Good afternoon everyone and welcome to the Americans with Disabilities Act (ADA) audio conference session set to start in five more minutes. Just doing a sound check and are want to announce that captioning is available and you can access that by clicking on CC icon found in the audio and video box. Ladies and gentlemen, your conference will begin shortly. Once again please stand by. Once again ladies and gentlemen, please stand by. Your conference will begin shortly. Good day ladies and gentlemen and welcome to building blocks for accessible health care. At this time all participants are in a listen only mode but we will later conduct question-and-answer session. If you should require assistance during today''s conference press 0 on the telephone to speak with an operator and this conference call is being recorded. Now I would like to introduce your host for today''s conference Peter Berg.
Thank you. I am going to spend a few minutes going over some housekeeping items and then turn it over to our moderator and today''s speaker. On slide 2 for those of you in the webinar room and those of you on the telephone following along with the handouts you will see that the sound is being delivered through the telephone service or the webinar room. Make sure if you are in the webinar room that your speakers are turned up. If you are running in to any issues with the sound inside the webinar room you can run the audio setup wizard to make sure that your system is properly configured. On to the next slide, slide 3, the ADA Audio Conference Series can be listened by having downloading on your Smartphone apps for blackboard collaborate and that there are apps available for both Apple devices as well as Android devices and you can find those in the Apple store in the market in downloading those and there is limited accessibility with the apps for users of voiceover and screen readers as well as there is no captioning available through the apps at this particular time. On to slide 4, captioning is being provided in the blackboard webinar room for those needing that service you can click on the captioning icon within the webinar room and the captioning icon or the captioning window can be sized to fit your specific needs. On to the next slide, slide 15 -- I am sorry slide 5, submitting questions when we get to the Q and A there will be two opportunities for questions during today''s session. Daniel will come and give instructions to those of you connecting by telephone. And for those of you in the webinar room, you can submit your questions in the chat area. So click on the chat area or control M will place the cursor in the chat area and you can submit your questions. You will not see your questions when they have been submitted in the webinar room but they are viewable by the moderators and today''s speakers. On to the next slide, slide 6 for those of you in the webinar room you can customize your views with the various panels. That can be done by accessing the dropdown menu adjacent to the panels within the rooms. Slide 7, the next slide the panels can also be detached and you can move those around. So you can put them on the screen. So it makes the most sense and is the best viewable by you. The next slide, for any technical assistance during today''s session and those in the webinar room you can go to the participant list and click on Great Lakes and send a message to Great Lakes if you run in to any issues. E-mail can be sent to email@example.com or call at 877-232-1990. And excuse me, with that I would like to turn it over to today''s moderator, Marian Vessels. Marian.
Good afternoon. We are very excited to have you here on this exciting venture that is a partnership with the Mid-Atlantic ADA Center and University of Pittsburgh Medical Center. I would like to introduce our two speakers today. You will be hearing first from Mary Duranti. Mary works at UPMC as the Director of the Disability Resource Center. She has been with UPMC for 15 years in various roles, including human resources and community workforce development and center for inclusion. Shes always had a passion for inclusion of people with disabilities. She has had tremendous experience throughout the region and disability access. The work of the Disability Resource Center is education and training on accessible health care and facility evaluation for accessibility, community engagement and outreach, policy review and development and serving as a resource to both internal and external customers as it relates to accessible health care for people with disabilities. Our second speaker is Karin Morris. Karin has a BA in Sociology from San Francisco State where in her junior year she suffered a traumatic brain injury as a result of a severe car accident. She eventually returned to San Francisco State to do graduate work there. She worked close with developmental disabilities before beginning her ADA career as a Technical Assistant Specialist for the Pacific ADA Center. From there she moved on to work with U.S. Department of Justice Disability Rights Section, Technical Assistance Unit as an Accessibility Specialist where she gained extensive ADA knowledge. Karin spent two years there at University of Pittsburg Medical Center as their ADA Accessibility coordinator and aiming to improve access to health care for individuals with disabilities. Karin has recently moved on and become the city of Bend, Oregon, Accessibility Manager where she is involved in all aspects of ADA compliance. It is great pleasure that I turn the session over to Mary.
Thank you Marian. We can move on to the next slide. And I actually met Marian at one of the ADA Conferences here in Washington D.C. in the Baltimore area and started our conversation with building blocks for accessible health care. Karen and I and many others in the health care industry recognize that health care is not as accessible as many people think. And we really thought that it was important to share some of the materials that we have developed; it is not that we think that we are the experts or that our materials are the best or cutting edge. But just a good foundation and a good starting point to help other health care providers on their journey to accessible medicine. We wanted to share and also recognize those resources that are out there and that we found most helpful. And finally we hope to develop a networking system as an outcome of this conference in the hope that other health care providers will share their best practices and add to our building blocks. If we can go on to the next slide, I will go ahead and move it. Just to tell you a little bit about UPMC. UPMC is a large integrated health system and we are -- we are located or headquartered in Pittsburgh, PA and we are affiliated with the University of Pittsburgh but are now known as UPMC. We have over 20 hospitals which include academic community and specialty hospitals as well as outpatient sites such as rehab, and long-term care. It is important to say this because I think that we were in a very unique position having access to so many different parts or spectrum of health care and how they all intertwine in helping to develop tools. And so I think that put us in a unique position as well as having Karin''s expertise and experience at the Department of Justice. A little bit about the Disability Resource Center, we were founded in 2007, a board directive at UPMC. We did not provide direct patient care but we developed tools and resources for staff to help them in providing accessible care. Our work tends to fall in to four main areas, so one of them is access to facilities and Information Technology (IT). We do a lot of education and training and also community engagement and then serving as a resource for both our internal and external customers. We are a small team, we have -- that myself the director, we also have an ADA accessibility coordinator as well as a shared FTE to help us in our work. We have a disability champion in every one of our business units that help us to operationalize our initiatives. We have a facility review committee and our Section 504 coordinators. We have a DRC physician advisory group and we partner with the women with disabilities clinic and most importantly we have our DRC advisory council that consists of leadership internally to UPMC and also leaders in the disability community. Go on to the next slide. And this will be slide 14. So what types of issues are common in health care and what are the things that we run in to as well as other health care providers? I think effective communication ranks up there at the top. You know whether it is with people who have vision loss, hearing loss intellectual or cognitive disabilities. Also service animals is something that comes up frequently and then, of course, the physical access piece. Karin, do you want to jump in and mention anything about the physical accessibility?
Yeah, we have developed maintenance trainings for each business unit or hospital''s maintenance pane as that includes, you know, working with them to figure out the appropriate methods of getting access to accessible call bells and other types of equipment. So just reaching out to all the various different sectors within such a large entity is key in trying to make everything flow.
And I think another thing and Karin, let me see if you agree, oftentimes even if you have the accessible rooms or the accessible equipment, it is a key piece to make sure that staff are aware of what they are and how to access them. And that''s always a challenge with staff turnover and new employees coming on board.
Okay. We can go on to the next slide. So our approach has been through educational work. As a foundation we also very important do community engagement and that has been key to the successes that we have had as well as serving as a resource and taking phone calls both from staff and then from people in the community whether they are patients, advocacy or governments or agency. Oftentimes there is a plus and a downside to being such a large system and I think that one of our values is providing an advocate within the system to help direct people to get what they need. Karin, do you want to touch on anything additional with the facility aspect which that''s a whole other ball of wax?
We will discuss those later on as well. We have a facilities review committee that has been pretty essential in partnering with them to make sure that each facility''s renovations or if there are problem areas to go evaluate and see what can be done. So working with facilities again is pretty key.
Okay. Thank you. We will go on to the next slide. So for our education and training, I just wanted to quickly review some of our modules that we have developed. Of course, our key module or our foundation is disability awareness and effective communication with individuals with disabilities. And what we have developed other modules as well including service animal video, the breast screening for individuals with intellectual disability. Karin, do you want to talk a little bit about your maintenance training?
Yeah, the maintenance training works really well because we partner with a community member to sort of bring home the message of what actually occurs or what someone goes through had they confront a barrier such as entering a rest room when exiting there is no door maneuvering clearance. Shirley has been essential in making the maintenance workers buy in and become our advocates and they see things now and they get a better perspective through these examples and she discusses what happens when she confronts certain barriers that can sometimes be easy fixes and sometimes not so easy but helps improve that relationship and helps them buy in to what we are trying to accomplish.
Lessons learned from education and training on our end, we have found that case studies or scenarios are an effective tool to engage people in the audience and allow them to come up with ideas of how they could make use of the tools that we have developed. The world institute on disability has great case studies and scenarios in their materials. I wish I would have found them earlier in my journey but they are extremely helpful. Another thing we did to tried to make it more engaging, oftentimes people can have a discomfort level with discussing disability and maybe they are just not familiar. And so we utilized a game show ice breaker and we can go on to the next slide which will be slide 17. And I used to use this in my workforce development days and then we modified it for disability awareness questions and this particular question is on person first language. So I like this multiple choice format. It doesn''t put people on the spot. We kind of make it fun. They can do audience participation, 50/50, phone a friend. I have actually been at the school of nursing presenting the students and they pull their cell phone out and phone a friend and we embed stories and learning opportunities in to the game show and it just helps to get people talking and, you know, start the conversation. We can go on to the next slide which will be slide 18. One of our challenges in education I think is how do you make that message stick? You have your foundation courses you have that one or two hour annual training. But that can''t be your only answer. It is a good starting point staff take it but then they don''t remember all the information when they need it. And maybe disability and accommodation isn''t something that they have to deal with on a daily basis. So we have really tried to have a multi avenue approach. So, of course, we have our onsite training and our e-training. We have e-mail blasts that go out and we have information on our Info net site. Ive already talked about case studies. One of our -- we worked with corporate communications to come up with clinical screen savers where we develop bullet messages on various topics such as service animals and interpreters actually push them out to all the clinical desktops. That was a great way to get the message out as well as our FAQs. We did develop FAQs on various categories of disability. And I keep hearing Mary give me something one page. Like front and back. Give me bulleted information. So you can have a lot of narratives. So we developed some FAQs and they have been a great help. If we can go on to the next slide, one of the things -- they always ask me Mary if you can only have staff remember three things, like what three things do we need to know about disability. And you know I would always say no, there is so much more than you need to know. But actually when Karin and I sat down and thought about things, we thought if we can get staff to remember to ask, ask what is the best way to communicate, what''s the best way to transfer, what''s the best way to assist? And then communicate that information, understand and communicate it so that you know you communicate that need for accommodation to others. Often the handoff in clinical care can be an area where things fall through the cracks. So if you are sending someone on to another facility or if they are going down for a procedure or testing, make sure that you communicate that need for accommodation. And then finally take action. If you don''t know what to do, if you don''t know what tool that will help, ask somebody. There are so many resources. So we came up with that ACT acronym. So those are my three things. If we can go on to the next slide which will be slide 20, this is just a sample of the clinical screen saver that we developed with corporate communication. Just what are the most important information that staff need to know...What are the two questions that you can ask somebody under Title III when they have a service animal. And if we go on to the next slide, on community engagement, community engagement has been such an important part of our work and I don''t think that we could accomplish the majority of our work without the contact and engagement and insight from our community. We do serve as a point of contact. So we accept many calls, requesting information or requests for help or facilitating something from patients, families and advocacy organizations and we link with those advocacy organizations to accomplish our work and I will talk a little bit about a sample in a minute. We do have a number of the advocacy groups on our advisory council and they are instrumental in guiding our work in giving your priorities on what we need to focus on. Let''s go on to the next slide. As the other health care providers on the line or on the web as you are developing your community partnerships some of the places that you can look are, you know, your local disability advocacy organizations and service providers, centers for independent living. Karin I am going to let you talk about some of the local and state government and federal agency because that''s your sphere.
Yes, you can always -- the Department of Justice''s ADA.gov site has lots of materials as well. Some states have some pretty good materials in regards to health care access. There is also, you know, the Regional ADA Centers which have materials and are a great place to call as well. Marian I don''t know if you want to mention anything additional in regards to that?
Can''t he her. Can''t hear her. Are available to 1-800-949-4232 and you can reach them at ADA.org. We provide information on all aspects of Americans with Disabilities Act. And so whether it is -- whether it is disability or accessibility coordinators, medical staff have a question about service animals. What can I say or not say? Any of those questions, Employment questions all are answered by the ADA Centers. And we did a regional format so that we provide access at a local level. We will not only tell you what federal regulations are but give you resources that will help you further comply with the Americans with Disabilities Act. The ADA -- is launching a health resource section and the materials from University of Pittsburgh will be located on that site as we continue to develop them and then materials that you got you will see the beginning collaboration are University of Pittsburgh and the ADA Centers are two documents. One is accessible entrances and parking and then the others are useful documents that you can use as well. So please consider it is worth checking out adainfo.org for further information as we develop our partnership.
Marian and I met at, this is Mary speaking, the Mid-Atlantic conference and started this discussion about the needs for healthcare providers. (inaudible). So thank you Marian. At this point we can break and take some questions and answers. So if there are any questions on line.
Ladies and gentlemen, at this time if you wish to take a question from the phone line you may press star and 1 to enter the queue.
While we are waiting for questions it looks like you all have a lot of great information that you share throughout your facility-- how is it that you are able to engage -- to develop this kind of -- because this effort having the staff that you see -- commitment across campuses. Can you talk a little bit about how you develop that partnership with your - DRC?
Well, the DRC came about in 2007 as a board directive and there has always been a commitment at the top to provide excellent care and to make sure that our staff have the tools to do so. Not always an easy job to get all the information and the tools out where they need to be, when they are needed. But we have continued to partner throughout UPMC. And we have buy-in from our leader, patient safety and quality and innovation. We have buy-in from the facilities management and they make our job easier in that we are able to get in front of people and we have to sell the point on why accessibility is so important and have the information to back it up. But we have certainly gotten their attention and every -- we have partners in supply chain, in nursing, in radiology, and facilities and administration and corporate communications and I think that people want to do the right thing, that maybe they just don''t always know what it is to do. And so when you give them the tools and the information to help them make the good decisions it is just a win all the way around.
We do have a question from the phone lines.
Yes. I have an issue and I use a wheelchair. And I am unable to get up on to exam tables unless I use a Hoyer lift. And my doctors don''t have Hoyer lifts. Of course, I could bring one from home to do that. But what should I do in that kind of situation?
I think that it is important to, you know, have that conversation with your physician and your health care provider. And I don''t know if they may have something similar to a disability resource center advocate in their system. I know it is sometimes difficult to have Hoyer lifts in every doctor''s office. But many times the height adjustable exam tables are a big plus. And I know that we have been working hard to get height adjustable exam tables in our physician offices and it continues to be a problem throughout, you know, the United States. I know there were some recent articles about accessibility and, you know, it can be difficult. But I would just suggest talking to your physician and then the other thing that you could do is, you know, perhaps, you know, look at or talk to other people, maybe the centers for independent living to see if they can make recommendations or know physician offices that are accessible.
Another avenue would be to encourage your local doctor''s office to become more accessible if you provide them with tools for access, do they know what accessibility means and theirs also tax credits available for small businesses, private doctors offices and they would be able to use those. You can find tax credits information through your local ADA Center and Department of Justice has a tax factsheet on tax credit as well.
Do we have any additional question?
I see no questions at this time.
Okay. Then we will go on to the next slide. As I had mentioned we serve as a resource for our external customers and I wanted to talk a little bit about a program that we developed that is called Let Us Help You or LUHU and this was the brain child of the Dr. Peg Reedy. What It is a concierge type services. People with disabilities who are going in for elective surgery either contact us or the doctor''s office contacts us or become aware of it through the pre-surgery procedure and we have a rehab liaison who is nurse case manager reach out to the patient and find out what accommodations they will need while they are in the hospital. Whether it is a pressurized mattress or a positioning trapeze or a padded shower bench or a sign language interpreter or documents in alternative formats and then we work to make sure that those resources are available to the person that they are I assigned to the proper room and that our nursing unit, the unit director and those in patient access or registration and scheduling are aware of the patient''s needs. And it has been very labor intensive. We are working to streamline the process, excuse me, but I think that it has been really a success in reducing anxiety for people going in to the hospital. It has also been a great resource for staff and staff has mentioned that it was a very positive experience. It was a great team building exercise that they were happy to be able to know where the resources were and how to access them. So that is something that we are working to expand within our system. And if we can go on to the next slide, which is examples and the next slide will be slide 24. And these are -- I wanted to give you some examples of ways that you could collaborate with your partners, both internally and externally and I won''t describe all of them but I did just want to talk a little bit about the emergency room accessibility work group. Our DRC advisory council asked us to focus on access through the emergency room for people with disabilities. Excuse me. And what barriers it may be encountered. So we actually got together a work group consisting of people internally. So unit directors from five or six of our emergency rooms, leadership within the health system for the emergency room system wide leadership group as well as pre-hospital care and then in addition we brought in people from the community and we broke the work up in to -- we would have a monthly meeting. One month we would focus on those with vision loss and the next month we would focus on those with hearing loss. The next month it might be mobility disabilities. And so we brought people in from the community depending on which, you know, topic we were talking about. And we identified barriers that patients and family would face in the emergency room. We identified barriers that the staff faced in providing care and knowing where resources are. We inventoried our current resources, took a look at the gaps and then made recommendations for each category. We had our final meeting in August and we took a look at all of our recommendations and narrowed it down to a workable list that will be taking care of system wide emergency room group so we can make some changes to make care even more accessible but I think it was just an illustration of people working together instead of at odds and it was very productive and there were a lot of ah-ha moments as we did our work. And then I am going to turn it over to Karin now and she is going to take the next slide which will be slide 25.
When we are first starting the work on our tools we want to develop we didn''t figure we needed to reinvent the wheel. There are a lot of different organizations out there doing some really good work. Here there are some examples on this slide to provide you more information. But if you are just beginning looking, you know, you can look at these slides and also you reaching out to your community members within your own community. There are the ones who know what kind of problems are occurring and they have a wealth of knowledge and information to share. So I would encourage everyone to reach out to those local and individual community members or organizations. There is also the National ADA Centers have archived their webinar series along with the U.S. Access Board for further guidance on sort of facility aspect what has been developed as training and give more guidance for health care entities regarding their physical accessibility needs. And we can move on to the next slide, which will be 26. Let''s see, again this was just discussing how we build partnerships internally. There was a lot of reaching out to other departments or business units. You know working with the facilities and maintenance are key for physical accessibility requirements. Working with physician services divisions, center for assistive technology helps provide us with a lot of information and knowledge, again the schools of nursing. So again trying to build those partnerships is key to making the work not only beneficial but to make that benefit go across the entire system of a large health care entity. Next slide, please. This is a document that we developed to try and having 20 hospitals within UPMC system it was each hospital does things a little differently. So we developed this to try and find okay, what business unit and what accessibility services or aids or accommodations they have. So we have, you know, some of the common accommodation requests, large button telephones, magnifiers, bed side commodes. Assistive listening toolkits, et cetera, lifted and are they offered at this location and if they are, how does staff request them. Who do they contact? Is it physically located in a certain spot? So this information or this sheet was an interesting tool to just sort of see to have staff that would allow and see if they, you know, knew of the -- what the items were, where they were, so it helps sort of really acted as an education tool as well as providing some significant needed information across the system. Next slide, please. These are some examples of the toolkits we developed for each of the business units. Of course, we have the assistive listening toolkit, including the TTY, talk it talkers, signal -- the sound signaller, things like that. We also now have video remote interpreting at 19 of the 20 hospital locations which have helped a great deal for individuals who are deaf or hard-of-hearing. So that has been really good and very big celebration to get that across the system implemented. And next slide, please.
Karin I wanted to just mention, too, that we partnered with one of our community partners on the assistive listening toolkit. So we worked for the center of hearing and deaf services to make sure that we were meeting the needs and they were a great help.
Sorry about that. Forgot them. The blind and low vision toolkit on that same vain we developed this in conjunction with the blind and vision rehabilitation services located in Pittsburg to kind of low tech easily accessible items could be useful for interacting with patients and customers that have blind or vision disabilities. So not always do we -- do you need a high tech device to, you know, have some simple to get some things done. Signature guides are very low tech but they are extremely helpful. Also we have a -- we also provided the health care communication boards to each business unit across a system to provide some sort of easy communication aspect for individuals with various difficulties verbalizing whether that be intubated or they have a speech impairment, et cetera. Next slide, please. Mary you want to discuss the IPad piloting?
Yes, I would love to. We did a trial with iPad and some very basic apps to help with communications or effective communication. And we recently purchased 20 IPad and set them up with the basic apps including a basic white board app and PDF voice stream reader. We have the health care communication board app that''s on there. Very similar to the communication board that was on the previous slide but it actually voices when you touch the icon and there are multiple icons and it can also voice in Spanish or as well as English. But one of the things that we were most excited about was that we partnered with our -- the deaf community and then also with Purple Technology. We were able to get 20 public Kiosk numbers assigned to UPMC. And we have a VRS number or video relay service number assigned to each of the 20 IPad so that the iPad are available when someone who use sign language to communicate is in the hospital and when his own friends and families. They don''t have to use the TTY. They can use the iPad to phone friends and family or other people. So that was a big project that took a lot of coordination. But we were really excited to get them out there. We just distributed those in late July and we did an evaluation form as well. So we can continue to monitor which apps are useful, which apps are not. But I wanted to give a shout out to the patient provider communication forum and their website was on one of the previous slides. But that''s an international forum that talks about patient and provider communication and that''s actually where I got the idea for some of the apps and, you know, some of the ideas. So I just, you know, wanted to let you know how helpful they have been. And Karin do you want to talk about the FAQs and checklists as well?
Yep. I just want to mention we partnered with our supply chain to locate different agencies that could provide alternative formatting services. So whether it is Braille or large print, et cetera. And then we also, you know, while I was going out and doing accessibility reviews I developed an accessibility checklist for different scenarios, whether it be a public rest room or an inpatient room using, you know, the U.S. Department of Justice 2010 design standards as well as the -- one of the Regional ADA centers documents that they have out as well and sort of combined them both to create a checklist that works best for my scenario. And those checklists are actually being reviewed and vetted by the Northeast ADA center which will eventually go on their website as well. So keep checking back to their website for that information because those are extremely useful. And again we have mentioned the frequently asked questions, documents that we have had out as well. Next slide, please. So the facility review committee again I can''t stress how important this group is to get some really good attention to the need that exists within the facilities for acute inpatient rooms, again public rest rooms, outpatient facilities such as the rehab unit, the rehabilitation center, the entrances and accessible routes. And then also we have the UPMC contracts with ADA consultant when dealing with a very large project or new construction which is key to making sure that at the planning stages they really are double checked for accessibility at that very beginning stage. Can we move on to the next slide, please? And again with the facilities review committee we have developed sort of again the maintenance and housekeeping training that gives a brief overall what common problems exist, how to make, you know, get the maintenance and housekeeping on our - sorry, On the -- to be able to be our eyes and ears; To be able to see problems that exist and maybe bring them to a higher level attention if that needs to happen. Again we have included, we created sort of a toolkit for them as well that includes checklists as well as tape measure or door pressure gauge, those types of materials. We even created a 60 inch turning space circle. So to easily measure that so you pull it out and unfold it and you can lay it down to see if that exists. Move on to the next slide, please. I also worked with facilities in developing the assistance if you need assistance signage which is placed in key areas such as, you know, information booths, entrances, emergency room areas that will provide people if you need assistance, come talk to us and come get someone. Another aspect of facilities is the frequently asked questions, sorry not the facilities. The next -- the book to the side is a disabilities resource center at UPMC booklet. It includes lots of useful information for staff. It has in the beginning just some general overall disability awareness materials. It also has tabs that are broken down in to different types of disabilities such as blind low vision, deaf, deaf-blind and hard-of-hearing. Developmental and intellectual as well as mobility impairments and these -- this booklet is great. It has also the federal -- some of the federal guidelines that the Department of Justice (DOJ) has put out regarding accessible health care. It has under the desk tab it has guidelines for cleaning and disinfecting the assistive listening toolkit because disinfection is very big hospitals. Under the mobility impairments there are transfer tips, theirs is what is an ADA accessible room and the features within that room. So that is -- that document is extremely useful to sort of look at how many factors are in an accessible room. Honestly when I was evaluating one inpatient room it would take me approximately an hour to go through all the little checkpoints. Is there a protruding object, is there turning space? Are the door knobs at the right size? Are the right type of door fixture and not a knob? That is a good document as well and then if we can move on to the next slide. These are the regulations that I have sort of looked at to help create a lot of the toolkits and checklists. Of course, the Americans with Disabilities Act as amended for the 2010 the amendment -- the ADA Amendment Act, Section 504 of the Rehabilitation Act, are the state and local building codes. The joint commissions new regulations for regarding effective communication has really sort of helped UPMC push forward how important effective communication is. And how many problems can be solved to buy effectively communicating. That was a really good tool to help the Disability Resource center within UPMC sort of push for those improvements. So using regulations to assist you in building the reason behind what you are trying to do is a very good avenue to get higher up buy-in. And then Mary do you have anything else?
Well, I think if we go on or Marian, did you have anything that you wanted to add regarding regulations?
No. Just that it is important for people to realize that there can be very many competing regulations, understanding the difference between the original ADA guidelines and the new 2010 regulations and how they apply. And Karin do you want to talk a little bit about that and how challenging it can be for a facility to understand the difference when they do new construction or any modifications?
Yeah, it can be quite challenging. It is also challenging when there are -- there is lots of things out there that are facility checklists and it is really important before you use any to find out what they are based on because unfortunately there is very few out there that are to the 2010 design standards. So you don''t want to be using -- so if you haven''t done alterations ever you are going to be using the 2010 design standards. So -- and again you don''t want to use the -- you have to be very careful as to not using the ''92 design standard checklists that exist because it is not the same. There tend to be some things have changed, like even reach ranges which are very little would seemingly be a small factor but it is pretty big when you are the one who is trying to reach for something and you can''t and it is based on the ''92 standards which now have been changed. So it is a very tricky situation. You have to have a high -- reach out to people who can assist like the regional ADA centers and really get some people with some high knowledge on who have that ability to understand the two differences.
I know Karin, that the archived webinars on the Access Board like they have multiple on public rest rooms, on entrances, sidewalks, I know I watched the one on rest rooms at least six times but those I thought were very helpful for getting someone with a basic understanding.
Thank you. Yes I forgot to mention that. As well as any archived trainings that the Regional center and the Access Board has put out will help in understanding kind of what is required of an agency.
And the regulations and compliance are so important. But I think in just looking at what the spirit of the regulation was is -- has always helped me as well. I just wanted to share someone had said something to me one time, you know, we want to provide excellent health care and I think, you know, that''s why many people get in to health care, that they have a compassionate nature and the person who was telling me this was an advocate and she was explaining to me and she said when I go into a facility and I know when I belong and when I don''t belong. I go into a facility and the receptionist desk is too high and I can''t see over it I feel like I don''t belong. If I ask staff for something that I need and they have no idea what I am talking about, I feel like I don''t belong. And when I feel like I don''t belong, I get very anxious about my health care. And, you know, for some reason that just really resonated with me and I think that some of the simple tools that are basic building blocks even, you know, as a start in helping people to feel like they belong and that we are thinking about them and that we welcome them in to our facility. And that''s important. Now I guess we can go on to the next slide. And that lists our contact information at the disability resource center. So there is our website, e-mail address as well as our phone number. And I just want to offer to those of you on the line, online and on the phone line that if you have any best practices that you would like to share or if you would like to begin networking or have conversations about how we can make health care more accessible and what works at your facility, and just start the conversation. Please, you know, send us an e-mail and let us know of your interest and I have roped Marian into working, we have agreed to work together to just have a conversation or create a format of people who are interested in doing so. So I urge you to do that. And I guess at this time we can open it up for some additional questions.
And Marian this is Peter. We just have the -- everyone mute their phones when not -- when they are not speaking so the captioner can keep up with the -- with what is being said.
Great. Operator, can you tell us if anyone has questions on the line?
Once again ladies and gentlemen if you wish to ask a question, please star then 1.
Mary, In the meantime several resources that we think might be of assistance to folks, when you are looking at accessible technology, a great resource in your communities is the statewide assistive technology project. Each state has one, they have loaner equipment that you can borrow and see if it is effective. In addition to some of the tools that Mary talked about they may be a great resource for you. Another one that I understand many of you may not have heard, my audio wasn''t as effective. The tax credits and tax deductions that are available to businesses, to comply with the ADA. There is a small business tax credit available to businesses that would provide not only physical access but communication access. It could be used for a small of private doctor''s office. So we encourage you to go on line to the Department of Justice at www.ada.gov and check out those tax regulations. They may be of assistance to small facilities in providing communication as well as physical access. And there is a tax credit available for larger businesses in removing their tax -- their physical barriers and transportation barriers.
Marian I wanted to mention you talked about the lending library and we actually worked with the three river center for independent living which has the lending library in Allegheny County and we are able to borrow an UbiDuo and try it out in a couple of our facilities at Western Psyche and up with one of our facilities they found it was extremely helpful and some people preferred to use that. And to, you know, it helped with effective communication. So it was a great help to try it out and they did end up purchasing two of them. So thank you for mentioning that.
And we do have a question from the line.
Hi. She is going to write down the answer to the question. Hi Marian! You are doing a phenomenal job. It couldn''t come at a better time for us down here in Charlotte. My question is about the joint commission and they have some guidance. I would like to know how to get a copy of that. Because we do have a lot of hospitals and doctor''s offices that will like to say well, where is it written that we have to provide an interpreter and just saying that the Department of Justice says so isn''t good enough but if I told them that the joint commission says so it would get their attention.
If you go on to the joint commission website and I don''t know that off the top of my head but I am sure in you Google or if you Google roadmap to effective communication, there is a document out there that its called Road Map to Effective Communication that outlines the joint commission recommendation on effective communication. And that should be a great help, you know, especially in the hospital setting.
This is Peter, www.jointcommission.org.
Excellent. Thank you.
Another document that we found was really helpful was there is an ADA brief on effective communication in the health care setting. And we have actually included that in our disability awareness guide or booklet. And that''s something that is an easy to understand, you know, not a huge document that you could take with you to emphasize the importance of providing interpretation.
And website for that document would be just ada.gov.
This is Marian, we have posted many of these resources and we will add the commission''s document to our health care resources page at ADAinfo.org.
I got a question that someone had e-mailed directly to me, If I could pose this and if the Mary or Karin had any thoughts on this. In talking about the different barriers to health care, and attitudinal barriers and any suggestions, comments, recommendations, with regards to the education, the doctors and nurses going through medical school and going through nursing school and sort of that medical model of disability and how that, you know, clashes with the social model of disability and you have these professionals being trained and now they are dealing with patients disabilities. Any thoughts or outreach to medical schools?
That''s a great question. And we recognize that the need to -- and how much easier it is when you get someone who is a student or a medical resident. We do work with our schools of nursing at UPMC and that''s been received really well. We have done some work with the University of Pittsburgh and we just had a medical resident come through on a disability rotation. And she was actually from Michigan and spent four to five weeks in Pittsburgh learning about disability medicine. It is difficult I know to get in to the schools of medicine. We have worked with different community advocacy groups such as FISA. We are having some conversations but that''s a great avenue to go. I don''t have an easy answer on how to get -- to make those end roads. I think you have to find a champion within the schools of medicine and reach out. I know that at our school of dental medicine they have done great work on accessibility in dental medicine. And we are actually going up to present to approximately 200 dental medicine students. They have a special needs clinic that all of the students rotate through. And it is a part of the curriculum and I think that''s actually a great model. I don''t know if that answered your question.
I will let you know if there is any feedback from the person that submitted that. I don''t know if there are any questions that you are seeing on line.
Right now at this time I don''t. I do have a question --
We are having trouble hearing you at this time Marian.
Sorry. At this time we -- I don''t see another question. But I think that a question I had gotten earlier as well from Mary''s session was the physical access issues in many medical facilities are very challenging. And Mary you and Karin developed a document called common problems that were posted. Karin, could you please review a little bit what you found were the common problems and solutions I think would be most helpful for folks.
Yeah. I mean there are some common issues that I saw lots of wrong door hardware, door knobs instead of a lever. Bins, whether it be for dirty laundry or dirty clothing or, you know, the different types of trash bins, hazard bins, those types of things being placed in areas where they shouldn''t be, like for clear floor space, for next to the toilet or commode, In the bins located in the door maneuvering clearances. These are easy fixes. They just need to be told where the appropriate location would be for those bins. There is also, you know, something I found that are -- that do have easy fixes like the bins and door knobs. Other things it is a little more difficult, like having a bed being too close so you can''t even open the bathroom door or close it, making it difficult to maneuver around. I mean in those cases, either you know if it is because the room is too small, then maybe the need is really look at some big renovation projects to correct that issue. If it is just a bed got pushed too far one way, then, you know, being cognizant and aware of that it is going to have to be put back. If you can''t open the bathroom door, that causes some problems. And again there is another -- just chairs, trays, things placed in accessible routes, clear floor spaces, turning space is difficult. Those are easy fixes. There are a lot of things that are going to be larger -- needed to be larger renovations. And so in that sense you really need to get that team of facilities management people on board to understand how to get that in the process of going forward. Too narrow doors, doorways that are lower -- are not -- do not meet the 32 inches wide problem and that most of the time I saw that was in the older hospitals and for the rest room doors in inpatient room. So again that''s just a renovation that''s going to need to occur and you really need it get that facility buy-in to have that on plan. I mean no one expects you to do those large renovations overnight but you have to be trying to make some effort in to getting that done in the next, you know, two to five years, getting it really put on the higher hospital board agenda, making everyone aware of the problems that exist.
Karin I think one of the things that you did really well was coming up with some practical solutions and oftentimes we have things that are protruding objects in the hospital room, whether it is a sharp box or the hand sanitizer but coming up with some solutions like placing them over a counter top or some other type of detectible warning or moving them out of the path, the path of travel. And so even some, you know, common sense solutions such as that I think were really well received by our facility folks.
Yeah, and there are lots of different problems, you know, a lot of them, you know, if a bathroom has a shower head that''s on a bar that goes up and down, you know, a lot of times that bar is just placed too high. You need to unscrew the bar and remount it so that the showerhead could be lowered to the appropriate height. It can get down to 48 inches above the finished floor. There are some things that need to be done in that sense. You know, and when I was doing some more of the facility, you know, looking at plans, I often told the architects don''t put a range; you can have it up to 36 inches above the floor for grab bars. Give them the middle range. So you give them aim for 34 inches above. Because contractor in my history, in my experience always aim for that high, whatever the high range number is they will aim for that. When they aim for that they oftentimes will get it actually to be half inch above it. So then you are completely out of the range. One of the good things about the 2010 standards they provide you ranges now. You can tell them aim for 34 and if they get 35 or if they get 33 they are still going to be within that range. So I mean I always whenever I was speaking to architects I really encourage them to give that middle and not to give the full minimum and max. Just to give them a middle number.
We have some questions that have come in. We have some questions that have come on line. Several people have been asking about some of the resources that Mary mentioned such as the breast cancer screening for individuals with developmental disabilities, getting a copy of the disability rights guide and other documents that were discussed. The Mid-Atlantic ADA Center in conjunction with the University of Pittsburgh Medical Center are developing and providing those information as we reconfigure them for public use and those will be posted on the Mid-Atlantic ADA center''s website, ADAinfo.org under our resource list. Keep checking back on that website and you will begin to see more and more of those documents as they become available. Another question is, are the presenters available to consult on other hospitality or I am sorry other hospital accessible projects? Mary?
That''s not something that we have had posed us or have thought about before but if there would be interested in that, that''s something I would have to check with our leadership. I am certainly willing to help people when possible. And I really don''t know the answer to that. We have not done consulting in the past but I would have to take that to leadership to see what we could do.
Thanks. Another question we got is if a deaf person doesn''t want the hospital to use VRI, which is video relay interpreter they can still request a live interpreter, correct?
I will take that question. We have had a lot of discussion about that. And I will ask Marian to jump in at some point, too, but the new 2010 standards did adjust -- did address VRI as part of effective communication. So our obligation is health care provider is to provide effective communication. And VRI can be a method of effective communication. However there are some parameters that need to be met. First of all, you have to make sure that the equipment is working properly, that the staff know how to use it. That there is no pixilation that the picture is clear and also you want to make sure that the patient does not have any type of issue with their vision loss. If it is a very sensitive topic, for example, somebody is meeting with their physician to talk about a terminal diagnosis, you know, if it is a talking about a parent who may have to go off of life support, there are times when VRI may not be the best choice. And so we have been addressing those issues and it is a learning curve. And we have developed an Frequently Asked Question (FAQ). We are actually doing some training in some of our facilities and working with our office of deaf and hard-of-hearing to address those issues. When I have someone who is really resistant to using VRI and it is not because of a problem with the equipment or it is just that they don''t like to use VRI my recommendation to the facility has been listen, get the interpreter for, you know, when the doctor is rounding for whenever this conversation is happening, have a live interpreter there that while the live interpreter is there could you demonstrate the VRI so that they can ask questions while they have a live interpreter there and maybe feel more comfortable and my caution to the folks who are resistant to VRI is it could be such a good bridge because it can take two hours or more to get a live interpreter sometimes and then there is travel, you know, travel time as well. And if it is an emergency setting, or if the doctor stops by unexpectedly, don''t you want to know how to use that VRI so that you can effectively communicate and communicate when you need to. Marian, I don''t know if you have anything you want to add to that.
No. It gets back to as you mentioned the beginning, it gets back to effective communication and that is the requirement and it is on a sometimes as Mary indicated a case by case basis. We do have a message from one of our other ADA Centers, the Rocky Mountain ADA Center. Their parent company does provide health care consulting and you can reach them through ADA TA.org and go to the Rocky Mountain site and be able to talk with them about any consulting that is needed. Another question we got around interpreters is queued interpreters available outside of VRI or only ASL?
We use a companied called SeraComm and they have ASL available. For the cued interpreters or the oral translators as well we would have to work with our local agencies to provide those. But they have been very responsive and I know that, you know, they are willing to work with us on many things. So that could be a question that we pose to them. I know that they do offer some international languages in VRI. I think they currently offer 10 international languages and sometimes it is important to have those visual cues in speaking with someone with limited English proficiency.
Thank you. Another question we got is do you have a recommendation for handling complaints?
That''s a good one.
Just -- I think just listening and being empathic and making sure you get all the details and, you know, as well as the different perspectives and, you know, trying to get down to the root cause of what happened. Karin, I don''t know if you have anything that you -- any suggestions because you handled so many questions when you were with the DOJ.
Yeah. Really it is just -- I think it helps now that we UPMC has 504 coordinators to sort of look at complaints and put that process in place. I think that is going to be very beneficial and so Mary do you want to discuss what those -- that role is?
So we have a Section 504 coordinator at each of our business units that would handle any grievances related or complaints related to a disability and there is a separate process, the first thing I do recommend that you, you know, have your policy on grievances and how are they handled and then fit to that policy and procedure and make sure that the staff handling the grievances are aware of all the parameters and then also the resources. Another thing that I want to just give arecognition to is that we do have an intermediation process at UPMC. Where we have independent mediators who -- where if there is a complaint that can''t be reasonably solved that we have this process so that a third party will listen to both sides. And help to facilitate the process and our corporate risk attorney that we work with Shitan Turner helped to bring that process in to place and I think that''s a real value added and I would recommend other health care systems to take a look at that.
Okay. One of the questions that came in to us was how many employees does UPMC have?
We have over 55,000 employees. So we are a very large employer. And like I said there are, you know upsides and downsides and I think that creates a challenge in communicating new policies procedures or resources to all of those staff. And so that''s where we, you know, rely on our disability champions and our other partners internally including corporate communications. The good news is that when we finally get something through or we come up with a new resource, that we affect a lot of people. And that''s a really good thing.
Do you know how many of those people employed are people with disabilities?
No. We do not track the number of this people employed with disabilities. That''s not something that is tracked through the employment process. But I know we have some great programs in place to assist in employment of people with disabilities. We have -- and I actually I was in workforce development and we do have a centralized accommodation process and budget which I think is a huge help in removing, you know, barriers for accommodation, meeting accommodation needs. And then our center for inclusion and acquisition has some very innovative programs and one of which is Project Search. Project Search was based on the model from Cincinnati children''s hospital and we have youth who are in their last year of schooling where they take their classes, their didactic classroom is within the hospital setting and half they go out and get work experience in multiple areas of the health system to help them gain work experience and they also -- so it is a collaboration with Goodwill Industries, with the education system, with OVR as well as with UPMC. And we have Project Search in two or three of our facilities and have hired some of the grads and they have great jobs. It is not your typical high school dietary housekeeping stuff. Some of the students were doing things in imaging and radiology, in supply chain, in pharmacy, transporting medical equipment; Very innovative and a great program.
If I can just interject real quick, we have to remember that involuntary to disclose to employment whether or not you have a disability. That''s why it is very difficult to actually track the number of employees with disabilities because it is based on voluntary disclosure.
Mary, one last question. Somebody wants to know what books were referenced on slide 18.
I believe slide 18 we actually compiled out of the FAQs that we developed as well as some of the briefs from the ADA briefs from the Department of Justice. Transfer kits that we actually got from Alta Bates Summit Medical Center had developed a breast health awareness for women with disabilities and they had included in their material transfer kits and so we just compiled all of that information as well as like a sheet with just common accommodations in health care relating to various disability categories and put them together and did a -- had corporate communications design a cover. So that was something that we did internally. And I will certainly, you know, talk to Marian and see if there is a way that we can, you know, share those -- or some form of that booklet down the road on the website that the Mid-Atlantic ADA Center is creating for health care accessibility.
One last question. We had somebody who wanted to know the joint commission information again. It was posted on the chat room. And you can find it at www.jointcommission.org. Alright, one last question somebody wanted to know the app that you use. Would you be willing to share a list of the apps that you use for the iPad?
We can certainly share those and once again they were some basic apps but I would be happy to send those to Marian and also encourage you to look at that patientprovidercommunication.org website and they have a lot of great discussion about apps and which ones are working and which ones are not and that''s where I got a lot of information on effective communication ideas and applications as well.
I know that there are plenty other questions that you all may have. And since we are nearing or we are at our completion time I would encourage you to reach out to your local ADA center, www.adata.org or 1-800-949-4232 to answer questions and you have Mary''s website/e-mail address and phone number for specific questions that Mary may be able to answer. Peter back to you.
Alright, Thank you Marian, Mary and Karin for that excellent presentation. Just as a reminder today''s session is being recorded and the edited transcript will be posted approximately 10 to 15 business days along with the materials from today''s session. Our next session in the ADA Audio Conference Series will take place on October the 15th. That will kick off the 2013-2014 audio conference series. That session will be successful disability inclusion strategy and feature speakers from the U.S. Business Leadership Network. The registration is not yet available for that. Stay toon the e-mails will be sent out as well as you may our site www.ada-audio.org or give us a call at 877-232-1990. So thank you all for joining us today and thank you for a successful 2012-2013 ADA Audio Conference series and we look forward to all of you joining us for the next series kicking off on October the 15th. Thank you. And good day!