Barriers to Healthcare
Barriers to Healthcare
Architectural and Programmatic Barriers
- Patients using wheelchairs rarely get weighed or have their height measured, contrary to widely accepted practice standards. (Accessible scales exist for this purpose.)
- Patients using wheelchairs are often examined while seated in their chairs when good practice would require them to be examined while lying supine on a table. (Accessible exam tables exist for this purpose.)
- Healthcare provider offices, clinics and diagnostic centers have no procedure for determining in advance whether a patient has an impairment that requires some sort of accommodation such as lifting assistance, Sign Language Interpreters, materials in non-print formats, or appointment flex-time, which results in delays. Even when a patient or referring physician notifies the provider or facility of the person’s needs in advance, frequently no arrangements are made.
- Sign Language Interpreters are rarely provided to ensure that people who are deaf can communicate effectively with healthcare practitioners. (Models for efficient delivery of interpreter services in some settings are in place at a few locations in the country.)
- Healthcare informational, educational and instructional materials are not made available in formats that are accessible to people who are blind or have visual impairments. (Models are available for efficiently providing alternative formats such as Braille, Large print, digital, and audio.)
- Healthcare information is often provided on websites that are not designed to conform with widely accepted accessibility standards.
- Diagnostic procedures such as MRIs, X-rays, ultrasounds and bone density scans are often done only after a patient is transferred from her or his wheelchair to the examination table with great difficulty and risk by unqualified individuals such as security guards.
- Many appointments take an excessive amount of time, involve undue hardship or must be rescheduled because appropriate staff, methods to ensure effective communication, and/or adaptable, accessible equipment are not available.
- Additional appointment time is rarely provided even when it is required to ensure effective communication for people who are deaf or hard-of-hearing, have other communication disabilities, or to accommodate individual patients who may require transferring assistance.
- Hospital admissions personnel do not assess patients’ needs for accommodations such as accessible inpatient rooms, beds and bathrooms, and frequently do not have methods to ensure that patients with mobility disabilities can be placed in such accessible rooms.
- Captioned audio-visual information and Sign Language Interpreters are rarely provided for hospitalized patients who are deaf or hard-of hearing.
- Waiting rooms and exam rooms are too small and crowded to accommodate patients using wheelchairs.
- Patient privacy is compromised due to small exam, testing and interview rooms.
- Privacy is compromised when print materials are not made available in accessible formats allowing for private, independent review by the patients with vision impairments.
- Architectural barriers exist throughout many facilities, including reception counters that are too high; narrow hallways cluttered with carts, boxes and unused equipment; house phones that are out of reach; heavy doors, and lack of Braille and other accessible signage, among other things.
- Patients with disabilities report feeling frustrated, humiliated or angry on many occasions. In describing the care they receive they make statements such as: “my doctor doesn’t understand my disability,” “the doctor only wanted to talk about my disability, not the problem I came in for,” “the nurse won’t listen to me about my body,” “they treat me like I’m stupid, but I know what’s going on,” “they think I can read lips, but I can’t. I really need a Sign Language Interpreter,” or “they blame me because I can’t get up on the table.”
Public Policy Barriers
People with disabilities experience significant secondary health disparities as compared with the general population due to complex factors that include:
- Lack of healthcare coverage - between 17 and 28% of people with disabilities do not have health insurance.
- Even when people with disabilities have health insurance, essential benefits such as specialty care, durable medical equipment and assistive technology, prescription medications, dental and vision care, and rehabilitative and long-term care often are either inadequate or not covered.
- Disability competency training is lacking in core educational curricula for healthcare professionals and people with disabilities, therefore, do not always receive effective and appropriate care.
- Federal healthcare funding agencies do not monitor state and health plan compliance with the Americans with Disabilities Act (ADA) and Section 504 of Rehabilitation Act or require disability performance standards as a condition of healthcare funding.
- Certain Healthcare accreditation agencies such as the Joint Commission do not evaluate healthcare programs or facilities for accessibility and capacity to accommodate people with disabilities.
Environmental Barriers
Multiple Chemical Sensitivity (MCS)
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MCS means an unusually severe sensitivity or allergy-like reaction to many different kinds of pollutants including solvents, VOC’s (Volatile Organic Compounds), perfumes, petrol, diesel, smoke, and “chemicals” in general. MCS often encompasses problems with pollen, house dust mites, and pet fur and dander.
In health care settings, fragrances present an invisible barrier to care for some people. They are present in personal care products used by staff and other patients, and in the various hand cleansers often found in examination rooms. Fragrances are also found in various air “freshener” products, disinfectants, and cleaning materials commonly used in health care environments.
Resources:
Health Care Without Harm — an international coalition of hospitals and health care systems, medical professionals, community groups, health-affected constituencies, labor unions, environmental and environmental health organizations and religious groups. The mission of Health Care Without Harm is to transform the health care sector worldwide, without compromising patient safety or care, so that it is ecologically sustainable and no longer a source of harm to public health and the environment.
US Access Board Policy to Promote Fragrance-Free Environments
National Institute of Building Sciences Recommendations for Commercial and Public Buildings
Fragranced Products Information Network