RERC on AMI logoHealth Care Facilities Access


Updated 11.22.04

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 businesses make their facilities, goods and services accessible for all people with disabilities. Title III of the ADA covers commercial facilities, nonprofit service providers that are public accommodations, and some privately operated entities including privately operated medical and health care facilities. Examples of such facilities are offices of doctors, optometrists, psychiatrists, dentists, and other medical offices. The ADA also covers offices of private health care providers located in private homes.

People with disabilities should be able to travel to a health care site, approach and enter and move around the building as conveniently as everyone else. Access issues that should be considered include: 1

  1. Accessible path-of-travel into and throughout the facility,
  2. Wide and easy-to-open exterior and interior doors,
  3. Accessible examination and/or treatment rooms and equipment,
  4. Accessible office and examination room hardware,
  5. Appropriate reach ranges, and
  6. Accessible toilet and dressing rooms.

1. Accessible entrance and exit route

A continuous unobstructed path, to and from at least one accessible entrance/exit and connecting all accessible elements and spaces of a building or facility. Interior accessible routes may include corridors, floors, ramps, elevators, lifts, and clear floor space at fixtures. Exterior accessible routes may include parking access aisles, curb ramps, crosswalks at vehicular ways, walks, ramps, and lifts.

Within a site, "at least one accessible route shall connect accessible buildings, accessible facilities, accessible elements, and accessible spaces that are on the same site." 2

Figure 1 3

Accessible entrance and exit route to a medical office. Includes: A continuous unobstructed path, to and from at least one accessible entrance/exit and connecting all accessible elements and spaces of a building or facility. Interior accessible routes includes corridors, floors, ramps, elevators, lifts, and clear floor space at fixtures. Exterior accessible routes may include parking access aisles, curb ramps, crosswalks at vehicular ways, walks, ramps, and lifts, detectable warnings at curbless walks that cross traffic lanes cue people with vision disabilities of possible hazards, and visible and easily understood signage to indicate entrance, parking etc.

Clear (Path-of-Travel) Floor Space: After determining that the entrance is accessible, you must consider how people with disabilities will move into and around lobby and office reception areas, and determine the minimum unobstructed floor or ground space required to accommodate a single, stationary wheelchair and occupant.

Figure 2 4
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.

A. Path of Travel (Space Allowances): 5

In general, a 36" wide accessible route is needed with a slightly larger space provided at corners. If a 180* turn is needed to exit an area, then a 60" diameter turning space or a 36" wide "T" is needed (see Figure 6).

Wheelchair Space Allowances:

Figure 3*
A single wheelchair user and the space allowances in inches needed to maneuver in a straight forward path. The space allowances are 30 inches across from wheel to wheel and 48 inches, which is the length from back on wheels to the end of the wheelchair footrest.
* The Access Board, ADAAG Standards, (Wheelchair space allowances)

Clear ground space: The minimum clear floor or ground space required accommodating a single, stationary wheelchair and occupant is 30 in by 48 in (760 mm by 1220 mm).

Figure 4*
A single wheelchair user and the space allowances in inches needed for clear passage along an accessible route. The space allowances are 36 inches, but may be reduced to 32 inches.
* The Access Board, ADAAG Standards, (Wheelchair space allowances)

Wheelchair passage width: The minimum clear passage width for a single wheelchair shall be 36 inches (915 mm) minimum along an accessible route, but may be reduced to 32 inches (815 mm) minimum.

B. Wheelchair Turning Radius (turning space needed)

Accessible route turns around an obstruction: A U-turn around an obstruction less than 48 inches (1220 mm) wide may be made if the passage width is a minimum of 42 inches (1065 mm) and the base of the U-turn space is a minimum of 48 inches (1220 mm) wide.

Figure 5*
A single wheelchair user and the space allowances in inchesneeded for an accessible route turn around an obstruction: A U-turn around an obstruction less than 48 inches wide and minimum of 42 inches, with base of the U-turn of 48 inches minimum.
* The Access Board, ADAAG Standards, (Wheelchair space allowances)

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; the circular space is 60 inches in diameter.

Figure 6*
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.
T-Shaped Space for 180 Degree Turns
*The Access Board, ADAAG Standards, (Turning radius)

Figure 7*
Diagram of a single wheelchair user and the space allowances in inches needed to for an accessible circular turn, which is 60-inches by 60 inches.
Space 60 in.- Space for 180-Degree Turn
*The Access Board, ADAAG Standards, (Turning radius)

2. Exterior and interior doors that are wide and easy to open

Door openings should provide a clear width of 32 inches (815 mm) minimum. Clear openings of doorways with swinging doors shall be measured between the face of the door and the stop, with the door open 90 degrees. For more information and specifications on structural access, see ADAAG Standards (The Access Board, ref. ii).

Figure 8 6
Measurements needed for both exterior and interior doors that are wide and easy, and accessible to open. Door openings should provide a clear width of 32 inches minimum. Clear openings of doorways with swinging doors shall be measured between the face of the door and the stop and open to 90 degrees.

3. Accessible Office and Examination Room Hardware

Knob Hardware: Inaccessible door hardware (Figure 9) can prevent access to medical offices. For example, the handles shown below require the user to tightly grasp the handle to open the door. People who have limitations in grasping, such as arthritis, find these types of handle difficult or impossible to use. 7

Figure 9
2 Non-accessible door handles. 1st: a thumb latch that is not accessible because one must grasp the handle and pinch down on the thumb latch at the same time. 2nd: a traditional ball type-round door knob that is also not accessible because it requires tight grasping and twisting to operate.

Non-accessible door handles should be modified or replaced, if doing so is readily achievable.

Figure 10: Accessible door handles
A loop-type handle that is accessible because it can be used without grasping, pinching or twisting.
Two pictures of lever handles which can be operated without a tight grasp, pinching or twisting.

4. Appropriate Reach Ranges 8

The maximum reach ranges (detailed below) should be considered in the placement of information brochures, magazines and other items located in medical office lobbies, reception, and waiting room areas. Figure 11 (high forward reach range), and Figure 12 (side reach range) illustrate reach ranges accessible to wheelchair users or people with limited mobility.

Figure 11
Wheelchair user reaching directly in front. Appropriate reach ranges should be a maximum forward range of 48 inches.
*The Access Board, ADAAG Standards, (reach ranges)

High forward reach limit: Forward reach range is 48 inches maximum and 15 inches minimum

Figure 12
Wheelchair user reaching directly to the side. Appropriate reach ranges for a wheelchair of scooter user to should be 54 inches maximum.
*The Access Board, ADAAG Standards, (reach ranges)

Side reach limits: The 30-by-48-inch wheelchair clear floor space is located a maximum 10 inches (255 mm) from the wall. Side reach height range is 54 inches maximum and 9 inches minimum.

Other fixtures and hardware can prevent access to medical offices. Accessible coat hooks, shelves and mirrors provided within medical exam and treatment rooms should be located within the following reach ranges:

Coat hooks: Accessible coat hooks provided within toilet compartments shall be located within the reach ranges specified above. When provided, a fold-down shelf shall be located 40 inches (1015 mm) minimum and 48 inches (1220 mm) maximum above the floor.

Shelves: If the clear floor space allows a parallel approach by a person in a wheelchair and the distance between the wheelchair and the shelf exceeds 10 inches, the maximum high side reach shall be 48 inches (1220 mm) above the floor and the low side reach shall be a minimum of 9 inches (230 mm) above the floor. Maximum distance from the user to the shelf shall be 21 inches (535 mm).

Mirrors: If mirrors are to be used by both ambulatory people and wheelchair users, then they must be at least 74 in (1880 mm) high at their topmost edge.

5. Accessible Toilet and Dressing Rooms

Figure 13 9
Accessible Toilet and Dressing Room indicating visually and with description. Points include: doors must swing out on smaller restrooms and dressing rooms, clothes hooks should be placed at a maximum height of 48 inches, full length mirrors should be installed for viewing by both standing and seated users, and dressing benches should be at least 24 inches deep by 48 inches wide and 17 to 19 inches above the floor.

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, (added 2/2/00) 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: www.access-board.gov

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

Endnotes

  1. 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.
  2. The Access Board, ADAAG Standards. Section 4.3 Accessible Route, Section 206.2.2 Within a Site.
  3. Mace, FAIA, Ronald L.
  4. Mace, FAIA, Ronald L.
  5. The Access Board, ADAAG Standards, Clear Floor or Ground Space for Wheelchairs
  6. The Access Board, ADAAG Standards, section 4.2.5
  7. 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
  8. The Access Board, ADAAG Standards, section 4.2.5
  9. Mace, FAIA, Ronald L.
  10. Mace, FAIA, Ronald L.

Disclaimer: The Center for Disabilities Issues and the Health Professions does not endorse nor profit in whole nor in part, from any manufacturer or vendor whose equipment appears in this publication. Illustrations of specific equipment are provided for information and educational purposes only.

Distribution is encouraged, and permission is granted provided that:

(1) This copyright notice and citation is attached to each copy;

Kailes, J., and Mac Donald, C., Health Care Facilities Access, 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,

(2) No alterations are made to the contents of the document;

(3) The document is not sold for profit; and

(4) The Center for Disability Issues and the Health Professions is notified of such use. Please contact the Center by way of fax (909) 469-5503 or e-mail: ahcs@westernu.edu

The Rehabilitation Engineering Research Center (RERC) on Accessible Medical Instrumentation is a five-year project that evaluates methods and technologies to increase the accessibility and usability of diagnostic, therapeutic, and procedural healthcare equipment, and associated assistive technologies, for people with disabilities. This brief was funded, in-part, by the National Institute on Disability and Rehabilitation Research, U.S. Department of Education, under grant #H133E020729