From Family Physician to ICU: Access to Health Care Is Critical

Volume 13
Number 2

The United States has one of the most advanced and sophisticated health care systems in the world. Extensive networks of highly qualified practitioners provide diagnoses, treatments, and therapies in offices, clinics, and hospitals across the country. A vast array of modern medications, tools, and equipment is available to support their efforts.

Yet patients who are deaf continue to struggle to find providers who will take the steps necessary to communicate effectively with them. People who use wheelchairs find it difficult to locate accessible facilities where they can obtain even the most basic preventative screening services. People with developmental disabilities are routinely excluded from mental health research studies and treatment options.

Although the ADA requires health care programs provided by state and local governments, as well as most private health care businesses, to ensure that people with disabilities have appropriate access to their services, there are some unique challenges related to health care services and facilities.

Communication is Crucial

Effective communication is always essential when people interact with businesses or agencies. When it comes to interactions that involve life and health, though, the communication may be more complex. Additionally, the stakes are simply higher.

Communication, by nature, is a two-way street. It cannot be effective unless each party understands and is understood. A patient might understand and follow his doctor’s advice perfectly, but the advice may be flawed if the doctor misunderstood what her patient tried to express. Likewise, the doctor may give her patient the right instructions, but the patient may not be able to follow them if he doesn’t understand them.

Communication with family members or others is often just as essential as communication with a patient. Health care providers routinely engage parents of minor children, spouses, or adult children of elderly parents in the treatment of their loved ones. These allies must not be excluded merely because they have disabilities.

Communicating with many people with disabilities will not be any different than communicating with others. Some individuals, however, may need to be given a little more time and consideration. Still others, particularly those who have impairments that specifically affect communication (such as hearing, speech, and vision disabilities), may need to utilize alternative methods or tools to communicate.

Such “auxiliary aids or services” may include written notes and printed materials, materials in alternate formats (e.g., large print, Braille), assistive listening devices, and the use of interpreters.

Health care providers covered by the ADA must provide auxiliary aids and services when they are necessary for effective communication, as long as the provision of such aids or services does not fundamentally alter the nature of the health care service or impose an undue burden (a significant difficulty or expense) on the provider.

When auxiliary aids or services are requested, providers must first determine if they are needed, based on their knowledge of the nature of the communication that typically takes place within the context of the service to be provided. Providers should consult with the individual making the request to determine the individual’s needs and preferences (state and local government providers must give primary consideration to the preference of the individual).

Facilities and Equipment

Inaccessible facilities and equipment also interfere with the provision of quality health care, particularly for people with mobility limitations.

Providers should assess their facilities to identify barriers, removing them wherever possible. Accessible equipment, such as adjustable height exam tables or scales that can weigh individuals who use wheelchairs, is an excellent addition to any medical facility. Not only can it increase the quality of care provided to patients, it can help reduce the risk of injury that can affect both patients and staff when such equipment is not available.

Tax Incentives

Tax incentives are available in some cases to help offset the costs associated with removing barriers or providing auxiliary aids or services.

An “Architectural/Transportation Tax Deduction” of up to $15,000 can be used for the expenses of removing barriers in existing facilities or vehicles.

The “Disabled Access Tax Credit” is available to small businesses, and can be used to offset a portion of money spent on removing architectural barriers or providing auxiliary aids or services.

The Department of Justice has more information on tax incentives for businesses.

The contents of this newsletter were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research. NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this newsletter do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the federal government.

© 2008 TransCen, Inc.