Livable Communities--Accessibility

Livable Communities--Accessibility

Iowa’s Community Access Project

Iowa’sCommunity Access

Project

COMMUNITY ACCESSIBILITY

PROJECT OVERVIEW AND BACKGROUND

• What is the project’s purpose?

• The purpose of the Community Access Project is to build livable communities; that is, communities that provide, for all its citizens:

– Affordable and appropriate housing

– Supportive community features

– Accessible and responsive services

– Adequate mobility options


Community Access Project Goal

Improving the physical and programmatic access of• Public health programs• Private health care facilities• Disaster shelters


Role of the Access Specialist

• Promotes full inclusion of people with disabilities in all aspects of community services and life

• Through needs assessment, education, action, and advocacy

• Provides technical assistance and acts as a resource for the community


Access Specialist Responsibilities1. Meet with organizations and businesses to

encourage them to complete an ADA audit 2. Answer common questions regarding the ADA

Guidelines (ADAAG)3. Assist the target programs in conducting ADA

surveys4. Work with the Office of Disability and Health to

obtain a review and analysis of ADA surveys


Access Specialist Responsibilities continued

5. Offer technical assistance to target programs to become ADA compliant

6. Make appropriate referrals to assist target programs with ADA compliance

7. Work with the community and specific businesses to identify and fill resource gaps

8. Develop incentives for ADA compliance and implement recognition programs


IDPH Office of Disability and Health (ODH)

Will assist Access Specialists by:• Identifying public health programs in their area • Providing training and consultation in completing the

Iowa ADA Building Access and the ADA Program Access Surveys

• Analyzing survey results• Preparing a letter that summarizes the findings from

both surveys and provides recommendations to improve access

• Providing on-site technical assistance if requested


Center for Disabilities and Development (CDD)

Will assist Access Specialists by:• Training, mentoring and certifying community

Access Specialists

• Providing technical support

• Providing addition training and resources to enhance project

• Evaluating the project



APPLYING ADA ACCESSIBILITY GUIDELINES

The Access Specialist will:• Understand key concepts in the ADA Accessibility

Guidelines (ADAAG) • Understand the difference in expectations for large,

small and public businesses.• Demonstrate knowledge of reasonable

accommodations for—– health care facilities.– public health facilities.– disaster shelters.


• ADA language is confusing

• It is important to understand the “intent” of the ADA

• It is important to understand the application of the ADA

• Become familiar with Titles I through IV


Understanding the ADA

Key Terminology:• “shall” means mandatory specification or requirement• “should” means it is an advised specification or

requirement• “may” means options or alternative• “comply with” means meets one or more specification• “if…..then” means applies only when certain conditions

exist


Understanding the ADA

Business owners who serve the public are responsible for removal of physical barriers that are “readily achievable”• Means it can be easily accomplished and without to

much expense• Based on size and resources available• Don’t expect business’ to go bankrupt to achieve

accessibility• Many things business’ can do to improve access that are

inexpensive


Small vs Large Business

• Privately operated medical and health care facilities are covered under Title III- buildings, services and products must be accessible to people with disabilities

• Examples – doctor’s offices, dental offices, clinics, day surgery centers, family planning clinics, private hospitals, private psychologist or social work offices, and physical or other therapy treatment facilities

• For physical access, think in terms of parking, entrance, common areas and bathrooms for the physical location


Reasonable Accommodations for Health Care Facilities

• Closest available to an accessible entrance• Upright signage using the universal symbol of

disability• First space must be designated “Van accessible”• Access aisles must be available• Must have a clear, level path of travel• Curb cuts (ramps) near parking• Ratio 1 in 25


Parking


• At least one accessible route leading to an accessible entrance, level with 36 inches wide surface

• Connected to the accessible parking• Thresholds are no higher than ¾ inch for exterior sliding

door and ½ for other doors with 32 inch clear opening• Door hardware that is easy to grasp with one hand and

does not require tight grasping, tight pinching, or twisting of the hand and wrist to operate

• Each entrance/exit is identified with the universal symbol of accessibility


Entrances

• Common areas or interior circulation are public areas free from obstacles

• All doors have a clear opening of “32 inches, with a push/pull weight of 5lbs

• Door hardware is easy to grasp with one hand and does not require tight grasping, tight pinching, or twisting of the hand or wrist to operate

• Interior doors shall not be over ½ inch, with a flat surface of five feet• Ramp ratio is 1/12 meaning the ramp rises one inch per each foot• Ramps is higher than 6 inches will have railings on each side with

the rail extending one foot beyond the ramp• Any amenities offered to the public must be accessible, water

fountains, phones, alert systems


Common Areas

• Identified with the universal symbol• Path of travel shall be free of objects• Doors have a 32 inch opening with push/pull of 5 lbs or less• 5 foot radius of open space in at least one stall or open floor in a

single use restroom for transfer• The stall door should swing out and follow the person in• Grab bars are 1 ¼ to 1 ½ in diameter with 1 ½ inch from wall• The toilet are 17 – 19 inches from finished floor• Lever, push-type, touch-type, or electronically controlled handles on

the sink • Protective insulation on hot/cold pipes under the sink to protect

knees


Restrooms

• Elevators, wheelchair lifts and ramps may provide access to above floors

• Cost may prohibit installation• Freight elevators and service routes can be

used but must be a clear path of travel• If not readily achievable, alternate locations that

are accessible can be used• Provide same or similar services


Stairs - Elevators

• Standard equipment in medical, dental and health care facilities prohibits certain exams and procedures

• Primary health care providers can’t provide a full exam of a patient when they are in a wheelchair

• Gold Standard = adjustable height exam table• May not be “readily achievable” -- $10,000• Alternatives:

– lower table the height of a wheel chair seat– transferring patient to table (safety?)– referral to use of equipment in another facility


Accessible Exam and Testing Equipment

• Service animals are any domesticated animal• Service animals that are dogs or cats are allowed

anywhere their human partner goes – protected under the ADA

• Health care facilities must allow their entrance except where they would compromise health or safety

• Two questions allowed to determine if it is a service animal – • Do you need this animal due to a disability?• What tasks or work has this animal been trained

to perform?


Service Animals

• TTY’s (TeleTYpewriters) helpful but not required; a low-cost accommodation at around $250

• Train staff to use Relay Iowa• Use computer terminal or pad and paper for routine

communications• Use licensed sign language interpreters when dealing

with complex medical issues such as surgery or informed consent (rarely provided)

• In Iowa providers can bill Medicaid for a licensed sign language interpreter for billing and consult

• Allow extra time


Accommodations for Those with Hearing or Speech Disability

• Try to make all written materials available in large print, audio recording or Braille; placing materials online can be useful if the font size can be increased or the person has a Braille reader

• Every effort should be made to have important forms such as informed consent or patient pre-procedure instructions available in alternate formats.

• Other alternatives:– Provide a reader– Have a powerful magnifying glass available


Accommodations for Those with Low- or No-Vision

• Communication should be clear and simple• Repetition can be helpful• Pictorial boards or simple drawings • If individual is not capable of giving consent,

must get consent from parent or guardian


Accommodations for Those with Cognitive Disabilities

The ADA prohibits medical and health care facilities from denying treatment to a person with disability because of his or her disability

Or denying treatment because of behavior resulting from a disability may be disturbing to other patients or clients

That practice is discrimination


Refusal of Treatment

• Public health services are covered under Title II• Public entity’s services, programs or activities must be

readily accessible to and usable by people with disabilities

• Know as “program accessibility”, applies to all existing facilities of a public entity

• Not required to make all facilities accessible• Do not need to remove physical barriers if they can

make their programs, services and activities through alternate methods


Reasonable Accommodations for Public Health Programs

Alternative methods• Relocating a service from third floor to first which is

accessible• Provide an aide or personal assistant to obtain the

service• Provide services in the individuals home• Provide services in an alternative location that is

accessible


Public Health Programs Continued

Public Health Programs Continued

Examples of Local Public Health Programs• Local departments of public health• WIC Programs• Maternal and Child Health Centers• Substance Abuse Treatment Programs• Domestic Violence Shelters• Chronic Disease Management Programs


Reasonable Accommodations in Disaster Shelters

• In Iowa, county Emergency Managers must locate facilities for temporary shelters.

• These shelters and the goods and services provided must be accessible to people with disabilities.

• Because these shelters are temporary, accessible features can be temporary i.e.; three parking spaces equal two accessible with the center as an access aisle,

ramps can be built to create an accessible entrance• All “temporary” features must be safe


Disaster shelters continued

• If the shelter that the individual with a disability is taken to is not accessible, emergency responders shall identify an alternative site that is accessible

• Possible alternative = A voucher for an accessible hotel that is located out of harm’s way

• Medical shelters aren’t appropriate for most people with disabilities; they are intended for those in hospitals and nursing homes

• Using medical shelters for most people with disabilities:

– Separates them from family and personal support people at a time when they need support

– Is a waste of precious county resources


Disaster shelters continued

Shelters should also be prepared to:• Handle service animals• Arrange for personal attendants to be near the individual

with a disability they are helping• Provide or arrange to obtain needed assistive technology• Request and receive needed medications for residents• Stock foods for residents with special dietary needs and

provide kitchen access if needed• Provide low stimulation or “stress-free zones” for

residents whose disabilities are aggravated by stress


COMMUNICATION ACCOMODATIONS IN ALL SETTINGS

IANet Task Force Guidelines on:

Communicating About Health Care to

People Who Have Disabilities

A copy is included in your Access Specialist Accessibility Resource Manual



CONDUCTING IOWA ACCESS SURVEYS

The Access Specialist will:

1. Demonstrate knowledge of Iowa’s accessibility surveys.

2. Understand physical access issues. 3. Understand program access issues.



Iowa ADA Building Access Survey• Developed by the Department of Human Rights, Division of Persons with Disabilities• Focuses on physical accessibility in four areas:

• Parking• Entrances/Exits• Common Areas (Internal Circulation)• Restrooms

• Appropriate for use in private health care facilities and public health programs

Iowa ADA Program Access Survey

• Developed by the Community Access Project team for testing in the pilot

• Focuses on program access issues:• Accessible exam and testing equipment• Communication for those with hearing or

speech disability• Communication for those with visual disability

• Appropriate for use with private health facilities and public health programs


ADA Checklist for Emergency Shelters

• Produced by the US Department of Justice• For use with Emergency/Disaster Shelters• To be completed the county Emergency

Manager• The role of the Access Specialist:

• Facilitate completion of the survey• Provide TA to Emergency Managers on making

shelters accessible



PROVIDING TECHNICAL ASSISTANCE TO IMPROVE ACCESS


1. Understands the concept and content of a compliance action plan.

2. Identifies resources to assist programs in making their facilities and services accessible.

3. Guides programs in developing their compliance action plan.


Analysis of Surveys and Development of Recommendations for Compliance

• Completed surveys will be reviewed by the ODH• Letters will be sent to providers with recommendation for

compliance if necessary• Access Specialist will be notified when these letters go

out• Your responsibility will be to provide technical assistance

in identifying and accessing resources for compliance• Access Specialist should create a resource file,

especially resources in area• See Appendix A, pages 68-76 for examples


An Accessibility Compliance Action Plan

• Help providers develop a Compliance Action Plan that: – Identifies achievable outcomes– Sets realistic goals with a timeline, e.g. “In 6 months all doors

will have lever handles

• Help providers who can not “readily achieve” accessibility identify other accessible locations they can use.

• Advocate for inclusion of the Compliance Action Plan in the organization’s strategic or business plan.

• Help the organization establish an Accessibility Compliance Folder


Develop an Accessibility Resource File

Include:

• ADA Ramp and Other Construction Contractors—Contact Iowa COMPASS at -800-779-2001

• Accessible Medical Equipment or Assistive Technology—Check will local durable medical equipment companies or call Iowa COMPASS

• TTYs (TeleTYpewriters)—Call Iowa COMPASS


Accessibility Resource File Continues

• Relay Iowa--7-1-1 or 1-800- 735-4313 (voice)

• Licensed sign language interpreters—Go the Iowa State Interpreters for the Deaf web site at http:/www.new.iowastaterid.org/ and select Interpreter Search or contact Iowa COMPASS for referral to an on demand virtual interpreter provider

• Brailling—Contact the Iowa Department for the Blind at 1-800-362-2587 for referral to a certified contract Braillist.



GETTING STARTED—DEVELOPING YOUR PLAN OF ATTACK


1. Understand how to identify and target programs within the community.

2. Demonstrate competency in creating a message and making a presentation to the targeted programs.

3. Is familiar with the tax incentives available to businesses who wish to become ADA compliant.

4. Know the options available for creating a rewards program for businesses who become ADA compliant.

5. Demonstrate competency in approaching and engaging programs and creating a positive climate for change.


Decide Which Programs to Target

1. Determine your geographic area2. Make a list of the health care facilities and public

health programs in your area3. Develop criteria to select programs, e.g.,

• All in a smaller geographic area• A certain type of facility, e.g. doctor’s offices• Use/conduct a mini-community assessment to decide

4. Target more than you can handle; not everyone will participate.

5. NOTE: Most hospitals are physically accessible. Problems are in program accessibility.


Your Message and Presentation

• A message tells your target audience:• what they are being asked to do, • why it is worth doing, and • the positive impact their action can have.

• You will have a limited amount of time, so know what you are going to say ahead of time


Two Rules for Messages

1. Keep it simple• Keep it short and to the point• Limit yourself to two or three main points, and

focus on your best supporting arguments • Data you can use for supporting arguments is in

Appendix B, pages 77-78

2. Know your audience• What motivates them• What past work they have done with ADA

accessibility


Health Care and Public Health AudiencePrimary Motivation = Providing good care

Your Message should address:1. How what you are proposing will improve client or

patient care2. How they can improve care at a reasonable cost3. How changes they make can increase their “customer

base”


The Emergency Manager AudiencePrimary Motivation = Protecting the Community, Saving Lives

They need to know that:1. A large percentage of the community (20%) have

some type of disability2. That all but about 2% of them lives in homes

throughout the community3. Medical shelters aren’t appropriate for most and are a

waste of precious resources4. Many shelters can be made ADA compliant at a

reasonable cost


Financial Incentives To For-Profit Businesses for Accessibility1. Tax Credit

• For small businesses = revenue up to $1 million; fewer than 30 full time employees

• For costs associated with making current facilities accessible (not new construction)

• Expenditures may include removing architectural barriers; purchasing sign language interpreter or reader services; purchasing assistive technology

• $5,000 maximum tax credit


Financial Incentives Continued

2. Tax Deduction• For any size business• Maximum of $15,000 per year• Can be used by small businesses in combination

with a tax credit


Developing a Rewards Program

• Everyone appreciates having their efforts recognized

• All business appreciate good press• Case Study: Proudly Accessible Dubuque

• A group that partners with the city of Dubuque and the Chamber of Commerce

• Is the carrot of a carrot and stick approach to promote accessibility by the City of Dubuque

• The stick is an ordinance that allows those with disabilities to file a discrimination complaint against any business that is not accessible


Proudly Accessible Dubuque

Businesses who become 100% ADA compliant receive:

• Proudly Accessible Dubuque logo clings to hang in windows• Permission to use the Proudly Accessible Dubuque logo in

advertising• Listing on the Proudly Accessible Dubuque web site• Special listing on the Dubuque Area Chamber of Commerce

web site• Special listing in this year's Dubuque Convention and Visitor's

Guide• Inclusion in regular media blitzes• Increased customer base and improved customer relations


Identify Who to Approach and How to Approach Them• Who to approach

• Always approach the right decision maker• They may not be implementers but they must

approve your plan and ask employees to help

• How to approach them• Do schedule a one-on-one meeting• Avoid blanket letters and leaving materials with

the secretary or at the front desk


Issues You Can Expect to Encounter

1. Your audience doesn’t think they need what you are offering; they believe they are ADA compliant

Most have done some work on accessibility and ADA compliance; most also have more to do


Issue One Continued

Consider the findings of a 2009 Illinois Iowa Center forIndependent Living study of consumers in Scott, Muscatine and Clinton Counties• 28% reported their doctor’s office was “accessible with difficulty”• 92% thought having access to an adjustable height exam table

was important; 78% indicated one wasn’t available• 75% thought having forms instructions available in large print or

Braille was important; 89% indicated this accommodation wasn’t available

• 100% thought an interview or examination conducted in a space with limited background noise was important; 75% indicated this accommodation wasn’t available.


Issues You Can Expect to Encounter

1. Some of your audience may seem nervous, anxious, defensive or even avoid meeting with you

The ADA is a Civil Rights Law. Your owners may fear the costs complaints, law suits or bad press.

Establish early on that you are not the ADA police.


Establishing a Positive Climate for Change—Your Approach is Key• Establish early on that you are not the “ADA Police”• Present yourself as a resource• Let the individual, group or organization know that

the goal is to find low- or no-cost solutions to accessibility problems

• Acknowledge that not all solutions will be without significant cost, but your role is to help identify options and alternatives that are doable


Your Approach Continued

• Be informative and assertive; never use an aggressive or combative approach

• If you don’t know the answer to a question, let them know that you know how to find it; then follow through.

• Agree on any future steps to be taken following the meeting. Indicate that you will follow up after an agreed-upon period of time, and always remember to follow up

• Remember the lessons learned in your leadership training about first impressions and presentations to key players/decision makers.


Documents

Livable Communities--Accessibility