Written by QuickMedical on Monday April 22, 2019
According to the U.S. Census Bureau, more than 12.6 percent of the general population has one or more disabilities. These 40 million Americans face greater challenges in obtaining quality health care in part due to a lack of accessible medical equipment. The most prevalent type of disability involves difficulty walking or climbing stairs, with 7.1 percent of the population reporting mobility issues of this nature. A clear understanding of the guidelines surrounding accessibility and medical equipment will allow you to make the best decision when selecting new equipment for your organization.
The Americans With Disabilities Act (ADA)
The Americans with Disabilities Act was approved in 1990. This measure applies to all organizations with more than 15 employees and was designed to give people with disabilities equal opportunities and full participation in their communities. Independent living and the ability to achieve self-sufficiency on an economic level were also goals of the act. The most widely-known aspect of the ADA is that it prevents discrimination in the workplace and also seeks to guarantee equal physical access to establishments both public and private.
An ADA violation can have a significant negative impact on any organization that incurs it. The maximum civil penalty for violating the Act just once is $75,000 as of 2014, and will likely increase over time. If your organization picks up a second penalty, the maximum fine rises to $150,000.
Liability is another crucial consideration when it comes to accessible medical equipment and facilities. If a patient finds that your facility or equipment limits their ability to receive equal, adequate care as determined by the ADA, they can sue. In 2018, there were more than 10,000 ADA lawsuits filed in federal courts under Title III of the act. Between civil penalties, litigation and a desire to provide the best care for all patients, complying with all accessibility standards is the smart way to go.
Scope of the ADA
For non-government medical facilities, Title III of the ADA is the most applicable standard to comply with. Title III applies to "places of public accommodation," which include the offices of health care providers as well as hospitals or other facilities where patients receive treatment. Title III requires medical providers to offer equal services for people with disabilities. This involves making reasonable alterations to policies when required to provide equal access and providing extra accommodations that facilitate communication.
The ADA does not set forth specific standards for accessible equipment. Instead, it primarily regulates fixed structures like parking lots, entrances and restrooms. Both tenants and landlords of medical office space are responsible for ensuring compliance with Title III, which can sometimes come with expensive architectural modifications. Fortunately, tax breaks are available in the case of significant remodels or other alterations made to comply with ADA building standards.
Accessible examination rooms are a necessary precursor to accessible equipment. These are the ADA recommendations for an accessible exam room for patients with limited mobility:
- Patients must be able to navigate to and through the room.
- The doorway must be at least 32 inches wide when the door is open 90 degrees.
- There must be adequate clear floor space of at least 30 inches by 48 inches along the exam table.
- There should be adequate clear space of 60 inches in diameter so wheelchairs can turn 180 degrees.
Accessibility also considers those with vision impairments. Because people with vision impairments tend to move closely along walls, any objects mounted on walls need to create minimal disruption for people navigating. These are the vision-related ADA standards that regulate things like exam room flags and even wall-mounted glove dispensers:
- Objects above headroom can protrude any amount.
- Objects between 27 and 80 inches high can protrude a maximum of four inches from the wall.
- Protruding objects cannot reduce the minimum width of wheelchair-accessible routes.
- Objects 27 inches or lower are within range of a cane sweep, so objects in this area can protrude any amount.
Essentially, ADA standards call for accessible routes and rooms to be clear and without clutter that can block movement or cause a hazard for a person with impaired vision navigating against the wall. With these criteria met, your examination spaces are much better prepared for the adoption of accessible diagnostic equipment.
Standards for Accessible Medical Diagnostic Equipment (MDE)
The Patient Protection and Affordable Care Act (ACA) expanded section 510 of the Rehabilitation Act. The Rehabilitation Act of 1973 was the precursor to the ADA and is still in effect today. It forbids discrimination based on disability in any program administered by a federal agency or receiving federal financial assistance. The ACA expansion to this act gave the U.S. Access Board authorization to partner with the Food and Drug Administration (FDA) to create accessibility standards specifically for medical diagnostic equipment.
These standards are concerned with the ability of people with disabilities to access and use MDE to the maximum possible extent. They establish a minimum technical standard that applies to a range of medical diagnostic equipment including:
- Examination tables and chairs
- Mammography equipment
- Radiological equipment
- Weight scales
- X-ray machines
The MDE standards also address requirements for design and operating features, focusing on those that allow people with disabilities to move to examination surfaces independently rather than having to be moved by medical staff.
The standards are broken down into four categories based on the position of the patients who are using the equipment. Each position has a corresponding code which addresses specific features of the equipment.
- M301 - Supine, Prone or Side-Lying Position: Standards address the size and height of the transfer surface, lift compatibility and supports for the limbs and head. These standards apply to exam tables and reclining chairs.
- M302 - Seated Position: Standards for exam chairs, seated imaging equipment and seated weight scales address the same features as lying position equipment.
- M303 - Seated in a Wheelchair: These standards address the space available for wheelchairs and changes in the floor level where wheelchairs enter spaces. In some equipment, it concerns the ability of the machinery to examine patients in wheelchairs effectively.
- M304 - Standing Position: For patients who can stand but still have limited mobility, these standards address the need for slip-resistant surfaces and adequate standing supports. This category includes weight scales and some imaging equipment.
The standards were finalized and released in February 2017 with some caveats. They are not specific in regards to the numbers and types of accessible equipment different types of facilities must have, do not set forth mandatory requirements and were not enforceable at the time they were introduced. In December 2017, the Department of Justice (DOJ) announced it was revoking these rules and "reevaluating whether regulation of the accessibility of non-fixed equipment and furniture is necessary and appropriate."
While the final decision on these standards is still in a state of flux, the requirements they outline are of great value to any practice that wishes to increase the quality of care for all patients. As accessibility continues to be a problem in the medical field, forward-thinking organizations may benefit from the "future-proofing" offered by accessible equipment.
The Most Common Forms of Accessible MDE
Mobility disabilities are the most common to need accommodations in a medical setting. People who use wheelchairs, walkers, crutches or scooters to get around often find that the average equipment available in medical facilities doesn't work around their mobility needs. This can result in providers giving substandard care and foregoing crucial diagnostic procedures because the equipment is not accessible. The following are the most important types of mobility and accessibility medical equipment for an examination room according to ADA recommendations.
1. Exam Tables and Chairs
Exam tables and chairs are where medical professionals do a great portion of diagnostic and exam work. Traditional tables and chairs remain at a fixed height and aren't accessible to the majority of people with a mobility disability. Someone using a walker or wheelchair won't be able to transfer themselves to the exam table if it is too high, and factors like the severity of mobility issues, height and weight of the patient may exacerbate the issue. Some doctors attempt to perform examinations while the patient is seated in the wheelchair, but the ADA discourages this practice as it is not as thorough.
An adjustable exam table allows some people with a mobility device to use exam tables with greater ease. Someone with a walker, for instance, can simply walk over to the lowered exam table and sit down. If the table is low enough to be flush with a wheelchair seat, that patient may be able to transfer over to the table or chair with minimal assistance.
Accessible exam tables and chairs should meet two criteria:
- The ability to reach the height of a wheelchair seat, approximately 17 to 19 inches from the floor.
- Stabilization and support elements such as rails, straps or cushions.
For the highest level of accessibility, look for tables and chairs with the greatest range of customizability when it comes to tilt and positioning. Equipment that includes headrests, armrests or footrests expand the capabilities of the table and can make the examination easier on the doctor.
2. Patient Lifts
Some patients cannot get onto and off of an exam table even if it lowers to wheelchair seat height. When a helping hand from staff or a transfer board is not enough to facilitate patient transfer, patient lifts allow safe movement to and from exam tables or chairs. Some lifts are mounted to the ceiling, offering increased weight capacity without the need for storage space or extra clear floor space in the examination room.
The other type of lift is far more cost-effective and common. Portable floor lifts have a U-shaped base that fits around or goes under the exam table to facilitate patient transfer from a wheelchair. Portable lifts can be moved from room to room, making them significantly more versatile than their overhead-mounted counterparts. They do require more clear floor space for storage and operation, however.
One or two people can operate portable lifts, depending on the model and application of the equipment. Having an accessible, adjustable exam table makes lift transfer easier. A lift has to position patients centrally over the surface of the table, so choosing compatible equipment is paramount. Lifts with low base heights fit the greatest variety of tables.
Lifts can also help increase the accessibility of some radiological procedures. A patient in a wheelchair will likely experience significant difficulty trying to transfer onto the table for a CT scan or X-ray, for example. Because this specialized equipment is significantly more expensive than an exam table or chair, a portable lift presents a cost-effective way to increase accessibility without purchasing expensive new radiological equipment.
Weight is information medical professionals can't skip. This information plays a key role in the diagnosis, treatment and monitoring of all patients. While patients without disabilities get their weight taken as a matter of course, patients with limited mobility are much more likely to be told they can't be weighed. To prevent this significant oversight, accessible scales are a must. There is a wide range of wheelchair-accessible scales available, and all should meet these standards:
- No abrupt level changes from floor to weighing platform.
- Edge protection at the scale drop off.
- Adequate space to maneuver onto and off of the scale.
- Large platform capable of accommodating wheelchairs of varying sizes.
Scales with ramps are generally the most cost-effective, but they tend to take up a significant amount of space that smaller practices may not be able to spare. Flush mount or wall mount scales save on space by retracting into the wall or folding up when not in use.
In-floor scales are another option, completely eliminating tripping hazards. They also save time as they don't need to be set up or put away with each use. Their installation into the floor also means they generally have a greater weight capacity and expanded options for platform dimensions. In-floor scales are the most expensive option, but their value extends beyond accessibility.
Training for Accessibility
For accessible medical equipment to fulfill its intended purpose, medical practitioners and staff need to be trained to operate it effectively. This includes knowing the location of portable accessible equipment when it is required, so patients don't have to suffer unduly long wait times. Staff also need to know which exam and procedure rooms are accessible.
When new accessible equipment arrives, everyone who might operate it should receive thorough training on its use and maintenance. Even if a piece of equipment significantly enhances your staff and doctors' ability to provide care for people with disabilities, those patients won't see the benefit if no one knows how to make the most of that tool.
Staff training should address the fact that mobility disabilities don't affect everyone the same way. Patients will have different levels of physical ability, and different preferences on how to transfer. Asking questions is the best way to tailor the use of each piece of medical equipment for the best patient outcomes.
QuickMedical: Your Source for Accessible Equipment
Medical equipment accessibility is something no organization can afford to overlook. If a patient cannot receive an equal quality of care due to a lack of accessible equipment, the civil penalties and litigation can deal severe damage to your practice. And as a medical professional, you always strive to provide or facilitate the best care and treatment possible.
If you're ready to secure better compliance for your organization and better care for your patients, come to QuickMedical for your accessible equipment needs. We have been supplying medical providers with top-of-the-line equipment since 1993, and we have the experience to help you find the products that suit a variety of needs.
Register for a QuickMedical account to benefit from exclusive features like the ability to submit payment online as well as manage and pay invoices. We carry more than 50,000 products, so you can come to us for all of your equipment and supply needs. With QuickMedical, adding accessible equipment to your organization can be fast, easy and affordable.