The Americans with Disabilities Act (ADA) is a civil rights law that does or has the potential to, affect your practice.
What is your understanding of the ADA, and how much do you know about it?
But first, what is it?
The ADA, enacted in 1990, is a federal law that prohibits discrimination based on disability in:
- Employment
- Transportation
- Public accommodations
- Communications and
- Access to government programs and services.
The goal is to ensure that people with disabilities have the same access and opportunities as everyone else.
According to ADA.gov, “all types of businesses that serve the public, regardless of their size or the age of their buildings, must follow the ADA.”
The general requirement is that businesses provide everyone with the same opportunity to access their goods or services.
Medical providers, including dentists, nurse practitioners, and physicians, are covered and fall under public accommodations.
Please Note…
Before I continue, let me be clear that I am not an attorney, and this article is in no way legal advice. I am simply providing you with information as I understand it. Please consult a legal professional for advice and guidance, as the ADA requirements can be complex.
Let’s get back to our conversation with that out of the way.
Even though I want to highlight one specific aspect of the ADA (online accessibility), I want to briefly discuss the major areas covered under the law and how they might affect your practice.
Physical Accessibility
1. Removing Architectural Barriers: Practices must remove physical barriers where it is “readily achievable,” meaning easily accomplished without much difficulty or expense. This includes installing ramps, widening doorways, installing grab bars in bathrooms, and ensuring accessible parking spaces.
If you own your office space, you will need to make any necessary adjustments. However, if you are leasing space, your landlord may make adjustments, such as removals or additions, in common areas, whereas you may be responsible for changes to your space (consult your lease).
2. Accessible Medical Equipment: Examination tables, scales, and other medical equipment must be accessible to patients with disabilities. This requirement should be considered when purchasing or leasing equipment.
Reasonable Accommodations
1. Joint Decision-Making: Providers and patients must jointly determine reasonable accommodations to ensure equitable care. This may include modifying policies, practices, and procedures as necessary. For example, you will accommodate service animals in your practice, while you do not allow pets to accompany patients.
2. Non-Discrimination: Practices cannot refuse to treat patients because of their disabilities and must provide services in a non-discriminatory manner. Ensure you are familiar with the requirements under the ADA and how you can accommodate someone with a disability.
Employment Practices
Employment Compliance: If a practice has 15 or more employees, it must comply with ADA employment regulations, which include non-discrimination in hiring and providing reasonable accommodations for employees with disabilities.
Legal and Financial Responsibilities
1. Shared Responsibility: As mentioned earlier, landlords and tenants are responsible for ADA compliance in leased buildings. Typically, tenants are responsible for their specific spaces, while landlords handle common areas, such as parking, elevators, and shared waiting areas.
2. Cost of Accommodations: The practice, not the patient, is responsible for the cost of reasonable accommodations and accessibility modifications.
Training and Policies
1. Staff Training: Staff must be trained in ADA requirements and what constitutes reasonable accommodation for patients.
Training should include best practices for interacting with patients with disabilities. This ensures that everyone understands their obligations under the ADA and knows how to provide effective and respectful care to all patients.
2. Policy Adjustments: Practices may need to modify their policies, practices, or procedures to accommodate patients with disabilities unless doing so fundamentally alters the nature of the service provided.
For example, a practice might need to allow a service animal in the office or provide additional appointment time.
Availability of Assistance & Resources
1. Awareness of Resources: Practices should be aware of and utilize resources available to help them comply with ADA requirements. This includes consulting with ADA specialists, utilizing government resources, and engaging with disability advocacy groups for guidance and support.
2. Tax Incentives: Small businesses, including medical practices, may be eligible for tax incentives to offset the costs of making ADA-compliant modifications. These incentives could make it possible for small practices to make the necessary adjustments.
Effective Communication
1. Auxiliary Aids and Services: Practices must provide aids and services such as sign language interpreters, large print materials, and assistive listening devices to ensure effective communication with patients with hearing, vision, or speech disabilities.
While patients may bring a family member to help interpret, this may not always be an option or desirable, and a third-party interpreter may be required.
2. Website Accessibility: Medical practice websites must be accessible to individuals with disabilities. This includes providing text that can be read by screen readers, offering options to adjust font sizes, and ensuring videos have closed captions.
Since the web didn’t exist in the 1990s, it wasn’t explicitly covered under the original law. However, that has changed, and web accessibility today is required.
Importance of Web Accessibility
As most communications are online, web access is becoming increasingly important. Most of us don’t give it a second thought and take it for granted.
However, for people with visual impairments, accessing and using the web can be challenging; they must rely on screen readers and other assistive devices to utilize the web.
Screen readers help people who are blind or have limited vision access and interact with digital content on a computer or smartphone by reading the content of a webpage.
Screen readers can read text aloud and notify users of the following:
- individual elements on the screen, such as images and buttons
- the structure of a page, such as menus, headings, or the presence of column and row headings in a table
- the presence of fields for input of data, i.e., entering an email address
And here lies the challenge…
Tools like screen readers and text-to-talk software rely on properly formatted text to understand the words on the page.
Look at these two one-minute videos to gain a sense of the challenge.
Understanding Assistive Technology.
As you can see, a webpage is like a blank page without proper formatting. While there might be great content on the page, it can’t be consumed by the visually impaired user.
The Challenge…
How can you ensure your practice website is accessible to all users?
Whether you maintain your website or have someone else do it, keep the following considerations in mind.
Create your web pages with a clear structure:
- use distinct and clear navigation menus and links
- organize text on the page with headings and subheadings
- clearly identify fields for data input
Use high-contrast colors, such as solid black text against a white background over muted colors.
Use a bigger font size for all text.
Describe the purpose of hyperlinks before linking to them, i.e., instead of saying “Click Here,” say “Click here to book your appointment now.”
Underline hyperlinks with a high-contrast color to make them stand out.
Describe images on your page with meaningful Alt-text that conveys the message or the picture.
Keep the text on your web pages clear and to the point.
Keep the language simple and easy to understand.
Whether you use Microsoft or Apple software, use the built-in accessibility checkers to review and improve your web pages.
In Summary…
Regardless of size, all medical practices are obligated to provide accessible and non-discriminatory care to patients with disabilities.
Due to their more significant resources, large practices are expected to provide more extensive accommodations, make more substantial structural modifications, and offer a wider range of auxiliary aids and services.
Small practices are still required to comply with the ADA, but with considerations for their limited resources, potentially allowing for less extensive accommodations and modifications.
By adhering to these requirements, small medical practices can ensure they provide accessible and equitable care to all patients while also minimizing the risk of non-compliance penalties.
I hope you find the article informative and thought-provoking. Let us know what you think, we’d love to hear from you… Share with us what YOU will do to improve the accessibility in your practice.
By Johanna Hofmann, MBA, author of “Smart Business Planning for Clinicians” and regular contributor to the NPBusiness blog.