All people, including people with disabilities, are entitled to access to all facilities and services. Over 54 million Americans have been identified as having a disability. People with disabilities represent a large and growing sector of the population, and almost everyone experiences a disability as he or she ages. People with disabilities are still sometimes unable to get the services they need due to barriers, despite their prevalence in society and raised public awareness of disability issues.
To protect the rights of people with disabilities and increase accessibility, several disability rights laws have been established, including the Rehabilitation Act of 1973; “the purposes of this Act are to empower individuals with disabilities to maximize employment, economic self‐sufficiency, independence, and inclusion and integration into society” (http://access‐board.gov/enforcement/rehab‐act‐text/intro.htm).1
Another disability rights law, the Americans with Disabilities Act (ADA) of 1990 was established to provide “enforceable standards addressing discrimination against individuals with disabilities, and ensure that the federal government plays a central role in enforcing these standards on behalf of individuals with disabilities. The ADA Amendment Act (ADAAA), effective January 1, 2009, mandates Nondiscrimination on the Basis of Disability in State and Local Government Services.” The ADA gives people with disabilities civil rights protection equivalent to that provided to people on the basis of sex, race, national origin, and religion (http://www.ada.gov/).2
The New Freedom Initiative of 2001 was initiated as part of a nationwide effort to remove barriers to community living for people with disabilities; its goals are to: “increase access to assistive and universally designed technologies; expand educational opportunities; promote homeownership; integrate Americans with disabilities into the workforce; expand transportation options; and promote full access to community life.” Some of the initiative’s proposals include: promoting full access to community life through implementation of the Olmstead Supreme Court decision; integrating Americans with disabilities into the workforce through the creation of the Ticket to Work and Work Incentives Improvement Act of 1999; and the development of the New Freedom Commission on Mental Health (http://www.hhs.gov/newfreedom/).3
The following will discuss how disability rights laws oversee accessibility in the areas of: electronic and information technology; websites; federal, state, and local government services; meetings; and public facilities.
Accessibility: Electronic and Information Technology
Section 508 of the Rehabilitation Act of 1973 mandates access to electronic and information technology in the Federal government (but not the private sector) ; this law covers software applications and operating systems (alternative keyboard navigation), web‐based intranet and internet information and applications (including World Wide Web sites), telecommunications products (text telephones), video and multimedia products, self contained and closed products (information kiosks, ATM machines, copiers and fax machines), and desktop and portable computers (http://www.section508.gov/index.cfm?fuseaction=stdssum#web).4
Title IV of the ADA addresses telephone and television access for people with hearing and speech disabilities. It requires telephone companies to establish interstate and intrastate telecommunications relay services (TRS) 24/7, which enables callers with hearing and speech disabilities to communicate with each other through a third party communications assistant. The Federal Communications Commission has set minimum standards for TRS services. Title IV also requires closed captioning of federally funded public service announcements (http://transition.fcc.gov/cgb/dro/title4.html).5
Regarding the development of accessible websites, guidelines have been developed by the Web Accessibility Initiative of the World Wide Web Consortium. Follow the Consortium’s guidelines on: text alternatives (non‐ text content is changed into large print, Braille, speech, symbols or simpler language), adaptable content (creates content that can be presented in different ways without losing structure or information), distinguishable content (makes it easier for users to see and hear content by separating the foreground from background), keyboard accessibility (makes all functionality available from a keyboard), sufficient time (allows users enough time to read and use content), navigability (help users navigate, find content, and determine where they are in the website), readability (makes text content understandable and readable), help with input (assists users avoid and correct mistakes), and compatibility (maximizes compatibility with assistive technologies) (http://www.w3.org/TR/2008/REC‐WCAG20‐20081211/#alt‐time‐based‐mediadef).6
Accessibility: Federal, State, and Local Government Services
“All government facilities, services, and communications must be accessible consistent with the requirements of Section 504 of the Rehabilitation Act of 1973” (http://www.sanantonio.gov/ada/EtiquetteHandbook 2011.asp?res=1024&ver=true).7 It’s important for federal, state, and local governments to involve people with disabilities in all phases of public programs, including planning and execution; one way is to involve people with disabilities as volunteers and staff members.8 All facilities, activities, and meetings should be made accessible. Include accommodation costs into the project budget (e.g., cost estimates for the publication of large‐print documents), and make sure events are physically accessible by holding them on a public transit route or in the community later in the day to allow community members enough time to get ready and go to the event. All staff members should be trained in working with people with disabilities and work towards increasing staff awareness on the importance of involving people with disabilities.
Assume that a person (or people) with a disability might attend each meeting that you plan; this is the start to eliminating barriers to full participation, which creates an improved environment for everyone. Meeting registration forms can be used to collect information beforehand on the needs of your participants. The following five areas (see listed below) should be considered when planning a barrier‐free meeting (http://www.fpg.unc.edu/~ncodh/ pdfs/rbmeetingguide.pdf): Meeting Facility, Emergency Evacuation, Meeting Rooms, Accessible Presentations, and Other Meeting Activities.9
If meetings are held in your organization’s own facilities, assess your environment; if they will be held in an outside location, it’s important that you visit the site before the meeting to determine accessibility. Various features of the meeting facility should meet ADA standards, including the entrances, parking, sidewalks, exterior and interior doors, routes of travel, elevators, ramps, signage directing people to all areas of a facility, and restrooms. A pre‐conference meeting with hotel staff is valuable for educating staff about disability awareness and proper etiquette.
Providing proper notification of an emergency situation and means of escape is required as an accessibility feature. If the meeting is located above the first floor of a building with several levels, planners should have an emergency evacuation plan for people unable to use stairs when the elevator cannot be used. Make sure that participants with a disability know where to go in case of an emergency, such as a fireproof room, and have an accessible route of travel to the emergency exit. During the preconference meeting with hotel staff, emergency evacuation policies and identifying persons responsible for assisting people with disabilities should be covered. Audible and visible alarms must be present to alert individuals of an emergency, and manual fire alarms or fire extinguishers need to be within reach.
Because meeting rooms often seem cramped due to last‐minute or unexpected participants, allow more room for participants with various disabilities. All participants should be able to maneuver throughout the room, sit where they are comfortable, see and hear the presentation, and participate in the conversation and activities. Accessibility in the meeting room can be ensured with wide aisles, reserved seats in the front and in aisles for participants with visual or hearing disabilities, outlets and extension cords for participants using assistive listening devices or computers, sign language interpreters close to the speaker and participants, and the allowance of personal attendants or service animals when needed. Other meeting room features to be considered include an accessible speaking area and adequate lighting, microphones, sound systems, and ramps.
It’s also important to provide accessible presentations, which involves effective communication and appropriate accommodations based on participants’ needs. Accommodations can include: alternate formats for written materials (large print, material on disk, or Braille); or auxiliary aids and services (assistive listening devices, Communication Access Realtime Translation, or interpreters for people who are deaf or hard of hearing).
Other Meeting Activities
When other activities are added to the agenda, find ways to ensure that they are accessible to everyone. These activities can include: food breaks, off‐site tours, and overnight stays. When a meeting requires an overnight stay, consider the accessibility of hotels being used or recommended for the meeting. Anyone planning a meeting should assess the accessibility of the venue before signing a contract for the site.
Accessibility: Public Facilities
“Public accommodations such as restaurants, hotels, theaters, doctors’ offices, pharmacies, retail stores, museums, libraries, parks, private schools, and day care centers may not discriminate on the basis of disabilities” (http://www.sanantonio.gov/ada/EtiquetteHandbook2011.asp?res=1024&ver=true).10 Existing public facilities should be made physically accessible by providing accessible features previously mentioned in the Meeting Facility section, as well as counters and service windows low enough for everyone to reach (including people who use wheelchairs). Auxiliary aids and services must be provided to people with disabilities so they can have equal opportunity to participate.
New and altered construction
All new construction in public and commercial facilities such as office buildings must be accessible. If these facilities are multi‐story buildings, accessible elevators are generally required to serve all floors. When changes to the primary function areas are made, an accessible path of travel to the altered area (and the bathrooms, telephones, and drinking fountains serving that area) must be provided. Regarding older facilities that may question whether they are “grandfathered” in and not required to remove barriers as required by the ADA, “places of public accommodation must remove barriers when it is readily achievable to do so. Although the facility may be ‘grandfathered’ according to the local building code, the ADA does not have a provision to ‘grandfather’ a facility. . . the ADA requires that a place of public accommodation remove barriers that are readily achievable even when no alterations or renovations are planned” (http://www.ada.gov/adata1.htm).11
The good news is there are tax benefits to help pay for the cost of the removal of qualified architectural and transportation barriers. Businesses can take advantage of Federal tax incentives every year to help cover costs of making access improvements for customers with disabilities; this includes barrier removal, provision of accessibility services, provision of printed material in alternate formats, and provision or modification of equipment (http://www.ada.gov/taxincent.htm).12
“Private hospitals or medical offices are covered by Title III of the ADA as places of public accommodation. Public hospitals and clinics and medical offices operated by state and local governments are covered by Title II of the ADA as programs of the public entities” (http://www.ada.gov/medcare_mobility_ta/medcare_ta. htm).13 New and altered facilities must meet the ADA Standards for Accessible Design. The ADA provides guidance on accessible doorways; turning space inside examination rooms; height for chairs, exam tables, and medical equipment; accessible scales; and transfer techniques. In addition to purchasing accessible medical equipment, ongoing training of medical staff on how to use the equipment is crucial. Staff training is also needed on how to assist with transfers and lifts, and to use positioning aids. Other examples of accessibility include: staff and health care professionals who use sign language or have access to someone who can use sign language, and print materials and signs in large size font for people with low vision (http://www.cdc.gov/ncbddd/disabilityandhealth/accessibility.html).14
Accessible medical equipment
The Affordable Care Act for Americans with Disabilities provides for “Accessible, Affordable Health Insurance and an Enhanced Commitment to Community Living.” The commitment to community living includes improving access to medical diagnostic equipment so that people with disabilities can receive routine preventive care and cancer screenings. To help meet this goal, exam equipment accessibility standards will be established by the Food and Drug Administration and the U.S. Access Board (http://www.healthcare.gov/news/factsheets/2010/11/affordable‐care‐act‐americans‐disabilities.html).15
The way forward
You can create accessible environments without spending a lot; in new construction, accessibility features generally do not increase costs, and in existing facilities, necessary changes are not always expensive. There may be alternative devices or services that can be used as when needed modifications may not be available. Integrating changes into buildings and services can provide universally usable environments beneficial to all consumers. As the aging population grows, the concept of “universal design” becomes an increasingly critical concern to the entire population.
We’ve come a long way in increasing accessibility, but there is more work to be done. By providing this information on accessibility, AAHD strives to help create more accessible environments and services and integrate disability into public health.
1U.S. Access Board, “The Rehabilitation Act Amendments of 1973, as amended.” Available at http://access‐ board.gov/enforcement/rehab‐act‐text/intro.htm
2U.S. Department of Justice Americans with Disabilities Act (ADA) website. Available at http://www.ada.gov/
3U.S. Department of Health and Human Services, “New Freedom Initiative” website. Available at http://www.hhs.gov/newfreedom/
4Section508.gov, “Section 508 Standards Summary” webpage. Available at http://www.section508.gov/index.cfm?fuseaction=stdssum#web
5Federal Communications Commission, “Title IV of the Americans with Disabilities Act (ADA).” Available at http://transition.fcc.gov/cgb/dro/title4.html
6W3C Working Group, “Understanding WCAG 2.0: A guide to understanding and implementing WCAG 2.0.” Available at http://www.w3.org/TR/2008/REC‐WCAG20‐20081211/#alt‐time‐based‐mediadef
7City of San Antonio, Disability Access Office (DAO) and the Disability Access Advisory Committee (DAAC), “2011 Disability Etiquette Handbook.“ Available at http://www.sanantonio.gov/ada/EtiquetteHandbook2011.asp?res=1024&ver=true
8National Association of County and City Health Officials (NACCHO), “Tips and Strategies for Successful Integration of People with Disabilities into Local Public Health Promotion Programs.” Available at http://www.naccho.org/topics/HPDP/healthdisa/resources/index.cfm
9North Carolina Office on Disability and Health in collaboration with The Center for Universal Design, Removing Barriers Planning Meetings That Are Accessible to All Participants. Available at http://www.fpg.unc.edu/~ncodh/pdfs/rbmeetingguide.pdf
10City of San Antonio, Disability Access Office (DAO) and the Disability Access Advisory Committee (DAAC), “2011 Disability Etiquette Handbook.“ Available at http://www.sanantonio.gov/ada/EtiquetteHandbook2011.asp?res=1024&ver=true
11 U.S. Department of Justice Americans with Disabilities Act (ADA), August 1996. Available at http://www.ada.gov/adata1.htm
12 U.S. Department of Justice Americans with Disabilities Act (ADA) Tax Incentives for Businesses. Available at http://www.ada.gov/taxincent.htm
13Americans with Disabilities Act, “Access To Medical Care For Individuals With Mobility Disabilities.” Available at http://www.ada.gov/medcare_mobility_ta/medcare_ta.htm
14Centers for Disease Control and Prevention Disability and Health’s Accessibility webpage. Available at http://www.cdc.gov/ncbddd/disabilityandhealth/accessibility.html
15Healthcare.gov, Affordable Care Act for Americans with Disabilities. Available at http://www.healthcare.gov/news/factsheets/2010/11/affordable‐care‐act‐americans‐disabilities.html
© 2011 American Association on Health & Disability
American Association on Health and Disability (AAHD) provides the materials and links for general information, education and disease awareness purposes only. Although every effort is made to assure that information is accurate and current, knowledge in the field of disability is changing often, and all data is subject to change without notice. AAHD makes no representations or warranties and assumes no responsibility or liability as to the accuracy, completeness, reliability or usefulness of any information contained in this document. Neither AAHD nor any parties, who supply information to AAHD, make any warranty concerning the accuracy of any information in this document.
This publication was made possible, in part, by a grant from the Department of Health and Human Services, Centers for Disease Control and Prevention (200-2010-36219).