines.
• Analyze potential changes to the ADA to improve
  health care access for persons with disabilities.

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Healthcare Access

• Decreased use of adequate care
• Limited preventative services
• Substantial consequences
• Reduced community integration
• Decreased quality of life
• Increase health care costs
• Delay of services
• Negative changes in social participation

(Diab Johnson, 2004 Iezzoni,McCarthy, Davis
Siebens, 2000 Iezzoni ODay, 2006 Nosek
Howland, 1997 Fouts, Andersen Hagglund, 2000
Drainoni, 2006 Neri Kroll, 2002).
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Physical Environment

• Substantial proportion of physicians offices not
  in compliance with the Americans with
  Disabilities Act (ADA) regulations
• Approximately 20 of physicians reported not
  being able to serve patients due to ADA related
  barriers (Grabois, Nosek, Rossi, 1999)
• Barriers to care
• Inaccessible offices
• Inaccessible or non-adaptive equipment

(Center for Research on Women with Disabilities,
2006 Kroll, Jones, Kehn Neri, 2005 Drainoni
et al., 2006 Morrison, George Mosqueda, 2008
Story, Schwier Kailes, 2009)
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ADA and Healthcare

• Title II Equal Access to Programs and Services
• Medicaid, Medicare or other Federal Funding
• All public entities
• Title III Private Office and Private Hospitals

(www.ada.gov, 2009 Pendo, 2009)
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Accessibility Guidelines

• Medical facilities, hospital outpatient
  facilities, rehabilitation facilities
• Patient rooms
• Visitor parking
• Passenger loading zones
• Signs
• Means of egress

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Research Questions

• How accessible do people with disabilities think
  health care facilities are?
• What are the physical features of health care
  facilities that persons with disabilities think
  are the most important for their participation
  there?
• Are these features addressed in the ADA
  Accessibility Guidelines?

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(No Transcript)
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Study Design
County M (n21)
County S (n 43 )
45 eligible
County C (n 16)
28 completed
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Survey

• Survey of Participation and Receptivity in
  Communities Doctors Offices (SPARC-DO)
• Personal
• Evaluative
• Environmental
• Support
• Physical factors
• Interpersonal

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Survey Additions

• Questions added to measure presence v. importance
  
• Example
• 26a. Does your doctors office have an accessible
  check in and checkout area?
• ? Yes ? No ? Do not know
• 26b. For you to participate at your doctors
  office, how important is an accessible check-in
  and check-out area?
• ? Not important ? Somewhat important ?
  Important ? Very important ? N/A

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Survey Participants

• Age
• Range 24 100
• Mean 60.5
• Median 64.5
• Race
• 89 (n25) White
• 7 (n2) American Indian
• 3.6 (n1) Black/African American
• Gender
• 75 (n21) Female

• Primary impairment
• 43 (n12) Physical
• 43 (n12) Vision
• 14 (n3) Hearing
• Support
• 75 (n21) use assistive technology
• 53.6 (n15) use help from others

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Evaluative Experience

• Importance
• 75 responded important or very important
• Choice
• 43 responded no choice or little choice
• Control
• 68 had some control or a lot of control
• Satisfaction
• 82.2 satisfied or very satisfied

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AccessibilityHow accessible is your doctors
office?
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Physical Features

• Least often present
• Accessible phone (29)
• Minimal background noise (25)
• Designated area of rescue assistance (25)
• Signage for accessible features (36)
• Loaner assistive device (39)
• Accessible weight scale (50)

• Most often present
• Flat sidewalk (96)
• Adequate lighting (96)
• Level entrance or ramp (93)
• Wide clear aisles (93)
• Accessible parking (89)
• Accessible bathroom (85)

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Presence v. Importance

• Mobility
• Covered pick up and drop off area
• Automatic or lightweight doors
• Height-adjustable exam table
• Vision
• Accessible directories
• Braille or large print forms
• Hearing
• Minimal background noise
• Closed captioning on television in waiting area
• Accessible phone (TTY)

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Meetings

• Stakeholders Meetings
• One meeting held in each of 3 Counties in
  Midwestern State
• County M (n9)
• County S (n38)
• County C (n8)
• Discussed positives, negatives, and solutions
• Transportation
• Physical Accessibility
• Provider Interactions
• Participation in Clinical Services

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Meeting Results

• Transportation
• No transportation available for short notice
  appointments
• Physical Accessibility
• Difficult to get on exam table, steps are
  dangerous
• Provider Interaction
• Attitudes of healthcare professionals can be
  negative
• Participation in Clinical Services
• Long wait time is difficult for people with
  fatigue

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Survey Meeting

• Frequent Barriers
• Height-adjustable exam tables
• Accessible directories/signage
• Accessible forms
• Automatic doors

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The Good News

• The features that are most often present in
  healthcare facilities are also covered in the ADA
  Guidelines
• Features that allow access into building
• Flat sidewalk (96)
• Adequate lighting (96)
• Level entrance or ramp (93)
• Wide clear aisles (93)
• Accessible parking (89)
• Accessible bathroom (85)

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The Not-So-Good News

• Features that were mentioned as not present or
  inaccessible are in ADA Guidelines
• Accessible phone, signage, covered pick up area,
  automatic/lightweight doors, large print forms
• Not being implemented?
• Not creating accessible environment?
• Features that are important for participation in
  clinical services not present
• Accessible weight scale, height-adjustable exam
  table, minimal background noise
• Not explicitly described in ADA

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Priority Areas

• Beyond basic access
• Examine how guidelines enable participation in
  specific environments
• Create guidelines based on desired clinical
  outcomes
• Educate and empower
• Consider universal application
• Remember overall intent of ADA

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Pending Guidelines

• Promoting Wellness for Individuals with
  Disabilities Act

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• Thank you!
• Questions
• Jacqueline Webel OTD OTR/L
• webelj_at_wusm.wustl.edu