Healthcare provider responsibilities under the ADA

The Americans with Disabilities Act (ADA) is a federal civil rights law. The law does not allow discrimination against people with disabilities.

Healthcare organizations that provide services to the public have responsibilities under the ADA. They must provide full and equal access for people with disabilities.

Responsibilities and what they mean

Healthcare organizations must provide:

Reasonable modifications of policies, practices, and procedures: adjusting or changing policies, practices, and procedures to provide access to services and facilities.

Effective communication: Making all communication easy to understand for each patient.

Accessible facilities: Removing any barriers to the physical environment so people with disabilities can have full access.

What types of facilities are covered?

Hospitals
Doctor offices
Medical clinics
Pharmacies
Dentist offices
Specialty offices that perform services like acupuncture, chiropractic, therapy, labwork

This list does not include all the types of facilities that may be covered.

Healthcare agencies run by state and local governments are covered under Title II of the ADA. Healthcare organizations run by private businesses or nonprofit organizations are covered under Title III of the ADA. Both types of organizations must provide access to their facilities and programs for people with disabilities.

Learn about Title II and Title III of the ADA.

What is a disability (according to ADA)?

You have a disability if your brain or body works differently than most people’s, and it is difficult to do everyday things like hear, see, speak, focus, sleep, walk, or breathe. Learn more about disability.

What are your responsibilities under the ADA?

State and local governments

People with disabilities must have an equal opportunity to participate in and benefit from all State and local government healthcare programs, services, and activities.

Business and nonprofit organizations

Businesses and nonprofit organizations that provide healthcare must give people with disabilities equal access to their programs, goods and services.

Making facilities and equipment accessible

Healthcare organizations must provide accessible facilities. The facility must meet 2010 ADA Standards for Accessible Design.

Examples of accessible facility features

Accessible parking spaces and entry
Doors with lever handles
Wheelchair accessible bathrooms with clear turning space, grab bars, and accessible sinks

No objects that protrude more than 4 inches along the routes of travel

Examples of accessible examination room features

Clear pathways of travel to the rooms
Entry doors that meet width requirements
Clear floor and turning space inside the rooms (sometimes this can be a simple solution like moving a garbage can, sharps container, or a chair)

Examples of accessible medical equipment

When possible, medical equipment should be accessible.

Accessible examination tables
Accessible imaging machines
Accessible scales
Patient lifts

Learn more about access to medical care for individuals with mobility disabilities.

Facility accessibility for state and local governments

State and local governments must provide “program accessibility.” This means their programs – when they are looked at as a whole – must be accessible to and usable by people with disabilities. If individual programs are not physically accessible, they can:

Remove the barriers to make the location accessible, or
Move the services to an accessible location

Facility accessibility for businesses and nonprofit organizations

Businesses and nonprofit organizations must make their programs, goods, and services accessible through “readily achievable barrier removal” at all of their facilities. Readily achievable barrier removal means taking away accessibility problems that are cheap and easy to remove.

Examples:

A private health care provider has 2 steps at the office entrance they can make accessible with a ramp.
A private health care provider has exam rooms that are too small to accommodate a person who uses a wheelchair. The provider can take down one wall between two exam rooms to make one larger exam room.

In these situations, the provider made a plan and removed the accessibility barriers. Sometimes, though, it is “technically infeasible” to remove accessibility barriers.

An exception to accessibility responsibilities

Technically infeasible can happen when:

Building a ramp with the proper slope is not possible because there is not enough space on the sidewalk at the entrance door.
Removing a wall is not possible because that wall holds up part of the building, or

Each year, private healthcare providers must:

review their barrier removal plans, and
show that some barriers were removed as part of the plan.

When policies and procedures need to be changed or adapted

If you are a healthcare provider, you need to make reasonable modifications to provide equal access to your facility and services. This means you may need to adjust your policies, practices, and procedures.

Examples

Allowing a patient with anxiety to have an early appointment so there will be fewer people and noise.
Allowing an aide or companion to assist a person with getting in the right position for an x-ray or scan.
Reading paperwork aloud for a patient who is blind or has low vision.
Allowing more time to explain care to a patient with an intellectual or cognitive disability.
Allowing a service dog to be present in an exam room.

Providing effective communication

Healthcare providers must make sure that communications with patients with hearing, vision, and speech disabilities are as effective as communications with other patients. They can provide effective communication by using “auxiliary” or communication aids or services. Learn more about effective communication.

The aid or service you should provide depends on:

How the patient usually or always communicates
How long and how complicated the information will be
The place where the communication will happen

Examples

Provide a qualified interpreter for a scheduled or non-emergency appointment for a person who is Deaf and uses sign language.
Read written information and instructions to someone who is blind.
Provide hospital discharge directions and medication information in large print.
Offer the relay service 711 for speech-to-speech translation services to patients with speech disabilities, if the provider has difficulty understanding them.

Learn more about communicating with patients who are Deaf or Hard of Hearing in hospital settings.

Digital accessibility

Accessibility of documents, electronic machines, and websites is often called digital accessibility. Digital accessibility is also required for effective communication, and can include:

Websites
Medical kiosks
Electronic health records
Telecommunications
Telephone health appointments (includes telepsychology and telemental health)
Medical information shared through phone apps

Exceptions to providing equal access

If it would be overly expensive (“undue financial burden”), or

If it would completely change the care or service provided (“fundamentally alter the nature of the service, program, or activity”)

In these cases, the provider would not have to follow the ADA requirements.

Undue burden and fundamental alteration

When deciding if something is an undue burden or fundamental alteration of service, you must think about the nature and cost of the action when compared to the size, resources, nature, and structure of the facility’s operations.

Only the head of the government or private healthcare provider, or someone they name, can say when something is an undue burden or fundamental alteration.

Helpful resources

Ask us

If you have questions about your responsibilities as a healthcare provider, please contact us.