Slide 1:
Welcome to the AccessibilityOnline Webinar Series
A collaborative program between the ADA National Network and the U.S. Access Board
The Session is Scheduled to begin at 2:30pm Eastern Time
We will be testing sound quality periodically
Audio and Visual are provided through the on-line webinar system.  This session is closed captioned.  Individuals may also listen via telephone by dialing 1-712-432-3100 code 930098 (This is not a Toll Free number)
The content and materials of this training are property of the US Access Board and the Great Lakes ADA Center and cannot be used and/or distributed without permission.  This program is funded through a contract 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)  www.AccessibilityOnline.org

Slide 2:
Listening to the Webinar
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Slide 3:
Listening to the Webinar, continued
If you do not have sound capabilities on your computer or prefer to listen by phone, dial:
1-712-432-3100 Pass Code: 930098 This is not a Toll Free number

Slide 4:
Listening to the Webinar, continued
MOBILE Users (iPhone, iPad, or Android device and Kindle Fire HD) 
Individuals may listen** to the session using the Blackboard Collaborate Mobile App (Available Free from the Apple Store, Google Play or Amazon )

Slide 5:
Captioning
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Slide 6:
Submitting Questions
You may type and submit questions in the Chat Area Text Box or press Control-M and enter text in the Chat Area
If you are connected via a mobile device you may submit questions in the chat area within                                                                                  the App                                                                                                       
If you are listening by phone and not logged in to the webinar, you may ask questions by emailing                                                                                                      them to webinars@accessibilityonline.org
Please note: This webinar is being recorded and can be accessed on the AccessibilityOnline website at www.accessibilityonline.org/Archives within 24 hours after the conclusion of the session.

Slide 7: 
Customize Your View
Resize the Whiteboard where the Presentation slides are shown to make it smaller or larger by choosing from the drop down menu located above and to the left of the whiteboard. The default is “fit page”

Slide 8:
Customize Your View continued
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Slide 9:
Setting Preferences
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Select “Edit” from the tool bar at the top of your screen
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Slide 10:
Technical Assistance
If you experience any technical difficulties during the webinar:
Send a private chat message to the host by double clicking “Great Lakes ADA” in the participant list. A tab titled “Great Lakes ADA” will appear in the chat panel.  Type your comment in the text box and “enter” (Keyboard - F6, Arrow up or down to locate “Great Lakes ADA” and select to send a message); or Email webinars@accessibilityonline.org ;  or Call 877-232-1990 (V/TTY) 

Slide 11:  Accessible Hospitals and Medical Care Facilities -   “Advanced 
Session” 

Slide 12:  Presenters
Earlene Sesker and Rex Pace, U.S. Access Board

Slide 13:  Session Agenda
•	The Standards
•	Scope
–	Covered Facilities
–	Employee Work Areas
–	Patient Sleeping Rooms
•	Spaces and Elements
–	Accessible Routes
–	Parking
–	Entrances
–	Doors
–	Alarms
–	Facilities for Children’s Use
–	Toilets
–	Sinks
–	Dispensers
–	Signs
–	TTYs
–	Audiology Sound
      Booths
–	Nurses’ Work Stations/Service Counters/Chart Tables
•	Proposed Standards for Accessible Medical Diagnostic Equipment

Slide 14:  ADA & ABA Standards
ADA Standards: 
•	places of public accommodation
•	commercial facilities
•	state & local government facilities 
Architectural Barriers Act (ABA) Standards:
•	Federally funded facilities

Slide 15:  ADA Standards for Accessible Design
DOJ Issued 2010 ADA Standards 
Based on Board’s ADA-ABA Guidelines (2004) 

Slide 16:  2004 ADA-ABA Guidelines
Diagram showing the organization of chapters of the 2004 ADA-ABA Guidelines
Cover of ADA-ABA 2004 Guidelines.

Slide 17: Examples of Covered Facilities
•	Hospitals, Rehabilitation Facilities, Psychiatric Facilities and Detoxification Facilities
•	Long-term Care Facilities

Slide 18:  Examples of Covered Facilities
Medical units in detention and correctional facilities

Slide 19: Employee Work Area
“All or any portion of a space used only by employees and used only for work.  Corridors, toilet rooms, kitchenettes and break rooms are not employee work areas.” (106.5 and F106.5)
ADA approach, enter, and exit ABA accessible

Slide 20: New Construction – ADA
Example: Medical Care Suite
Plan diagram of a medical suite showing exempt, partially scoped, and employee work areas.
Work Areas (Partial Access- e.g. reception area, nurses station)

Slide 21:  Employee Work Areas 
Controls and fixtures used by staff and students – university teaching hospital 
Hospital room with bed, medical equipment and file cabinet

Slide 22:  Employee Work Areas
Requirements for hand wash sinks in exam rooms
Perspective drawing of a exam room sink for medical staff use only, sink has a bas cabinet beneath lavatory and is not accessible for a forward approach.

Slide 23:  Employee Work Areas
Trash Enclosures and Dumpsters
Perspective drawing of trash dumpster inside a corral, accessible route is show to and maneuvering clearance at corral gate is shown.

Slide 24:  Patient Sleeping Rooms
223.2 - Hospitals, Rehabilitation Facilities, Psychiatric Facilities and Detoxification Facilities:      Conditions Affecting Mobility 
Specializing	100%
Not specializing	  10%
223.3 Long-term care:	  50%

Slide 25:  Patient Sleeping Rooms Dispersion
Medical Care Facilities Covered by 2010 ADA Standards
“Proportionate” by type of medical specialty – sections 35.151(h) and 36.406(g) incorporated by DOJ 
Long-term Care
By type of room e.g. private, shared, congregate space

Slide 26:  Patient Sleeping Rooms Alterations and Additions
Based on the number altered or added until overall number reached - maintains dispersion

Slide 27:  Patient Sleeping Rooms Toilet Rooms
Those serving patient rooms required to be accessible -Exception for toilets
in critical care or intensive care patient rooms

Slide 28:  Accessible Routes 206.2.1 Site Arrival Points
Sidewalks
Intensive care patient room with lots of medical equipment

Slide 29:  Accessible Parking Scoping
•	Hospital: 10 % of spaces
•	 Rehabilitation and Outpatient
Physical Therapy Facilities: 20 % 

Slide 30:  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 31:  Accessible Parking Scoping
Hospital campus with multiple occupancies and tenants sharing parking lots
Hospital Aerial View

Slide 32:  Accessible Parking
208.3 Location – Exception 2
Hospital Aerial View

Slide 33:  Entrances
206.4.1 Public Entrances: 60%
206.4.5 Tenant Spaces:  at least one entrance

Slide 34:  Handrails on Walking Surfaces
403.6 Handrails
Hospital corridor with handrails along both sides

Slides 35:  Doors – 404.2.4 Exception
Entry doors to hospital patient rooms not required to provide the clearance beyond the latch side of the door.
Plan figure from Standards showing maneuvering clearances in front of and to the latch side of the door

Slide 36:  Doors – 404.2.4 Exception
Minimum space for positioning/ maneuvering
Person using a wheelchair at door positioned at door and occupying space beyond the latch; forward approach maneuvering clearance show (perspective view)

Slide 37:  Doors – 404.2.4 Exception
Accessible door
Exception: latch side clearance at hospital patient room doors
Patient room door open.

Slide 38:  Doors – Latch Side Clearance
404.2.4 Maneuvering Clearances must not be obstructed 
ADA regulations to maintain accessible features

Slide 39:  Doors – Threshold
303 Changes in Level
Only first ¼ inch from floor or ground may
be vertical
Thresholds for transfer Showers (36” X 36”) are permitted to be ½ inch max. vertical – 608.7
Image of Patient room door open.

Slide 40:  Doors Means of Egress
404.2.9 Door and Gate
Opening Force
Fire doors must have a minimum opening force allowable by the appropriate administrative authority
Other than fire doors:
Interior hinged doors and gates - 5 lbs max.
Sliding or folding doors - 5 lbs max.

Slide 41:  Fire Alarms Systems 702.1 General - NFPA 7
NFPA 72 National Fire Alarm Code (1999 or 2002) – referenced standard
National Fire Protection Association (www.nfpa.org) 

Slide 42:  Fire Alarms Systems 702.1 - Medical Facilities
EXCEPTION:  Fire alarm systems in medical care facilities permitted to be provided in accordance with industry practice 

Slide 43:  Facilities for Children’s Use
Elements designed specifically for use by children 12 and younger.  
•	Drinking fountains (§602)
•	Water closets and toilet compartments (§604)
•	Lavatories and sinks (§606) and 
•	Dining and work surfaces (§902).  
•	Advisory notes on children’s reach ranges (§301.1) and ramp handrails (§505.4)  

Slide 44:  Children’s Toilets
Alternate Specifications:
•	 WC centerline	12” – 18”
•	 WC seat height	11” – 17” 
•	 Grab bar height	18” – 27”
•	 Dispenser height	14” – 19”
Slide 45:  Children’s Toilets
Advisory information provides guidance according to age group - 604.9
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 46:  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 47:  Bed Pan Washers at Toilets
Rear grab bar must not be obstructed
Figure 604.5.2 Rear Wall Grab Bar at Water Closets from the Standards showing the minimum size and location of the grab bar.

Slide 48:  Scrub Sinks for Visitors
Sinks used by public covered, 5% of each type – Sections 212 and 606
“Touchless” faucet with automatic sensor 
Photograph of a touchless faucet with automatic control. 
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 49:  Dispensers Clear Floor Space - 309.2
Recessed dispenser mounted to side – does not overlap clear floor space
Surface mounted dispenser mounted over toe and knee space
Plan of clear floor space at lavatory with surface mounted paper towel dispenser over lavatory
Plan of clear floor space at lavatory with paper towel dispenser recessed into side wall, dispenser does not overlap clear floor space

Slide 50:  Dispensers Clear Floor Space - 309.2
Toe and knee space may be used
If above 27”, cannot protrude more than 4”
leading edge of recessed drinking fountain projecting 4" max. from alcove
Close-up of knee and toe space shown in profile; 17" min. depth at elements where knee and toe space required

Slide 51:  Protruding Objects 204 and 307
Flag signs used in medical settings cannot protrude into circulation paths more than 4” unless above 80” 

Slide 52:  Tactile Characters Installation Height/Location
Standards figure 703.4.1 Height of Tactile Characters Above Finish Floor or Ground showing 48 inches minimum and 60 inches maximum height of the baseline of tactile characters above the finish floor or ground.

Slide 53:  Location – 703.4 
Push side exception for doors with closer and no hold open devices 
Illustration showing woman using braille signage on the latch side of the door.
Standards figure showing 18" by 18" minimum clearance centered at tactile characters of sign and located beyond swing of door open 45 degrees.

Slide 54:  Pictograms (Tactile Signs)
Pictograms used to label permanent spaces (216.2)
•	 Where pictogram provided
•	 Not to informational/ directional pictograms

Slide 55:  Pictograms -703.6
Standards figure showing sign with male pictogram on a field 6" high minimum and outside this field is the word "Men" in text and Braille.

Slide 56:  Pictograms
Examples of informational/directional
International Symbol for Disability; No Smoking, Hazardous Materials, TTY, No food or drink, Fire Extinguisher

Slide 57:  TTY’s  
217.4.6 - Public pay telephones
Where provided at hospital emergency room, recovery room, or waiting room – at least one TTY	

Slide 58:  Audiology Sound Booth
Audiology sound booths installed in a hospital or clinic covered by the Standards
•	Accessible route
•	Maneuvering clearances for doors
•	Clear floor space and operable parts

Slide 59:  Nurses’ Work Station
Public side covered as a service counters (227.3 and 904.4) – accessible portion of counter
Nurse staff side is employee work area (203.9) – approach enter and exit – accessible under ABA

Slide 60:  Examples of Sales and Service Counters
•	Information and reception counters
•	Registration
•	Billing, including teller windows
•	Pharmacy
•	Cafeteria
•	Gift shops
•	Nursing stations

Slide 61:  Sales and Service Counters 227.3 and 904.4
Scope Requirements
•	at least one of each type
•	dispersion
•	technical provision same for all counters type - with and without cash registers

Slide 62:  Sales and Service Counters 227.3 and 904.4
Technical Requirements
•	parallel or forward approach
•	length and height of accessible portion of counter
•	forward approach must have knee and toe space

Slide 63:  Folding Chart Tables and File Holders
Must not be protruding objects - 204 and 307

Slide 64:  Proposed Standards for Accessible Medical Diagnostic Equipment (MDE)

Slide 65:  MDE – Background
•	Section 4203 of Patient Protection and Affordable Care Act 
–	(Public Law 111-148, 124 Stat. L. 119)
•	Added Section 510 to the Rehabilitation Act of 1973 on March 23, 2010
•	Title: “ESTABLISHMENT OF STANDARDS FOR ACCESSIBLE MEDICAL DIAGNOSTIC EQUIPMENT”

Slide 66:  MDE - Background
•	ANSI/AAMI HE75 – 2009 Human Factors Engineering – Design of Medical Devices
•	Chapter 16 – Accessibility Considerations

Slide 67:  MDE - Background
ADA and ABA Accessibility Guidelines

Slide 68:  Equipment for Children’s Use
Technical criteria are based on adult dimensions and anthropometrics, use of medical equipment by children not addressed in proposed rule.
Illustration of a man using a power wheelchair positioned on the raised platform of a weight scale.
Illustration of person using a wheelchair executing a parallel transfer onto an exam table.

Slide 69:  Proposed Organization of Standards
•	M1 Application and Administration
•	M2 Scoping Requirements
•	M3 Technical Criteria
–	Supine, Prone, or Side Lying Position
–	Seated Position
–	Seated in Wheelchair
–	Standing Position
–	Communication
–	Operable Parts

Slide 70:  Supine, prone, or side-lying position - M301 Seated position - M302
Photo of a woman using a wheelchair transferring to an examination chair
Photo of the patient scanning bed of a piece of imaging equipment, several people using wheelchairs are discussing how transfer may be accomplished onto the long flat surface

Slide 71:  Seated in a wheelchair - M303 Standing position - M304
Photo of a platform weight scale that accommodates both people who can stand and those using wheelchairs
Photo of a woman using a wheelchair pulled up underneath eye examination equipment, adequate knee and toe space is provided.

Slide 72:  Technical Criteria Supports - M305
Close in photo of a patient’s arm with hand gripping handrail to side of an examination table.
Illustration of a man standing on weight scale holding onto the standing supports to each side of the raised platform.

Slide 73:  Technical Criteria Across Equipment Types
Communication M306  Operable Parts M307
Photo of a MRI bore with indicator lights and control panel

Slide 74:  Advisory Committee Recommendations
55 recommendations made and 9 issue areas
Final report
http://www.access-board.gov/guidelines-and-standards/health-care/about-this-rulemaking/advisory-committee-final-report

Slide 75:  MDE - NPRM Steps
Comment Period
Public Hearings
Advisory Committee
Final Rule

Slide 76:  DOJ Guidance is Available ww.ada.gov

Slide 77:  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 78:  U.S. Access Board
(800) 872-2253 (voice)
(800) 993-2822 (TTY)
E-mail: ta@access-board.gov
www.access-board.gov

Slide 79:  Thank you for participating in today’s webinar
Next session: February 5, 2015 
Accessible Play Areas - "Advanced Session"
2:30 pm – 4:00 pm
www.accessibilityonline.org
(877) 232-1990 (v/TTY)

Slide 80:  Continuing Education
AIA Provider Number: I017
LA CES Provider Name:  Great Lakes ADA Center
AICP Provider Name:  Great Lakes ADA Center
Course Title:  Accessible Hospital and Medical Care Facilities-Advanced Session
Course Number: GL201501048
Date: January 8, 2015
Credits earned on completion of this course will be reported to AIA CES for AIA members and LA CES for those with an LA number. Certificates of Completion are available upon request.
This course is registered with AIA, LA CES, and AICP for continuing professional education. As such, it does not include content that may be deemed or construed to be an approval or endorsement by the professional organizations of any material of construction or any method or manner of handling, using, distributing, or dealing in any material or product.
Questions will be addressed at the conclusion of this presentation.