ADA: Physical Facilities

March 1, 2010 | Health System Risk Management


Individuals with disabilities are the largest healthcare consumer group in the United States, accounting for 291.1 million people in 2005 and representing 18% of the population, according to the U.S. Census Bureau (U.S. Census Bureau). Of all people with disabilities, 32.5 million, or 12% of the total population, have a severe disability. Individuals with disabilities tend to be in poorer health and tend to use healthcare services at a significantly higher rate than those without disabilities, yet they continue to be disproportionately affected by barriers to healthcare, despite the enactment of the Americans with Disabilities Act (ADA) in 1990 and its regulatory requirements and standards. ADA was enacted to combat, among other things, the discriminatory effects of architectural, transportation, and communication barriers on people with disabilities.

The National Council on Disability (NCD), in The Current State of Health Care for People with Disabilities, its 2009 report to the president and Congress, stated that “significant architectural and programmatic accessibility barriers remain, and health care providers continue to lack awareness about steps they are required to take to ensure that patients with disabilities have access to appropriate . . . care.” The NCD report made numerous recommendations to spur healthcare providers to improve access for individuals with disabilities. The recommendations included calling for accreditation bodies to evaluate healthcare institutions based on the extent to which they offer minimum architectural accessibility in accordance with the ADA Accessibility Guidelines for Buildings and Facilities (ADAAG), establishing mechanisms for ensuring that programmatic accommodations (e.g., height-adjustable examination tables, wheelchair-accessible weight scales, lifting assistance, materials in alternative formats) are provided, and calling for healthcare institutions to implement grievance procedures that ensure that people with disabilities can resolve problems with accessing healthcare in a timely manner.

This Risk Analysis focuses primarily on the physical barriers that places of public accommodation must modify or eliminate in order to reasonably accommodate employees, residents, and invitees with disabilities, according to ADA Title III (42 USC §§ 12181-12189). Title III prohibits “any person who owns, leases (or leases to), or operates a place of public accommodation” from discriminating against individuals “on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation.” Title III requires, among other things, that such facilities be designed, constructed, and altered in compliance with accessibility standards established under the act, as set forth in regulations issued by the U.S. Department of Justice (DOJ) (28 CFR Part 36). Under Title III, a “public accommodation” is any facility that affects commerce, including most hospitals, nursing homes, physician offices, continuing care retirement communities, recreation facilities, barber and beauty shops, schools, restaurants, stores, pharmacies, day care centers, social service centers, senior citizen centers, libraries, and transportation services (e.g., shuttle buses), among many others that fall within any of 12 categories of facilities whose operations affect commerce.

The scope of this discussion is limited to federal accessibility requirements of Title III and does not address the various state laws, regulations, and building codes that are intended to prohibit discrimination against individuals with disabilities. As long as such state and local laws, building codes, and regulations do not conflict with ADA, affected entities must follow both. In the event of...

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