Improving Accessibility With Limited Resources

Improving Accessibility With Limited Resources

 

Updated 11.20.04

June Isaacson Kailes MSW, Associate Director
Christie Mac Donald MPP, Senior Policy Analyst
Center for Disabilities Issues and the Health Professions
Western University of Health Sciences
309 E. Second Street, Pomona, CA 91766
Voice-909.469.5213/TTY-909.469.5520, Fax 909.469.5503, ahcs@westernu.edu

Contents of this briefing

Other briefs

Introduction

The Americans with Disabilities Act (ADA) requires that public accommodations make their facilities, goods and services accessible for all people with disabilities. Title III of the ADA specifically covers privately operated medical and health care facilities, including those located in private homes. Examples of health care offices include: hospitals, urgent care, doctors, dentists, optometrists, physical therapy, chiropractic, psychiatrists, and others.

Barrier Removal: A Continuing Obligation

The ADA requires companies providing goods and services to the public to take certain limited steps to improve access to existing places of business. This mandate includes the obligation to “remove barriers from existing buildings when it is readily achievable to do so.” Readily achievable means, “easily accomplishable and able to be carried out without much difficulty or expense.” 1

The ADA establishes different requirements for existing facilities and new construction. However, while it is not possible for many existing small businesses to make their facilities fully accessible, much can be done without difficulty or expense to improve accessibility. 2

Readily achievable barrier removal is a continuing obligation. Barrier removal that was not readily achievable initially may later be required because you have more resources available. Therefore, you must continually monitor its accessibility as well as its financial and other resources and engage in barrier removal as new measures become readily achievable. It is also important to remember that when they move to new facilities accessibility features of the new location need to be a very high priority. 3

Determining if a barrier removal is “readily achievable” is, determined on a case-by-case basis. The “readily achievable” requirement is based on the size and resources of the business. Barrier removal is an ongoing obligation — you are expected to remove barriers in the future as resources become available. 4

Accessibility Guidelines

The Americans with Disabilities Act Accessibility Guidelines (ADAAG) issued by the Access Board can serve as a guide for identifying the various kinds of measures that can be taken to remove barriers and as a guide for how best to remove them. 5

Priorities for Barrier Removal

When funds are not available to remove all existing barriers, the Department of Justice (DOJ) recommends an order of priorities for barrier removal:

  1. Provide access from public transportation, parking areas, sidewalks, and entrances to the public accommodation so a person with a disability can “get through the door,” (e.g., installing an entrance ramp, widening entrances, and providing accessible parking spaces).
  2. Provide access to those areas where goods and services are provided (e.g., adjusting the layout of display racks, clearing routes to exam rooms, rearranging tables, providing braille and raised character signage, widening doors, providing visual alarms, and installing ramps).
  3. Provide access to rest room facilities when they are open to the public (e.g., removal of obstructing furniture or vending machines, widening of doors, installing of ramps, providing accessible signage, widening of toilet stalls, and installation of grab bars).
  4. Take other measures to provide access to goods, services, or facilities. 6

Conducting an on-site survey

It is extremely helpful to conduct physical access surveys with people with disabilities who have a user’s perspective and who are knowledgeable about cross-disability access issues. Surveying demands strict attention to detail. Items that may seem minor to a person without a disability can really be quite major. A perceived minor detail can make a person’s participation in an agency inconvenient or impossible. (See below for a listing of survey tool resources.) 7

Examples of low-cost barrier removal and/or modifications

These include, but are not limited to: 8

Entrance and exit

  • Installing:
    • Portables ramps for access into/out of the building,
    • Off-set door hinges,
    • Low-energy door operators, and
    • Lever door handles.

Path-of-travel

  • Ensuring:
    • 32″ wide clear route (e.g. rearranging furniture, re-locating tables, chairs, trash receptacles, and potted plants), and
    • Wheelchair turning radius.

Restroom access

  • Insulating lavatory pipes under sinks,
  • Repositioning a soap and/or paper towel dispenser to be in reach range,
  • Installing a full-length mirror and grab bars, and
  • Rearranging toilet partitions to increase maneuvering space.

Effective communication signage

  • Pictorial symbol sign, braille and raised lettering

General Access

  • Reachable placement of:
    • Pamphlets and brochures, and
    • Disposable water cups


Entering and Exiting the Building

If there are steps up to the entrance, ramping one step or even several steps may be readily achievable.

If a public accommodation cannot meet the ADAAG’s technical requirements for ramps because of space or other limitations, it can deviate slightly from these specifications as long as the ramp is still safe. If a permanent ramp cannot be installed, you can provide a portable ramp if readily achievable. Portable, i.e. moveable ramps must also be safe. Most portable ramps are relatively inexpensive to purchase or construct. 9

If you use a portable ramp you should install a doorbell (with an appropriate sign) to summon an employee to bring the ramp to the door, if readily achievable. If the accessible entrance is one other than the main entrance, a sign at the main entrance should indicate where the accessible entrance is located. 10

Figure 1: Threshold ramp
Portable aluminum threshold ramp

Figure 2: Portable ramp
Portable aluminum ramp

Low-energy door operators

Low-energy door operators can provide a cost-effective solution that meets the intent of barrier-free code requirements. Installation of a low-energy operator on a restroom door can reduce the need for expanded approach and clear space dimensions. 11

Figure 3*
Low-energy door operator-electrically opens an entrance door by pushing a large accessible button outside of the door

Figure 4*
Low-energy door operator-electrically opens an entrance door by pushing a large accessible button outside of the door

*www.edsdoors.com

Hardware: off-set (continuous) door hinges

Off-set door hinges can add 2″ to any doorway. Replacing existing hinges on your doors with swing-clear hinges can often provide the necessary width (32 inches) for a wheelchair user to pass through.

Figure 5
Off-set door hinges

Hardware: door knobs

Inaccessible door hardware can prevent access to the medical offices. For example, the handle shown (Figure 6) requires the user to tightly grasp the handle to open the door. People with limitations in grasping, such as arthritis, find this type of handle difficult or impossible to use. 12

Non-accessible door handles 13

  • A thumb latch is not accessible because one must grasp the handle and pinch down on the thumb latch at the same time.
  • A round door knob which requires tight grasping and twisting to operate or a handle with a thumb latch are inaccessible and should be modified or replaced

Figure 6
Non-accessible door handles. The first shows a thumb latch that is not accessible because one must grasp the handle and pinch down on the thumb latch at the same time. The second picture is a traditional ball type-round door knob that requires tight grasp

Accessible door handles 14

  • A loop-type handle is accessible because it can be used without grasping, pinching or twisting.
  • A lever handle is also accessible because it can be operated without a tight grasp, pinching or twisting.

Figure 7*
Three pictures of different types of accessible door handles.  The first two  are lever handles which can be operated without a tight grasp, pinching or twisting. The third shows a loop-type handle that can be used without grasping, pinching or twisting.

*www.dynamic-living.com

Clear (path-of-travel) Floor Space

In addition to an accessible entrance, evaluate how people with disabilities will get into and around lobby, reception areas, and exam rooms. For more specifications on space allowances see: ADA Accessibility Guidelines for Buildings and Facilities (ADAAG).

Wheelchair Turning Radius (turning space needed)

Turning radius: The T-shape space is 36 inches (915 mm) wide at the top and stem within a 60 inch by 60 inch (1525 mm by 1525 mm) square.

Figure 8*
T-Shaped Space for 180 Degree Turns
A single wheelchair user and the space allowances in inches needed to for a T-shape turning radius of 36 inches wide at the top and stem.

Figure 9*
Space 60 in. Diameter
Diagram of a single wheelchair user and the space allowances in inches that are needed to for an accessible circular turn, which is 60-inches by 60 inches.

*The Access Board, ADAAG Standards (Turning Radius)

To meet the necessary clear travel space of 32″ throughout your building, consider re-arranging potted plants, tables, chairs and other free-standing objects. (Figure 10)

Figure 10 15
Accessible medical office lobby and reception area. Includes: visible and easily understood directional signage, objects protruding from walls can be easily detected by canes, open floor areas for wheelchair, scooters, or baby carriages, refreshment counter with  knee space and all items easily within reach, reception area with multiple height counter and knee space, dual height water fountains serve standing and seated users, public telephones with shelve space for a TTY, lowered section of a closet rod, and entrance doors with glass or sidelight to see others approaching.

*Mace, FAIA, Ronald L.,(1998), Center for Universal Design and The North Carolina Office on Disability and Health, Removing Barriers to Health Care: A Guide for Health Professionals.

Restrooms 16

Most of the requirements for accessible restrooms address making the interior of the restroom usable:

  • One stall must be accessible,
  • It must have sufficient room for a person in a wheelchair to enter, close the door, and
  • Maneuver from wheelchair to toilet seat.

Possible solutions include:

  • Reconfigure rest room, and/or
  • Combine rest rooms to create one unisex accessible rest room.

Readily achievable elements in an accessible restroom include: proper door hardware, grab bars in toilet stalls, rear-ranging toilet partitions to create maneuvering space, insulating lavatory pipes under sinks to prevent burns, installing a raised toilet seat, installing a full-length bathroom mirror, and repositioning the paper towel dispenser.

Figure 11*
Readily achievable elements in accessible restroom include-replacing round facets with lever handles, installing full length mirrors over sinks, insulating sink pipes to prevent burns, and reposition a paper towel dispenser to seated users.

*Mace, FAIA, Ronald L.,(1998), Center for Universal Design and The North Carolina Office on Disability and Health, Removing Barriers to Health Care: A Guide for Health Professionals.

Effective Communication 17

  • Pictorial Symbol Sign: Tactile and raised at least 1/32″. The border dimension of the pictogram shall be 6″ minimum in height.
  • Text: Character height of 21/32″ (5/8″ minimum). Uppercase, simple serif type positioned directly below the pictogram.
  • Grade 2 Braille: Positioned directly below text.
  • Finish and Contrast: Matte, textured background with contrasting white graphics.
  • Mounting Height and Location: Mounting height shall be 60 inches (1525mm) above the finish floor to the centerline of the sign. Mounting location for such signage shall be so that a person may approach within 3 inches (76mm) of signage without encountering protruding objects of standing within the swing of a door.

Figure 12*
Pictorial symbol sign with tactile and raised grade 2 braille.

Figure 13*
Diagram of appropriate mounting height for signage-60 inches above the finish floor to the centerline of the sign and within 3 inches of signage.

*Note-For more specifications on types, placement and specifications of accessible signage see: ADA Accessibility Guidelines for Buildings and Facilities (ADAAG)

General Access

Other hardware and miscellaneous items can prevent access to the medical offices. The following are examples of low-cost solutions to improve access to brochures, and water fountains. For more information on accessible health care facilities see: CDHP Brief: Health Care Facilities Access. For specifications on reach ranges and water fountain placement and space allowances see: ADA Accessibility Guidelines for Buildings and Facilities (ADAAG)

  • Reachable pamphlets and brochures: A low-cost solution to inaccessible display racks is the use of desktop display holders.

Figure 14
Combined figure: Wheelchair user reaching directly to the side; appropriate reach ranges for a wheelchair of scooter user to should be 54 inches maximum. Plastic desktop magazine holder.

  • Water fountains and coolers: If your facility does not have an accessible water fountain (Figure 15), consider placing disposable cups next to the water fountain.

Figure 15

Combined figure: Dual water fountain with lower accessible to seated users. Paper cups.

Resources

To conduct a thorough review of the access of your facility it is recommended that you use an access checklist. There are many site survey tools available. Here is one resource:

Checklist for Existing Facilities:

Checklist for Readily Achievable Barrier Removal, Easy-to-use survey tool users to identify barriers in their facilities. The completed checklists and work sheets are the kind of documentation that organizations should keep on file to demonstrate that they are making a good faith effort to comply with the requirements of the ADA. Available for download as a PDF Version (Adobe Acrobat Format) or Text Version. 1995.

Additional Resources:

Common Questions: Readily Achievable Barrier Removal. U.S. Department of Justice, Civil Rights Division, Disability Rights Section. ADA-TA, a series of technical assistance (TA) updates from the Disability Rights Section of the Civil Rights Division of the Department of Justice, provides practical information on how to comply with the Americans with Disabilities Act (ADA).

Removing Barriers to Health Care: A Guide for Health Professionals, RBHC.12.98, 1998, 17 pp. – This booklet provides guidelines and recommendations to help health care professionals ensure equal use of the facility and services by all their patients. This guide gives health care providers a better understanding of how to improve both the physical environment and personal interactions with patients with disabilities.

U.S. Small Business Administration Office of Entrepreneurial Development, U.S. Department of Justice Civil Rights Division Americans with Disabilities Act ADA Guide for Small Businesses last revised – October 15, 2002. This guide presents an informal overview of some basic ADA requirements for small businesses that provide goods or services to the public.

The Architectural and Transportation Barriers Compliance Board (Access Board), ADAAG Standards. The Access Board is an independent Federal agency who issues guidelines to ensure that buildings, facilities, and vehicles covered by the law are accessible, in terms of architecture and design, transportation, and communication, to individuals with disabilities. Regulations issued by the Department of Justice and the Department of Transportation must be consistent with the Access Board’s guidelines. For technical assistance contact:

  • Architectural and Transportation Barriers Compliance Board
  • 1331 F Street, N.W., Suite 1000, Washington, DC 20004-111
  • 800-872-2253 (Voice) 800-993-2822 (TTY), 9:00 AM – 5:30 PM EST

Manufacturers of Accessible Examination Tables and Weight Scales

To download a 880KB Excel file containing a list of examination, procedural,
and treatment tables with accessible features,including manufacturers and
contact information, click here.

To download a 250KB Excel file containing a listing of increased access weight
scales (e.g., wheelchair, platform, bed, standing, and bariatric), along
with manufacturers and contact information, click here.

Endnotes

  1. Checklist for Existing Facilities version 2.1 (revised August 1995), Adaptive Environments Center, Inc. for the National Institute on Disability and Rehabilitation Research. For technical assistance, call 1-800-949-4ADA (voice/TDD).
  2. Americans with Disabilities Act ADA Guide for Small Businesses (last revised – October 15, 2002). U.S. Small Business Administration Office of Entrepreneurial Development, U.S. Department of Justice Civil Rights Division.
  3. Americans with Disabilities Act ADA Guide for Small Businesses
  4. Americans with Disabilities Act ADA Guide for Small Businesses
  5. Kailes, J. (1994). Americans With Disabilities Act Compliance Guide For Non-Profit Organizations, Kailes-Publications, 6201 Ocean Front Walk, Suite 2, Playa del Rey, California 90293-7556, jik@pacbell.net.
  6. Checklist for Existing Facilities version 2.1
  7. Kailes, J. (1994).
  8. Common Questions: Readily Achievable Barrier Removal. U.S. Department of Justice, Civil Rights Division, Disability Rights Section. ADA-TA, a series of technical assistance (TA) updates from the Disability Rights Section of the Civil Rights Division of the Department of Justice.
  9. The Access Board, ADAAG Standards (Section 4 Ramps)
  10. Kailes, J. (1994).
  11. Americans with Disabilities Act ADA Guide for Small Businesses
  12. Americans with Disabilities Act ADA Guide for Small Businesses
  13. Americans with Disabilities Act ADA Guide for Small Businesses
  14. Americans with Disabilities Act ADA Guide for Small Businesses
  15. Mace, FAIA, Ronald L.,(1998), Center for Universal Design and The North Carolina Office on Disability and Health, Removing Barriers to Health Care: A Guide for Health Professionals
  16. Common Questions: Readily Achievable Barrier Removal
  17. Common Questions: Readily Achievable Barrier Removal

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Kailes, J., and Mac Donald, C., Improving Accessibility With Limited Resources, 2004. Published and distributed by the Center for Disability Issues and the Health Profession, Western University of Health Sciences, 309 E. Second Street, Pomona, CA 91766 1854, (available at www.cdihp.org/products) Email: ahcs@westernu.edu Voice-909.469.5213/TTY-909.469.5520, Fax 909.469.5503,

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