Working with Patients with Physical Disabilities

by Laura Sachs Hills, MA^*

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don’t advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.

Despite current efforts for health promotion and illness prevention initiatives, the number of persons with disabilities has continued to increase in the United States in recent years. According to the U.S. Department of Health and Human Services, 54 million Americans are disabled today. That’s 20 percent of the U.S. population. Half of these persons have a severe disability that affects their ability to see, hear, walk, or perform other basic functions of life. About 12.9 million noninstitutionalized American adults are unable to walk (or walk with difficulty) a quarter of a mile. Seven million have a lot of trouble hearing or are deaf, and 20.4 million have vision trouble or are blind. Predictions are that these numbers will increase in the coming years, as the general U.S. population is living longer, and many disabilities tend to increase or become more severe during the aging process.

Some medical practices work largely or exclusively with disabled patients. Such practices no doubt are already well versed in the specific techniques that make working with these patients easier and more effective. The material in this article is for all the other medical practices that work with disabled patients on an occasional basis. While patients with physical disabilities are much like any other, your office can be better prepared to make your patients with special physical needs feel more welcome and at ease when they visit your medical practice.

10 WAYS TO PREPARE YOUR PRACTICE FOR PATIENTS WITH DISABILITIES

Patients with physical disabilities face challenges each day. In general, the United States has made progress in recent years in providing access to parking, buildings, and restrooms for those with mobility difficulties. More adaptations are needed inside many healthcare facilities, including medical practices. Patients with disabilities continue to face barriers, including lack of special equipment, insufficient space, untrained staff, inadequate communication methods, and inadequate appointment times once they enter a medical practice or other healthcare facility.

Following are 10 specific ways you can prepare your medical practice for patients with physical disabilities to ensure their accessibility, comfort, safety, and ease of mobility:

1. Provide ample reserved parking spaces and ramps/curb cuts for office visitors with disabilities. Be sure these are well marked.
2. Keep your sidewalk grade gentle—8 percent or less. Avoid using widely spaced flagstones or other uneven paving surfaces. Make curb cuts to the street or parking area textured, not smooth.
3. Provide handrails for the entrance ramp to your front door. The ramp itself should be at least four feet wide and with a nonslip surface. Again, the grade should not exceed 8 percent.
4. Install an automatic entrance door. Eliminate doorsills, thick doormats, and other impediments to entering or exiting your office.
5. Make sure all doorways in your office are wide enough to accommodate patients using wheelchairs, walkers, crutches, and canes. Plan on at least 32 inches of clearance for each doorway.
6. Provide individual, stable armchairs in your reception area. Avoid lightweight, very low, pillow-back, or armless chairs and sofas. These can be hard to get in and out of and become a hazard for patients with disabilities.
7. Plan your reception area so it is clear of small furniture and other objects that can be tripped over easily. Along similar lines, avoid throw or area rugs. Keep all rooms well lit.
8. Design magazine racks, reception counter, public telephones, water fountains, light switches, soap dispensers, hand towels, fire extinguishers, coat hooks, and anything else a patient would need to reach so they are less than four feet from the floor. This makes them accessible to patients using wheelchairs.
9. Provide handrails wherever patients have occasion to go in your office.
10. Allow five square feet of floor space in the restrooms. Install a toilet that’s the height of a wheelchair seat; safety rails on either side that support at least 250 pounds; and a sink that’s less than 34 inches high, with enough clearance to accommodate a wheelchair.

COMMUNICATING WITH PATIENTS WITH PHYSICAL DISABILITIES

Communicating with patients with physical disabilities is much like communicating with any patients. Healthcare should always be provided with respect for the patient as a person, but you can incorporate a few modifications in your written and spoken communications with patients who have physical disabilities:

1. Don’t assume that a patient’s special needs are more extensive than they really are. For example, don’t assume that a patient who is blind is also hard of hearing, or that a patient who is disabled physically is also disabled mentally.
   
2. When offering physical assistance to a patient who may be or is in need of special care, do so with great care. Offer your help courteously before you act. Don’t force help that is unwanted.
   
3. Let patients with special needs feel that they’re a welcome part of your practice by selecting reading material geared to them in your reception area. For example, you might have special materials for patients who have vision difficulties (such as personal audio equipment or the large-type edition of Reader’s Digest). You might even have some braille materials on hand.
   
4. Don’t communicate in front of a patient with a disability as though he or she isn’t there. Don’t whisper or gesture to others in the patient’s presence, thinking he or she won’t know. Most patients with disabilities you meet in your practice will be aware that you are talking about them. Assume they’ll know when they’re being talked about, as any patient would.
   
5. Don’t make assumptions regarding a patient’s way of communicating. Allow patients with disabilities to use their usual and preferred method(s) to communicate with you. For example, don’t assume that all people who are deaf use sign language to communicate. Some use lip-reading, which requires face-to-face communication. Some use an oral interpreter. Many patients who are hard of hearing or who are deaf may use assistive devices, such as a hearing aid, a text telephone, captioned videos, or a television with closed captioning to assist them in communicating.
   
6. Adjust written instructions and health education materials for patients with physical disabilities. For example, prepare patient brochures and handouts in large-print versions. In some situations, family members will want or need to be included in the health education sessions to facilitate effective communication with the patient and to assist with caregiving.
   
7. Become knowledgeable about the local resources available to your patients who have physical disabilities. Steer patients to those most appropriate for their needs. For example, most communities offer transportation services that are wheelchair accessýble. The medical practice staff is in an excellent position to refer patients to home-delivered meal services, housekeeping services, and support groups. Such information will be particularly welcome to patients who have a newly acquired disability and who may not yet be aware of the community resources available to them.
   
8. Sit in a chair whenever possible when communicating with a patient who uses a wheelchair. Communication will be easier and friendlier for both of you when you are positioned at the patient’s eye level.
   
9. Gather information from the patient on the best way the medical practice staff can provide their usual comfort measures. Learn whether additional time, staff members, or specialized equipment will be needed in order to accomplish routine care. If so, make sure that adaptive equipment and needed staff members are available at key times for caregiving.
   
10. During health education sessions, involve the patient with a physical disability actively in the teaching-learning process as much as possible. When needed, repeat and reinforce information several times to accommodate particular disabilities. Look for opportunities to provide information in multiple forms—verbally, in writing, through a physical demonstration, etc. to meet learning objectives.

OPPORTUNITY IN WORKING WITH PATIENTS WITH DISABILITIES

Patients with disabilities often have a greater need for health promotion and access to healthcare because they are at higher risk for serious health problems. The medical practice staff can play an integral part of the entire healthcare team in delivering direct care to patients with disabilities. Accommodating the needs of patients with special needs may be a challenge at times, but it can also be very rewarding.

The medical practice staff has a unique opportunity to accommodate patients with disabilities. Just having a willingness to assist these patients, however, is not sufficient to accomplish long-term health goals. In addition, the medical practice staff needs to ensure that patients with disabilities are also provided the chance to make informed choices regarding their care, treatment, and procedures.

“The medical practice staff . . . can make a significant difference . . . in empowering adults with disabilities to be active participants in their healthcare.”

Working with patients with disabilities can be a very effective way to build a medical practice. Patients with physical disabilities may be willing to travel considerable distances to use the services of healthcare providers who accommodate their needs. The medical practice staff must always remember that they can make a significant difference in improving healthcare services and empowering adults with disabilities to be active participants in their healthcare.

Additional articles from The Journal of Medical Practice Management:

• 10 Ways to Give Your Office a Face-Lift
• Age to Age: Insight into Managing a Multigenerational Staff
• Better Off Alone? Why Physicians Don’t Merge
• Consumer-Driven Health Plans: Latest Challenge to Practices’ Cash Flow
• Educate Patients on Billing Policies to Improve Your Bottom Line
• How a Successful Litigator Decides Whether or Not to Sue You
• How to Perform Your Own Practice Operational Assessment
• Practice Management Secrets: Get Personal with Customer Service
• Self Assessment for Practices Considering Electronic Medical Record Systems
• Six Elements for Creating a Framework for Employee Motivation and Performance
• Why Your Practice Must Do Background Checks

Reprinted with permission from The Journal of Medical Practice Management, Copyright Greenbranch Publishing, (800) 933-3711, www.mpmnetwork.com.

*Practice management author and consultant. 10618 Regent Park Court, Fairfax, VA 22030; phone: 703-691-1066; e-mail: merlegerle@aol.com. Copyright © 2006 by Greenbranch Publishing LLC.