# Presentation: 213579

## It takes more than rampsto solve the crisis of healthcare for  people with disabilities

**Judy Panko Reis, MA MS**
**Rehabilitation Institute of Chicago**
**Mary Lou Breslin, MA      Lisa I. Iezzoni, MD, Msc          Kristi L. Kirschner, MD**
**DREDF****	****	****   Harvard Medical School           Rehabilitation Institute of Chicago**

**Support for this project was provided by **
**The Robert Wood Johnson Community **
**Health Leadership Program**

## Introduction: Premise and Goals

**Premise: **
- - U.S. healthcare system not structured to provide safe patient centered care to PWD
**Goals:****	**** **
- Highlight gaps between safe, patient centered care and reality of experiences of PWD
- Explore role of ADA to improve access to healthcare
- - Recommend ways to bridge the gaps
** **

## Research Findings 

- PWD use healthcare services at a higher rate than PW/oD, yet commonly express dissatisfaction with their healthcare, are susceptible to disparities in healthcare, and experience widespread lack of appropriate accommodations.
- The roots of quality-of-care and safety shortfalls include inadequate training of clinicians, poor executive oversight to enforce the ADA, limited funds and few financial incentives.
- Healthcare institutions have the moral and the legal responsibility to take actions to improve the healthcare delivery system for PWD in a  safe, patient-centered, culturally competent way.

## ADA Healthcare Principles

**Non Discrimination**
**Prohibits intentional and non intentional discrimination including benign neglect, denial of service, inadequate service**** **
**Integration**
**Accessibility to existing medical offices , building, facilities and communication**
**Accommodation/ Reasonable Modification**
**Discrimination = failure to reasonably modify policies, practices, procedures when they are required to afford PWD access to health services**
** **

## Outcomes of ADA Enforcement

**Source: US Department of Justice Status Reports – April 1994 – March**** ****2003**

| CASE TYPE/ISSUE | Office Setting | Hospital Setting | Clinic or Service Center Setting | TOTAL |
| --- | --- | --- | --- | --- |
| Deaf or Hard of Hearing (effective communication) | 34 | 25 | 6 | 65 |
| Mobility Access | 27 | 4 | 4 | 35 |
| HIV Status | 5 | 1 | 2 | 8 |
| Blind/Low Vision | 2 |  |  | 2 |
| Access to Examination Tables | 0 | 1 | 2 | 3 |
| Intellectual Disabilities |  |  | 1 | 1 |
| TOTALS | 68 | 32 | 14 | 114 |

## Impact of ADA on Medicaid Providers

**Combined state and federal ADA implementation efforts and community advocacy have lead to useful guidelines and model projects.**
**HHS Guidelines for Medicaid Managed Care reflect ADA**
**New York’s Office of Medicaid Managed Care compliance w/ ADA guidelines**
**California Dept. of Health Services requires ADA compliance in contracts for Medicaid**
**Massachusetts  and Minnesota model Medicaid plans to meet the complex needs of PWD**

## Looking Forward

**Federal, state enforcement of ADA and private litigation have spurred important but modest reforms in healthcare service for PWD.    Many challenges remain**
**Most hospitals, large facilities and medical provider offices have not provided more than architectural accessibility**
**Medical providers in private offices also have little awareness of the ADA and their obligation to determine if a patient with a disability requires an accommodation and to provide that accommodation if possible**
**By ignoring the intent of the ADA, medical providers and institutions risk significant liability.  Patients can remain ill, suffer and die because care is inadequate**