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October 8, 2019

The ADA and Accessibility in Health Care

Written by: Compliance blogger


For your healthcare organization, compliance includes more than just privacy and billing; it also includes anti-discrimination. Title III of the Americans with Disabilities Act (ADA) prohibits discrimination on the basis of disability by public accommodations. “Public accommodations” includes places such as hospitals and healthcare providers’ offices. According to the law, these organizations must be physically accessible and there should be effective communication provided for individuals with disabilities.

Requirements Under the ADA

The ADA requires that public entities take the steps necessary to communicate effectively with people who have disabilities through auxiliary aids and services, such as notetakers, sign language interpreters, Braille, open and closed captioning, and other tools. The ADA Primer for State and Local Governments further notes that “public entities are required to give primary consideration to the type of auxiliary aid or service requested by the person with the disability.” They must honor the individual’s choice unless the public entity can demonstrate that:

  • Another, equally effective, tool is available,
  • The auxiliary aid requested would fundamentally alter the nature of the program or service in question, or
  • The individual’s choice of auxiliary aid would result in undue financial or administrative burdens.

If one of the above situations can be demonstrated, that does not end the organization’s accessibility obligation. They would still be required to provide another aid or service that provides effective communication, if possible. Ultimately, the goal for organizations is to find practical solutions for communicating effectively with their customers.

People interact with healthcare organizations in person during office visits as well as digitally through websites and patient portals. Therefore, your organization should pay close attention to accessibility requirements for both of these settings.

Health Care Accessibility Guidelines

Effective communication is something that is particularly important in healthcare. In this field, miscommunication can lead to issues like a misdiagnosis, improper medical treatment, or delayed treatment. Healthcare organizations, and other public accommodations, are encouraged to engage in a dialogue with the individual who has a disability to determine what type of auxiliary aids and services are most appropriate.


There are also provisions within the ADA regarding service animals and companions of individuals with a disability. A companion might be:

  • Someone who is legally authorized to make healthcare decisions on behalf of the patient
  • Someone who helps the patient with information or instructions provided by medical staff
  • A patient’s next of kin or family member
  • A person designated by the patient to communicate with healthcare providers about the patient’s symptoms, medical history, or care

When it comes to companions, it is important to remember that privacy and confidentiality are still key. HIPAA does not stop being applicable because the patient has a disability, and you should ensure that any disclosures of patient health information to companions follow the HIPAA Rules. If you need to strengthen your understanding of HIPAA privacy and security regulations, you might consider HIPAA Compliance Officer training with the American Institute of Healthcare Compliance. We also offer shorter HIPAA compliance programs for members of your staff.

The Barrier-Free Health Care Initiative

The Barrier-Free Health Care Initiative was first announced in 2012 as a way to enforce ADA requirements in health care specifically. It includes three primary items:

  • Effective communications for individuals who are deaf or have hearing loss,
  • Physical access for people with mobility disabilities, and
  • Equal access to treatment for people who have HIV/AIDS.

In 2019, there have been three cases settled under this initiative so far:

  • Thomas Jefferson University Hospitals entered into a voluntary settlement agreement to ensure physical accessibility of its imaging and radiology facilities.
  • ProMedica Health Systems agreed to undertake a number of actions to ensure that appropriate auxiliary aids and services are provided at their hospitals for individuals who are deaf or hard of hearing.
  • The Hazelden Betty Ford Foundation entered into a settlement agreement to remove, where possible, architectural barriers to their facilities.

What ADA Compliance Means for Websites

In addition to offices and hospital locations, a healthcare organization’s website can also include a wide range of services and tools to communicate with viewers, from informational web pages to patient portals. As public accommodations, healthcare organizations should make sure that not only their physical offices, but also their websites, comply with the ADA.

One standard that is often used to determine website accessibility is the Web Content Accessibility Guidelines (WCAG) developed by the World Wide Web Consortium (W3C). These guidelines provide recommendations for making web content more accessible based on whether the content meets the main criteria of the WCAG:

  • Perceivable
  • Operable
  • Understandable
  • Robust – Maximizing the content’s compatibility with current and future tools used by viewers, including assistive technologies

According to the ADA, one common problem that can keep web content from being accessible is when images do not have text equivalents or “tags.” Tags should be included with images because they are used by screen readers and refreshable Braille displays, tools utilized by people with disabilities that affect their ability to read a computer display. Similarly, when videos do not include either audio descriptions or text captions they are not accessible to all viewers.

Another issue that can often stand in the way of a website’s accessibility is when the color and font settings of a page cannot be changed by a user’s web browser. This is because individuals with low vision may need to use personalized display settings when they access the internet. Therefore, websites should be designed so that they can be viewed with the font size and color settings in a user’s web browser and operating system.

The ADA has several recommendations for organizations seeking to develop an action plan to increase the accessibility of their websites, such as:

  • Ensure that all new and updated web pages and online content are accessible
  • Train all staff members and contractors who work with web page content in accessibility
  • Provide a way for website visitors to request accessible information
  • Test your website periodically for ease of use
  • Make sure that there are alternative ways for individuals with disabilities to access information and services provided on your website

There are many resources available to help you review both your physical office locations and your website for adherence to accessibility guidelines. Visit the ADA website for more information about regulations, standards, and recommendations to support accessibility.


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