July 7, 2011 Accessible Hospitals and Other Health Care Facilities

Slide 1: 
Welcome to the AccessibilityOnline Webinar Series 
A collaborative program between the National Network of ADA Centers and the US Access Board.  The content and materials of this training are property of the US Access Board and the DBTAC - Great Lakes ADA Center and cannot be used and/or distributed without permission.  This program is funded under award #H133A060097 from the U.S. Department of Education through the auspices of the National Institute on Disability and Rehabilitation Research (NIDRR) and an inter-agency agreement with the U.S. Access Board. For permission to use training content or obtain copies of materials used as part of this program please contact us by email at adata@adagreatlakes.org or toll free (877)232-1990 (V/TTY) 

Slide 2: 
Webinar Features
Closed captioning – click CC icon (top of screen) or control-F8 and adjust your screen
Questions - type and submit questions in the Chat Area Text box or press control-M and enter text in the Chat Area. Please do not use emoticons or hand-raising features during this session

Slide 3: 
Presenter 
U.S. Access Board, Earlene Sesker 

Slide 4: 
Accessible Medical Care Facilities 
Session Agenda
Standards
Covered Facilities
Scoping
Patient Rooms
Common Use Areas
Questions 

Slide 5: 
New ADA Standards 
DOJ’s 2010 standards  
(Mandatory March 15, 2012)
Based on the Board’s ADA-ABA Guidelines (2004)  

Slide 6: 
ADA and ABA Standards 
ADA:  DOJ’s standards (2010) DOT’s standards (2006) for transit facilities, ABA (Federal Sector):
ABA standards updated (GSA, DOD, and USPS) Update of HUD standards still pending (UFAS still applies to housing covered by ABA)

Slide 7: 
Covered Facilities 
Hospitals, Rehabilitation Facilities, Psychiatric Facilities and Detoxification Facilities Long-term Care Facilities. Image of sign with large letter symbolizing hospital with word hospital written below letter. Image of a gentleman sitting in wheelchair nursing home elevator lobby; nursing assistant waiting at elevator

Slide 8: 
Covered Facilities 
Professional Offices of Healthcare Providers, Medical units in detention and correctional facilities whether, or not, licensed. Image of doctor speaking with woman in the hospital waiting room. Also in waiting area man reading magazine, woman reading magazine and teenager playing handheld video game. Image of prisoner in bed at correctional facility 

Slide 9: 
New Construction
All areas must comply except:
Exempted structures/ spaces, Work areas (ADA facilities), Partially scoped spaces

Slide 10: 
New Construction
Mechanical (exempt)Clustered toilet rooms  (partial scoping – 50%)_ Work areas (partial access) – e.g., reception area, nurses station_ Medical Suite Plan view showing clustered toilet rooms, mechanical rooms, patient rooms and the nurses’ station 

Slide 11: 
Scoping 
Parking
Entrances
Patient rooms
Toilet rooms
Accessible routes

Slide 12: 
Parking Scoping 
Section 208 (Parking Spaces)
Table of contents of the ADA-ABA guidelines (section 206 "Accessible Routes" highlighted) 

Slide 13: 
Accessible Parking Scoping
Hospital: 10 % of spaces
Rehabilitation and Outpatient Physical Therapy Facilities: 20 % 

Slide 14: 
Accessible Parking Scoping
Doctor’s Offices: use table
Medical Equipment Facilities: use table 
Table 208.2 Parking Spaces, Total Number of Parking Spaces Provided in Parking Facility Minimum Number of Required Accessible Parking Spaces 
1 to 25 = 1; 26 to 50 =2; 51 to 75 = 3; 76 to 100 = 4; 101 to 150 = 5; 151 to 200 = 6 
201 to 300 = 7; 301 to 400 = 8; 401 to 500 = 9; 501 to 1000 = 2 percent of total 
1001 and over = 20, plus 1 for each 100, or fraction thereof, over 1000 
Slide 15: Passenger Loading Zones_ At least 1 for every 100 linear ft. of loading zone space provided. Image of long passenger loading zone 

Slide 16: 
Patient Rooms 
Hospitals, Rehabilitation Facilities, Psychiatric Facilities and Detoxification Facilities
Conditions Affecting Mobility 
Specializing 		100%
Not specializing 	10%
Long-term care 	50%

Slide 17: 
Dispersion 
Hospitals
“Proportionate” by type of medical specialty (DOJ change) 
Long-term care, by type of room e.g. private, shared, congregate space

Slide 18: 
Toilet Rooms in Patient Rooms 
Those serving patient rooms required to be accessible
Exception for toilets in critical care or intensive care patient rooms
Image of intensive care patient room with lots of medical equipment

Slide 19:
Clustered Toilet Rooms 
New exception:
Access to at least 50% of single user toilet rooms clustered at one location that serve same users (instead of 100%) 

Slide 20: 
Clustered Toilet Rooms
Example: medical office suite
Floor plan of medical office suite with 8 single user toilet rooms adjacent to exam rooms.  These toilet rooms are shaded to indicate they are part of cluster and half are accessible.  A single user toilet room outside the suite and a multi-user toilet room are not part of the cluster. 
Slide 21: 
Patient Rooms - Alterations and Additions 
Based on the number altered or added until overall number reached Maintains dispersion
Photo of Hospital corridor 

Slide 22:
Common Use Areas 
All must be accessible unless otherwise stated, including exam rooms
Photo of inside an exam room looking toward door opening into the room. 
Image of exam room show space beside exam table for transfer 

Slide 23: 
Common Use Areas 
Congregate Dining Facility
Image of dining area in nursing home 

Slide 24: 
Public Use Areas 
Lobbies and Waiting Areas
Diagram of hospital lobby and waiting area

Slide 25: 
Public Use and Common Use
Toilet Rooms_ Image of accessible single user toilet room 

Slide 26: 
Work Areas (ADA)
Access for “approach, entry, & exit
Door man. Clearance (exterior), Compliant door (clear width, hardware, opening force, etc.)
Clear floor space, Recommended: Interior door man. Clearance turning space. 
Diagram a person in wheel chair entering employee work area showing clearance for door approach and wheelchair space within area highlighted in yellow

Slide 27: 
Employee Work Areas 
Controls and fixtures used by staff - exempt
Hospital room with bed, medical equipment and file cabinet
Image showing Knee space under lavatory in patient room obstructed by hazardous disposal receptacle 

Slide 28: 
Accessible Routes Scoping;  Connect: Boundary of site with bus stops, accessible parking, passenger loading zones, and entrances. Hospital Aerial View 

Slide 29: 
Entrances 
At least 60% of public entrances to comply.  Also:  Direct access from parking structures (all)
Direct access from tunnels or elevated walkways.  Entrances to different tenant spaces
 Restricted or secured entrances (at least 1)

Slide 30: 
Accessible Routes 
Coincident with routes used by others, Same general area
Photo of a building’s main entrance with both stairs and ramp 

Slide 31: 
Interior Accessible Routes
At least one accessible route connecting accessible entrance with accessible spaces and elements (all). Image of building layout in perspective view with entrance doors and toilet room doors highlighted

Slide 32: 
Vertical Access (Elevators) Required 
Professional Offices of a Healthcare Provider
Where a State-regulated professional provides physical or mental health services to the public
Title II entities. Photo an elevator 

Slide 33: 
Accessible Means of Egress
Reference to the International Building Code (IBC)
Standby power for platform lifts on egress routes

Slide 34: 
Wheelchair Accessible Public Telephones 
Coin-operated and coinless public pay telephones
Public closed-circuit telephones
Public courtesy phones
1 phone or 1 bank per floor, level, and exterior site  provided, 1 per floor, level or exterior site
2 or more banks per floor provided, 1 per bank

Slide 35: 
Technical Requirements 
Slide 36: Passenger Loading at Entrance 
Canopy not required (2010 ADA Standard)
Image of a building entrance with canopy over passenger loading zone 

Slide 37: Accessible Entrances 
Automatic Doors Recommended. Woman on crutches exiting door with one crutch located between double doors; Man in wheelchair about to enter building; Man using walker about to enter building through double glass doors/ one door partially open; Man on scooter opening door to enter building.  

Slide 38: 
Protruding Objects Image showing  railing placed as warning of protruding object created by architectural beam slanted from floor to ceiling along circulation path close up view of railing place under beam to warn of protruding object 

Slide 39: 
Protruding Objects 
4” max projection 27” to 80”
Fold-up after use to avoid obstacles and preserve clearances
Image of a fold down shelf protruding more than 4 inches at a height above 27 inches along the circulation path. Image showing close up of label on cart showing door maneuvering clearance and red lettering note stating that the cart must be kept out of the door maneuvering clearance
  
Slide 40:
Protruding Objects; Alcove or wing wall removes the drinking fountain from the circulation path. Image of drinking fountain placed in alcove so as not to be protruding object. Image of drinking fountain protruding into circulation path 

Slide 41: 
Protruding Objects 
Flag signs used in medical settings cannot protrude into circulation paths unless above 80” 
Photo of different colored flag signs 

Slide 42: 
Toilet Rooms
Public Use, Common Use and Accessible Patient Rooms

Slide 43: 
Water Closet Clearance 
Not permitted in 2010 Standards
Photo of water closet and lavatory immediately adjacent to it. 

Slide 44: 
Water Closet Clearance 
Allows space for side transfers
Person using wheelchair shown within the water closet clear floor space and in between the water closet and lavatory.

Slide 45: 
Toilet Room 
Door can swing into fixture clearances where unobstructed wheelchair space is available beyond. A toilet room is shown in plan view with a water closet and lavatory on the same (back) wall with clear floor space at both fixtures indicated.  An in-swinging door is located on side wall closest to the lavatory with door maneuvering clearance shown.  The door swing does intrude into the water closet and lavatory clearances.  Unobstructed wheelchair space beyond the arc of the door swing is indicated.

Slide 46: 
Rear Grab Bar
Elevation drawing shows the rear grab bar 36 inches (915 mm) long minimum, positioned so that 24 inches (610 mm) minimum extends toward the open transfer side and 12 inches (305 mm) minimum extends toward the side wall. 

Slide 47: 
Recessed Fixture Saves Space
24” min. rear grab bar allowed by new standards where adjacent fixture is recessed. Image of Lavatory recessed behind clear floor space at water closet.  Rear grab bar water closet is 24" min. long (allowed by new standards where adjacent fixture is recessed). 

Slide 48: 
Rear Grab Bar 
Grab bar can be split or shifted to open side to accommodate required location of flush control valves. Image of Water closet with rear grab bar split to accommodate flush controls for flush valves. 

Slide 49: 
Grab Bars
ANSI A117.1 requires 18” min. vertical grab bar (ADA and ABA guidelines do not)
Elevation drawing of water closet with horizontal side grab bar and a shorter vertical grab bar above it.

Slide 50: 
Flush Controls 
Location: open side of water closet
Height:  48” max. Image showing Water closet with flush control on transfer side. 

Slide 51: 
Grab Bars
Clearances:
1 ½” behind (absolute)
1 ½” min. below
New: 12” min. above

Slide 52: 
Dispensers 
Common problem: large dispensers above grab bar impact usability 
Photo of water closet with large toilet paper dispenser immediately above side grab bar. 

Slide 53: 
Toilets for Specimen Collection. Reminder: Clustered = 50% of each type of use in each cluster. Photo of   Accessible Specimen Toilet Room 

Slide 54: 
Specimen Cabinet 
Must be within reach from a clear floor space (parallel or forward approach)
Note lavatory clearances and mirror height
Image showing Specimen Drop located above grab bar, under paper towel dispenser and adjacent to accessible lavatory 

Slide 55: 
Lavatories 
Locate controls & dispensers above, not beyond, usable CFS to be within reach
A person seated in a wheelchair shown in side profile reaching over lavatory to faucet controls.  A dashed vertical line shows the forward reach corresponding horizontally to the toes. 

Slide 56: 
Lavatories 
Tip:  Avoid hospital style lavatories with deep projections  
They take up more space and require a greater reach to faucet controls and  dispensers
 Horizontally deep lavatory shown crossed out. 

Slide 57: 
Children’s Toilets 
Alternate Specifications:
 WC centerline	12” – 18”
 WC seat height	11” – 17” 
 Grab bar height	18” – 27”
 Dispenser height	14” – 19”

Slide 58: 
Children’s Toilets 
Advisory information provides guidance according to age group
WC Centerline Ages 3&4 12 in; Ages 5-8 12-15 in; Ages 9-12 15-18 in
Toilet Seat Height Ages 3&4 11-12in; Ages 5-8 12-15 in; Ages 9-12 15-18 in
Grab Bar Height Ages 3&4 18-20 in; Ages 5-8 20-25 in; Ages 9-12 25-27 in
Dispenser Height Ages 3&4 14 in; Ages 5-8 14-17 in; Ages 17-19 in

Slide 59: 
Children’s Lavatories 
Exceptions based on age of intended users 
Ages 6 - 12: 24” high min. knee clearance allowed (if lav 31” high max.)
Ages 5 and under: Side approach permitted 

Slide 60: 
Patient Rooms   Patient Room Space with two beds with transfer space adjacent to bed 

Slide 61: 
Patient Room Technical Requirements 
Accessible door
Exception: latch side clearance at hospital patient room doors
Long-term care privacy needs may differ
Image showing patient room with door open. 

Slide 62: 
Patient Room Technical Requirements 
Turning space within the patient sleeping room
Clear floor space on both sides of bed or between two beds Accessible storage. Image showing Patient Room Storage located in corner near head of bed not allowing clear floor space on one side of bed or space to access storage 

Slide 63: 
Operable Parts 
Think beyond light switches all controls to be operated by patient 
Furniture to be addressed by DOJ. Image of pull down TV over patient bed 

Slide 64: 
Operable Parts 
Operable with one hand – no tight grasping, pinching twisting or wrist turning 
Recommendation: tactilely discernable buttons.  Image of hand holding bed controller, hand reaching for curtain pull 

Slide 65: 
If Provided, Handrails on Walking Surfaces 
34” min. and 38” max. High 1 ½” clearance between rail and wall 
No sharp or abrasive edges (rail and wall) 100% unobstructed gripping surfaces (tops and sides)
80% unobstructed gripping surfaces (bottom), unless they are integral to crash barriers

Slide 66: 
Handrails on Walking Surfaces_ Image of hospital corridor with handrails along both sides 

Slide 67: 
Sales and Service Counters; Information and reception counters; Registration; Billing, including teller windows; Pharmacy; Cafeteria; Gift shops; Nursing stations 

Slide 68: 
Sales and Service Counters 
Full depth of transaction counter @ 36” max. Parallel or forward approach; Knee and toe space for forward. Removed:  alternatives to counter access

Slide 69: 
Nursing Stations
Space at the open end of nursing station. Image of nurse’s station with lowered counter on front 

Slide 70: 
Gift Shops 
Note cash register location; Image of cashier and customer at counter in hospital gift shop 

Slide 71: 
Rehab and Other Treatment Areas 
Clearances between equipment. Image of people using exercise equipment in rehab facility
Three women in rehab room, one sitting in wheelchair positioned in front of three steps, on pushing wheelchair, and one standing in front of wheelchair 

Slide 72: 
Windows 
Facilitate voice communication where security glazing separates teller and patron
Loop Symbol-Blue
Assistive listening device
Talk thru baffle

Slide 73: 
Restaurants, Cafeterias and Congregate Dining 
Accessible tables on accessible routes; Tray slide height – 28” min. and 34” max.
Self-service shelves and dispensing devices for tableware, dishware, condiments, food and beverages within reach; Accessible check-out counters

Slide 74: 
Queues and Check-out Lines.  Accessible route to each type of counter, e.g., order and pick-up_ people standing in check out line ordering or waiting for food 

Slide 75: 
Congregate Dining Facilities 
Ensure knee and toe space beneath tables. Image of women seated at dining room table in nursing home facility 

Slide 76: 
Communications 
TTY’s and Telephones
Visual Alarms 
Signs
Patient and visitor information

Slide 77: 
TTY’s and Volume Controls 
Public pay telephones
Banks of 4 or more units - 1/bank unless banks are within 200’
Where phones are provided at hospital emergency room, recovery room, or waiting room – at least one TTY; Volume Controls  At all public phones
						
Slide 78: 
Visual Alarms 
Comply with NFPA 72
Industry practice in medical areas
Visual alarms in areas served by audible alarms
Alterations – provide visual alarms when the system in altered or upgraded 

Slide 79: 
Signs 
All signs “designating permanent rooms and spaces must have raised letters and Braille
Informational signs must comply with provisions for low-vision access 
EXEMPT: Directories, menus, occupant names, building addresses, and company names and logos 

Slide 80: 
Types of Signs: Building directory, exempt, Directional Sign showing direction to accessible entrance, Room Designation, sign showing accessible men’s room. 

Slide 81: 
Patient and Visitor Information 
DOJ regs require covered entities to provide “effective communication” with individuals with disabilities and to provide auxiliary aids and services. TTY available for patient rooms. Image of Information kiosks

Slide 82: 
Section 510 of the Rehabilitation Act 
Authorizes the Access Board to Develop Standards for Medical Diagnostic Equipment man sitting on two different height exam tables
 
Slide 83: 
Grab Bars Swing to Side_ Image of exam chair that reclines to become an exam table_ Image of exam chair with fold away arm rests 

Slide 84: 
Operatory Chair with Support Cushions_ Image of doctor talking to a patient in an exam chair supported by numerous large pillows 

Slide 85: 
Articulating Headrest on Dental Chair_ Image of exam chair with articulating headrest 

Slide 86: 
DOJ Guidance is Available _sketch of examination room with women on table and doctor leaning over her. 

Slide 87:
Questions?
You May Type and Submit questions in the Chat Area Text Box or press Control-M and enter text in the Chat Area

Slide 88:
 U.S. Access Board 
(800) 872-2253 (voice)
(800) 993-2822 (TTY)
E-mail: ta@access-board.gov
www.access-board.gov

Slide 89:
Thank you for participating in today’s webinar
Next scheduled session:
“August 4, 2011 Accessible Health Clubs and Fitness Facilities”
www.accessibilityonline.org 
877-232-1990 (V/TTY)