Accessibility/Disability

At BMC

Kate Walsh, BA, MPH, President and CEO of Boston Medical Center (BMC).

BMC is a private, not-for-profit, 626-bed, academic medical center with a

community-based focus.

“Ensuring accessibility for all is central to BMC's commitment to Exceptional

Care without Exception. Each of us at BMC has a role to play in making sure

BMC meets its access goals, and this teaching tool is one of many we will use

to give us the skills and knowledge we need to do our best.”

Disability Course Contents

WHAT DOES DISABILITY MEAN?

• Defining Disability

• American Disability Act (ADA)

• Some Types of Disabilities

• Resources at BMC

• Equipment

An Individual with a Disability is a Person Who:1

• Has a physical or mental impairment that substantially limits one or more major life

activities (i.e., caring for oneself, performing manual tasks, walking, seeing, hearing,

speaking, breathing, learning or working)

• A physical or mental impairment means:

(1) any physiological disorder, or condition, cosmetic disfigurement, or

anatomical loss affecting one or more of the following body systems:

neurological, musculoskeletal, special sense organs, respiratory (including

speech organs), cardiovascular, reproductive, digestive, genito-urinary, hemic and

lymphatic, skin, and endocrine;

(2) any mental or psychological disorder, such as intellectual disability, organic

brain syndrome, emotional or mental illness, and specific learning disabilities.

• There are many other disabilities not listed here but identified by the US Department of

Health and Human Services

1. http://www.eeoc.gov/policy/docs/qanda_adaaa_nprm.html.

AMERICANS WITH DISABILITIES ACT (ADA) IN SUMMARY

The Americans with Disabilities Act of 1990 (ADA) prohibits discrimination

against individuals with disabilities in every day activities, including medical

services.

The ADA mandates equal access to medical care services and the facilities

where the services are provided.

Disabilities affect Americans of

all walks of life

Quick Facts:

• There are 56.7 million people who have at least one disability in 2010,

about 19 percent of the total U.S. population. This is nearly 1 in 5

people.

• Those with vision difficulties number 8.1 million, 7.6 million

experienced hearing difficulty, while 30.6 million have problems walking

or climbing stairs or used a wheelchair, cane, crutches or walker.

• Another 15.2 million have difficulty with some kind of cognitive,

mental or emotional functioning.

http://www.disabled-world.com/disability/statistics/american-disability.php

http://www.census.gov/newsroom/releases/archives/miscellaneous/cb12-134.html

DO’S & DON’TS when you meet a person with a disability

• The terminology associated with disabilities often changes as words and phrases take on

negative connotations.

• Here are some examples of old phrases that have become unacceptable and their newer,

more positive as well as other commonly used phrases.

• TIP: Use people-first language Put the person first. A person with …..

Some people prefer identify-first language ie: Deaf person

Ask the person: It is important to respect the person’s preferences

Unacceptable Acceptable

Victim of Person with

Confined to Uses

______ person Person who has ___________

Normal Able-bodied, Non-disabled

Slow, simple Cognitively Disabled

Crippled Mobility-Impaired

Insane, crazy Emotionally Disabled

Dumb, mute Speech Impaired

Retarded Person with intellectual disabilities

Sightless Blind

• When offering assistance to a person who uses a wheelchair, ask first if they

would like assistance and then follow the person’s instructions, when possible.

• A wheelchair is part of an individual's personal space. Respect that space. It is

not polite to touch or lean on a wheelchair without the user's permission.

• People are not "wheelchair-bound" or "confined to a wheelchair." Wheelchairs

are a source of freedom and mobility for people who can't walk or have difficulty with

movement or endurance. Wheelchairs help people get where they need to go and

do what they need to do.

• If a person transfers from a wheelchair to a car, barstool, bathtub, toilet, bed, mat,

etc., be sure not to move the chair beyond easy reach. Always make sure that a

chair is locked before helping a person transfer.

• When conversing at length with a person in a wheelchair, sit or place yourself at

that person's eye level.

PEOPLE WHO USE WHEELCHAIRS

PEOPLE WITH VISUAL IMPAIRMENTS

• There are many degrees of visual impairment. In fact, few people are totally

blind. White canes with red tips are used both by people who have low vision and

those who are totally blind.

• If you think someone needs help, ask first by saying something such as, "Would

you like assistance?" Follow the person’s instructions. They usually know what

works best for them.

• When meeting a person with a vision impairment, announce yourself and

introduce anyone else who may be with you or who may later join your group

• If requested, offer your arm as a guide (don't take the person's arm) and inform

the person of obstacles such as curbs, steps or low arches. When offering a

seat, place the person's hand on the back or arm of the chair.

PEOPLE WHO HAVE SERVICE ANIMALS

• Patients and visitors have the right to bring a service animal onto the

BMC campus and into BMC buildings

• People who have visual, hearing or mobility impairments, may use a

service animal such as a dog, cat or monkey.

• Don't pet or speak to a person's service animal. They are at work,

even when sleeping under chairs or awaiting commands. If they are

distracted they cannot do their job.

• Never feed a service animal.

People who are Deaf or Hard of Hearing

• There are many types of hidden disabilities and having a hearing

impairment is one of them. There are different types and degrees of hearing

loss; many people with hearing impairments are not totally deaf.

• Respect individual preferences and ask the person what kind of hearing

accommodations they need.

• Communicating with those who have been deaf or hearing impaired since

birth may be difficult and may require sign language or other gestures.

• People can lose their hearing after they've learned to speak. Those who are

late deafened (deafness occurring late in life) may speak but sign language

may be needed for comprehension.

People who are Deaf or Hard of Hearing

• Hearing aids do not restore hearing. They are usually only partially

effective with certain tones and decibel levels

• To get someone's attention, touch that person lightly, wave or use

another physical sign.

• Don't be embarrassed to rely on written notes. They can promote

effective communication. However, many older individuals who have been

deaf since birth, may not be able to read written language. Lip reading is

another form of communication that some people use.

• Patients have a right to an interpreter. Certified American Sign Language

(ASL) interpreters can be scheduled through the Interpreter Services

Department at BMC. These interpreters specialize in medical settings. Do

not rely on family members for interpreting.

PEOPLE WITH SPEECH IMPAIRMENTS

• Speech disabilities run the gamut from slight lisps to total speech loss.

• Be patient when a person with a speech impairment is speaking. Don't

finish a person's sentence - although it's okay to rephrase a person's words

to be sure you understand. Most people with speech impairments can

communicate but doing so usually requires mutual effort.

• Different types of communication devices can be used to facilitate

comprehension. Communication devices include alphabet boards, phrase

cards, electronic voice box (electrolarynx), computer speech devices and

voice output devices.

• While there is much research in the field, most alternative speech

technology is not yet on the market or is not appropriate for certain

users.

• If you have difficulty understanding someone's speech, don't be

afraid to ask for multiple repeats. Never pretend to understand when

you don't. Don't be embarrassed to rely on written notes.

• Most people with speech impairments can hear. Loud or simple

words aren't easier to understand.

PEOPLE WITH SPEECH IMPAIRMENTS

Different types of call light systems are

available for patients with functional limitations.

The “sip and puff” call light looks like a straw

and is used by patients with tetraplegia (also

called quadriplegia). When the client blows

through the straw it activates the call system.

Another call light available is a “pad” style

device that is initiated by applying direct

pressure onto the top portion of it.

A third call system device is a small bulb style

device (press call cord) that is also activated

by applying direct pressure to the soft cushion

bulb.

There are many other devices that the patient

may have used at home which they may bring

into the hospital with them.

CALL SYSTEMS COMMUNICATION DEVICES

Sip and Puff

Pad Call Cord

Pad Call Cord

People with Intellectual Disabilities

• Intellectual disabilities are often confused with mental illness, which

accounts for most of the misunderstanding that surrounds this disability.

• People with intellectual disabilities are able to read, write, drive, think and

lead productive, independent lives.

• When communicating, be respectful with all persons at different levels of

intellectual disability.

People with Mental Illness

• Mental disorders are among the most common causes of disability.

Mental illnesses are medical conditions that disrupt a person’s thinking,

feeling, mood, ability to relate to others, and daily functioning.

• Mental illnesses often result in a diminished capacity for coping with the

ordinary demands of life and a decreased ability to participate in health-

promoting behaviors.

• According to the National Institute of Mental Health (NIMH), in any given

year, an estimated 13 million American adults (approximately 1 in 17)

have a seriously debilitating mental illness.

• Mental illnesses are treatable. Most people diagnosed with a serious

mental illness can experience relief from their symptoms and manage

symptoms by actively participating in an individual treatment plan.

Resources at BMC

• BMC has an Accessibility website located under the

Departments tab

• ADA resources and links, disability awareness, parking

access, and other information is located here

BMC Contact Staff Chris Andry, MPhil, PhD Executive Director for Cancer Care Service

Vice Chair for Operations & Management

Associate Professor Department of Pathology & Laboratory Medicine

Associate Professor Department of Family Medicine

670 Albany Street, 4th floor room 413

Boston MA 02118

617-414-5292

Pager 617-638-5795 code 1027

Sheryl Katzanek

Director, Patient Advocate Program

Yawkey Building, Mezzanine, room15

617-414-1778

Pager 617-638-5795 pager # 7178

ADA Access and Equipment at BMC

Some Examples of Handicap Access

and Parking

Specialty Nurse Call Systems

• Specialty nurse call systems are distributed by Transport/Equipment.

• Three types are available: Breathe Call Cords (sip/puff), Pad Call Cords (pillow),

Press Call Cord (bulb).

Pad Call Cords

Press Call Cords

Breathe Call Cords (sip/puff)

Resources for Patients and Staff

Deaf and Hard of Hearing

• Language Interpreter Phones at each bedside and specified

locations throughout BMC. Individual volume controls for each

handset (patients and providers) can be helpful for some hard of

hearing patients.

• Telecommunications Devices – TTY device, cell phones for

texting/emailing, amplified telephones and volume amplifying head

phone device (pocket talkers) are available upon request.

• American Sign Language (ASL) interpreters can be requested.

• Video interpreting devices (MARTTI - My Accessible Real-Time Trusted

Interpreter ) for communicating in American Sign Language (ASL) are

available in areas of the ED, pre-op, some inpatient and outpatient and

are available upon request.

Resources for Patients and Staff

Requesting Deaf and Hard of Hearing Resources

• Contact the Interpreter Services Department:

Monday-Friday 8:30 A.M. – 5 P.M. at X 4-5549.

• After hours, weekends and holidays:

Contact the Operator Services Department at X 8-5788 who will page the

supervisor on-call for assistance

Visually Impaired

• Telephones with Braille Keys are available in all patient areas.

• Braille version of Patient Rights and Responsibilities is available

through interpreter services

Phones with Wheelchair Access

Phones with TTY (TeleTypewriter) access

TTY access

Standup handbar

weigh scale Wheelchair Weigh Scale

Exam table adjusts high/low for

wheelchair

Bariatric wheelchair Bariatric Chair

Slide Board for transfers

Transfers using Slide Board

Ceiling Lift Therapeutic Bed

Mobile Lift

Disability

Awareness

For more healthcare stories you can go to this link:

http://www.dredf.org/healthcare-stories/

Bibliography

AMERICANS WITH DISABILITIES ACT (ADA) IN SUMMARY

United States Equal Employment Opportunity Commission (EEOC) and "The

Positive Workplace," internet address: http://www.thebody.com/pos-work/ada.htn-d

WORLD HEALTH ORGANIZATION International Classification of Functioning, Disability and

Health (ICF) May, 2001 http://www.who.int/classifications/icf/en/

DISABILITY - MYTHS AND MISCONCEPTIONS

The Commonwealth of Massachusetts, Massachusetts Rehabilitation Commission

10 DO'S AND DON'TS WHEN YOU MEET A DISABLED PERSON

Provided by the Massachusetts Office on Disability

TERMINOLOGY ASSOCIATED WITH DISABILITIES

The Commonwealth of Massachusetts, Massachusetts Rehabilitation Commission

and "Straight Talk About Disability: A Guide to Basic Understanding and Common Courtesy,"

Rehabilitation Institute of Chicago

MENTAL HEALTH AND MENTAL DISORDERS

US Department of Health and Human Services, Healthy People 2020

http://www.eeoc.gov/policy/docs/902cm.html#902.1

http://www.unitedspinal.org/disability-publications-resources/disability-publications/

http://www.123rf.com/search.php?start=0&word=disability&itemsperpage=100&searchopts=

http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=28