When it comes to the Americans with Disabilities Act (ADA), there are a lot of questions and a lot of unclear answers. As a place of business, what is your practice responsible for? What are your patients entitled to? How do you know if you are in compliance with all the tenets of the ADA?

First, a few basic questions. Did you know:

That people with disabilities make up the largest minority in America?

That people with visual disabilities are protected from discrimination under the Americans with Disabilities Act?

That all places of business (including optometry offices) must comply with the Americans with Disabilities Act?

Why January 26, 1992, is an important date for ADA compliance?


Whats It All About?

The ADA is a federal civil rights law that was signed by former President George H.W. Bush on the White House lawn on July 26, 1990. It was intended to provide civil rights protection to people with disabilities and special needs.

The ADA is a complaint-driven lawif a person with a disability feels that he or she is being discriminated against by a business because that person cant enter and participate, he or she can file a complaint with the Civil Rights Division of the U.S. Department of Justice (DOJ), or that person can file a private lawsuit in federal court. The resulting fines, from either the DOJ or the courts (not to mention the legal fees), can be much greater than the cost to adequately accommodate patients with disabilities.

The provisions of the law went into effect on January 26, 1992, at which time all existing public entities had to begin the process of readily achievable barrier removal. Every business needed to examine its facilities, determine any possible barriers to any person with a disability, and begin the process (which is still ongoing) of removing these barriers to entrance and participation.


Whom Does It Affect?

When the ADA was passed, there were a reported 43 million Americans with disabilities. Since then, this number has risen to more than 54 million. These Americans report having a disability that impacts their ability to care for themselves or others.

Thats a pretty staggering number of Americansand any of these individuals could be your patients. The 2000 U.S. Census found that 41.9% of adults 65 years and older identified themselves as having a disability. And, according to the American Association of Retired Persons (AARP), 4 million Americans turn 50 each year. After age 50, adults are more likely to experience age-related physical changes that may affect their hearing, vision, cognitive abilities and mobility. This patient group is here and growing. Are you able to accommodate them?

Be Conscious of Your Actions

Look at how you interact with patients, family members and others. Although few people would admit to intentionally discriminating against someone with a disability (Who would openly say, I dont want those people in my practice?), subtle actions can be just as harmful.

Make sure that you and your staff DONT:

Raise your voice to someone with a visual disability, unless he or she also has hearing impairment.

Lean on someones wheelchairit is part of both his or her person and personal space.

Stand over patients in wheelchairs when youre talking with them. Instead, sit down next to them or move a few feet back so they dont have to strain their necks to look up at you.

Talk to the persons companion, family member or friend and not directly to the person with the disability (unless, of course, they are not capable of interacting with you). Unfortunately, many people seem to believe that a physical or sensory disability affects the individuals ability to think or speak as well.

Of course, all businesses (after all, a practice is a business) want to welcome everyone they can. All medical practices must comply with the ADA as a federal law. But, is your practice ADA friendly? Making sure that your facility is user friendly to people with disabilities ensures that everyone, including parents pushing strollers, seniors, and those with disabilities, can enter and take advantage of the care you offer.


What You Should Do

If you havent done an ADA barrier removal evaluation on your property since January 1992if you just bought a new building, for exampleits not too late to start.

Obtain and follow the advice of someone who knows ADA requirements; building and design professionals may consider it a building code rather than a civil rights law. Although the ADA does impact the construction or renovation of the building, it is more than just a code.

Begin the evaluation by documenting any physical barriers, such as steps, doors that are too narrow, doors that are too heavy, non-adjustable exam chairs or counters that are too high. Create and implement a plan to remedy such barriers through renovation or purchase of new equipment.

If you do not own the building, discuss such requirements with your landlord, who is obligated to comply with the ADA in common areas, such as rest rooms.

Request that your accountant or bookkeeper include these costs during tax time, as the IRS has made provisions for tax credits for barrier removal. (For more information, visit www.ada.gov/taxpack.htm.)

As you make changes, be sure to document them. And, if you renovate or build a new facility, make sure that all design and construction professionals fully understand the ADA requirements. Be sure to ask for references from the designers or contractors other customers.


More Than a Ramp

Barriers to people who have disabilities are not limited to the physical environment. Take care to look at your policies and procedures to make sure that someone with a disability is not excluded or separated from all treatment options available to non-disabled patients. For example, do not select an alternate or secondary treatment facility location, albeit one that is accessible, and require that patients with disabilities go there for treatment. Unless everything that is available at your main location is also available at the alternate location, this can be construed as discrimination.

Breaking Down Barriers

Many barriers in the built environment are simply overlooked by the general public. Here are some common barriers that prevent (or make it very difficult) for individuals with disabilities to enter and be treated in your practice.

Getting to the door: Steps are the biggest barrier. Even one step is too high for anyone using a wheelchair (or most people using walkers) to climb. Dont offer to carry people up the steps. This is not only prohibited as a means of access under the ADA, but it is unsafe for the people carrying the person and the person being carried. Instead, install a ramp that meets ADA specifications. Do not allow a ramp that is too steep; that can be just as hazardous.

Getting in the door: Narrow doorways (less than 32 wide), revolving doors and very heavy doors are all barriers. Instead, widen the doorway, replace a heavy door with a lighter one, or loosen the tension of the hinge.

Inside the practice: Other barriers are counters that are too high (higher than 36) and exam rooms that are too small for someone in a wheelchair to enter or transfer to the exam chair. If you have more than one exam room, pick your largest one and provide the space for wheelchair users to get examined from their chair, or to get their wheelchair close enough to transfer to your fixed exam chair.
For patients with hearing disabilities (either hearing impaired or deaf), you may face unique and significant challenges in meeting their needs. First, ask what type of accommodation the patient/family member needs in order to receive effective treatment. They may choose to use a pen and paper or a nearby computer. If the patient or family member of the patient (who is integral to your treatment of your patient) requires a sign language interpreter, the ADA requires that you not only provide a qualified interpreter, but also pay for the interpreters service. Do not rely on someone who is not competent in sign language or ask the family member to serve as the interpreter.

Many patients are losing their sight from diabetes, macular degeneration or other medical conditions. Reading materials, such as insurance forms or other records, may be too difficult for them to see. If you have those documents on your computer network, you have two simple options: Enlarge the print or copy the documents onto a CD for the patient to view on his or her home computer, or record the documents onto a cassette or CD so that anyone with limited vision, limited reading ability or English as a second language (ESL) will be able to listen to it. The same can be done for instructions given to patients.


What Not to Do

Dont think that because youve never had someone in your practice with a disability that you dont have to worry about the ADA. If there are access barriers to your practice (like steps), that may explain why you havent had patients with mobility impairments, or why some of your older patients have stopped coming. Instead, have an evaluation of your practice and develop a plan to modify such physical barriers as necessary.

Dont think that because no one has yet filed a complaint that youre off the hook. The ADA is a federal civil rights law that can be enforced at any time.

Dont think that because you didnt know anything about the ADA that you cant be held culpable. Its no more effective an excuse than trying to explain to the IRS that you didnt know you had to pay taxes.

Dont be afraid to welcome patients with disabilities into your practice. They will be the best and most loyal patients you have, and they will be the best referral source for new patients. Word of mouth is powerful, and when word gets out that you are an ADA-compliant, considerate practitioner, youll be opening your practice to patients who need the care that you provide.

If you look at the ADA as an opportunity, you will learn that opening your practice to everyone is not just the right thing to do; its the smart thing to do.

Ms. Stein is the president and CEO of Accessibility Development Associates, Inc. (ADA, Inc.), a national ADA consulting firm based in Pittsburgh. She is a nationally recognized expert on the ADA and speaks to a wide array of professional organizations across the United States. Contact her at jwstein@adaconsults.com.

Vol. No: 146:02Issue: 2/15/2009