The Future of Disability in America (2007) / Chapter Skim
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6 The Environmental Context of Disability: The Case of Health Care Facilities
6 The Environmental Context of Disability: The Case of Health Care Facilities
Pages 162-182
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From page 162... ...
report Disability in America particularly stressed the role of environmental barriers in contributing to disability. Indeed, the report defined disability as reflecting "a gap between a person's capacities and the demands of relevant, socially defined roles and tasks in a particular physical and social environment" (IOM, 1991, p.
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From page 163... ...
Still, growing numbers should mean a larger market for accessible products and an increasing demand for accessible environments. Part of the charge to the IOM included examination of the role of assis
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Furthermore, the discussion reflects value judgments, particularly the judgment that certain types of environmental barriers should be reduced or eliminated as a matter of fundamental equity, even if many people with chronic health conditions and impairments have demonstrated resiliency, persistence, and creativity in finding ways around such barriers and living full lives despite them. RESEARCH ON THE ROLE OF THE ENVIRONMENT IN DISABILITY As described in Chapter 2, the ICF systematically categorizes and codes features of the environment that may support or impede health and functioning (WHO, 2001)
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1 THE ENVIRONMENTAL CONTEXT OF DISABILITY limb)
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Male manual-wheelchair user with spinal cord injury All cited in Kailes (2006) As used here, physical access refers to features of individual facilities rather than to the geographic distribution of facilities, which is also an important issue for people with and without chronic health conditions or impairments.
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For further discussion, see Appendix F of this report. SOURCE: Center for Universal Design and North Carolina Office on Disability and Health (undated)
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More than 90 percent of people with vision problems did not receive medical information in alternative formats. A second survey of approximately 400 people nationwide, which was conducted by the Rehabilitation Engineering Research Center on Accessible Instrumentation, found that respondents identified physical examination tables, radiology equipment, exercise and rehabilitation equipment, and weight scales as the most difficult-to-use equipment in health care settings (Winters et al., 2007)
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From page 169... ...
Another chapter focuses on communications issues, some of which relate to access to information but others of which relate to the knowledge, sensitivity, and respectfulness of health care professionals and support staff and to their ability to see situations "through a patient's eyes." Studies of the use and underuse of health care services by people with disabilities generally do not directly assess the effects of physical access problems. Underuse of services may be due to a number of environmental factors in addition to physical access, including a lack of adequate health
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. People with a probable disability were, however, more likely than others to report a usual source of care and health insurance coverage, characteristics that usually predict increased use of preventive services.
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. Architects, engineers, and health care professionals use that document in the planning or renovation of health care facilities; and state and federal agencies and the Joint Commission for the Accreditation of Healthcare Organizations use the document as a guide or standard for the review of construction plans or completed facilities.
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The argument for allowing monetary damages is that such penalties create stronger incentives for compliance with the law than allowing only injunctive relief. As noted above, the Rehabilitation Act of 1973 created the Access Board, which develops and enforces the ABA minimum accessibility guidelines for federal agencies.
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would provide an important supplement to the health care facility standards issued by the Access Board. After passage of the ADA, the Access Board published the first ADA Accessibility Guidelines in 1991.
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Instead, the general nondiscrimination provisions of the statute, which prohibit exclusion, segregation, and unequal treatment, offer an avenue for claims related to inaccessible medical equipment. Several high-profile settlements negotiated by the U.S.
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For example, as described in the VA document, the standards for showers barely allow the entry of a person in a wheelchair and do not allow maneuvering of the wheelchair or room for other people to provide assistance to the user. For that reason, many of the VA's guidelines for its own facilities differ from those prepared by the Access Board.
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In that settlement, the organization agreed to provide accessible medical equipment in its facilities (37 medical centers and 282 medical offices in California) , survey its facilities and policies for barriers and remove such barriers or review policies, and provide appropriate staff training (Levine, 2005)
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meet ADA accessibility standards (including having an acces sible toilet room) ; 35 of 600 rooms to be made accessible within 5 years • Purchase adjustable-height beds for the accessible inpatient rooms • Hold the accessible rooms for patients with disabilities, unless hospital is operating at full capacity • Provide each department with at least one accessible examination table • Survey all equipment and purchase equipment needed for accessibility (e.g., examination tables and chairs, lifts, wheelchair-accessible weight scales, and radiology equipment)
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From page 178... ...
Chapter 7 includes recommendations on assistive and accessible technologies as features of the environment, and Chapter 10 presents a recommendation for additional research on interventions to reduce environmental and other factors that contribute to activity limitations and participation restrictions. Policies related to research and science and technology generally are not mentioned in the ICF classification scheme, but they, too, are part of the environmental domain of services, systems, and policies.
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. Improving the Accessibility of Health Care Facilities On the basis of available literature and the committee member's collective experience as health care professionals and health care consumers, the committee concludes that inaccessible equipment, deficits in communication, and burdensome and inaccessible health care physical plants remain commonplace and create significant barriers to the receipt of timely, highquality health care by people with disabilities.
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Congress should direct the Archi tectural and Transportation Barriers Compliance Board (the Access Board) • to develop standards for accessible medical equipment to be sup ported with technical assistance and with dissemination and enforce ment efforts by the appropriate federal agencies and • to collaborate with the U.S.
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Department of Justice, many other public and private organizations have roles to play in promoting adherence to accessibility standards in health care facilities as critical elements of the quality and safety of patient care and the rights of patients. For example, the Joint Commission (formerly the Joint Commission on the Accreditation of Healthcare Organizations)
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Department of Veterans Affairs and others to examine this question and to determine whether certain ADA accessibility guidelines and standards should be revised as they apply to health care facilities. The next chapter goes beyond the consideration of health care facilities and considers more generally the design of accessible technologies, the principles of universal design, and the importance of accessibility in "mainstream" technology that is not intended specifically for people with disabilities.
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