Ensuring Equal Access to Care for Patients with Mobility Disabilities: SPHM Equipment and Strategies
Please note: Federal laws are referred to and discussed below from an awareness perspective. HoverTech is not an attorney and cannot provide legal services. For related legal guidance, please consult an attorney.
More than 32 million American adults have a mobility disability, the most common disability among individuals ages 18 and over.
Despite the prevalence of mobility disabilities, though, many healthcare settings remain ill-equipped to accommodate them. Take examination tables. Some feature adjustable heights; still, they fall short for patients who can’t transfer to the table from a wheelchair. This is one reason many wheelchair users are examined while seated in wheelchairs, fully clothed.
Lower rates of routine preventative screenings also exist among wheelchair users, for similar movement-related reasons. Females are believed to be disproportionately affected, as breast exams and prenatal care require laying on an exam table in a supine position. Routine weight measurements are also sometimes bypassed among mobility disability patients when medical settings only have standard scales that require standing.
The scenarios above can have serious implications for diagnosis, care, and related patient health outcomes. They also run the chance of breaking the law. Earlier this year, an eye surgery practice in the western United States was sued for refusing to operate on patients who needed assistance transferring from a wheelchair for surgery, and for making patients with mobility disabilities pay for third party medical transport. The practice was determined to be in violation of the Americans with Disabilities Act (ADA), which mandates equal access to medical services – and consequently paid $1 million in damages. As part of the ruling, the practice is required, moving forward, to honor any ADA-mandated transfer assistance requests and to acquire equipment for providing transfer assistance, among other requirements.
Which begs the question: What can caregivers everywhere do to protect themselves in a similar high-stakes impasse? How can you know which patients with mobility disability you must accommodate by law?
INTERPRETING THE AMERICANS WITH DISABILITIES ACT (ADA)
The ADA is a federal civil rights law prohibiting discrimination against individuals with disabilities in everyday activities from voting to parking to, yes, receiving medical care.
The ADA requires that professional medical practices make “reasonable modifications to policies, practices, and procedures when necessary to make health care services fully available to individuals with disabilities, unless the modifications would fundamentally alter the nature of their services (i.e. alter the essential nature of the services).” This often leaves practices wondering: What constitutes reasonable?
In 2010, the ADA published the “Access to medical care for individuals with mobility disabilities” specifically to mobility disability. It outlines nuances many practices might find helpful in determining when they’re required to accommodate patients versus the rare occasions when they’re not. Particularly illuminating is Part 2: Commonly Asked Questions. Three questions in this section:
- Is it OK to examine a patient who uses a wheelchair in the wheelchair, because the patient cannot get onto the exam table independently?
- Can I tell a patient that I cannot treat her because I don’t have accessible medical treatment?
- Is it OK to tell a patient who has a disability to bring someone along who can help at the exam?
The answer to all three of these questions, perhaps to the surprise of some healthcare professionals, is no. None of the above is permissible within the boundaries of federal law.
Which begs the question: How, then, can healthcare providers aptly accommodate patients with a mobility disability?
This is where safe patient handling and mobility (SPHM) equipment enters the equation.
THE POWER OF SAFE PATIENT HANDLING AND MOBILITY (SPHM) EQUIPMENT
An abundance of technology has been developed in recent years to alleviate patient handling and mobility barriers.
Here are some that are particularly well-suited to help facilitate equal access to medical care:
- Powered height-adjustable exam/treatment tables – wider than standard exam tables, and typically with higher weight capacities, these can be lowered to the level of a patient’s wheelchair for an easier lateral transfer that eliminates the need to step up and onto the table.
- Powered height-adjustable stretcher chairs – these offer the same up-down adjustability as the tables described above. Many have padded stirrups for added leg support for women.
- Total-assist lifts – the benefits of total-assist lifts can’t be overstated. Floor-based or on the ceiling, they help ensure full examinations, diagnostics, and treatments. Dressing changes are performed more easily. A patient can be moved onto a radiation table, stretcher, or any other surface. Total-assist lifts can also help get patients in and out of cars when they arrive or are discharged – a common challenge when patients have a mobility disability. Recently, a patient unable to afford an ambulance transfer out of state was able to nonetheless receive hospice in the comfort of their home thanks to a total-assist lift that safely transferred them from a stretcher into a family member’s car.
- Total-assist lift with scale – these can weigh patients as they move them, and are a practical solution to the weight measurement barriers described earlier.
- Air-assisted devices – lateral transfers, sit assists, and car extractions are more readily possible for mobility disability patients via an air-assisted device like the HoverMatt Single Patient Use Air Transfer Mattress, which has the added benefit of protecting against shearing.
- Floor recovery device – patients sometimes fall, for a variety of reasons. Floor recovery devices – ideally in tandem with an air-assisted device – can help get them up off of the floor and onto a stretcher, chair, or wheelchair.
- Sit-stand devices – for mobility disability patients who can stand for short stretches, sit-stand devices keep them steady and help prevent falls. Available in non-powered and powered, these alleviate hurdles inherent to assisting to stand and maintain standing during transfers or toileting. A powered sit-stand device with a built in scale has the added benefit of letting you obtain a patient’s weight.
- Sit-assist – for patients who can’t sit up on their own, these can be used in radiology to alleviate seated positions on MRI, CT scan, and radiology oncology tables.
Of course, the greatest value of these SPHM tools comes when using them in tandem with one another. A lift and specialty chair together, for example, can both bring a patient to and position them in front of a mammogram machine. A lift, a stretcher with friction reduction devices, and an adjustable-height exam table together can help a patient reach a bone density scan table, which has limited adjustability.
ADA AWARENESS AND SPHM EQUIPMENT AT YOUR FACILITY
Understanding the power of SPHM equipment is one thing. Raising awareness of ADA compliance and gaining access to SPHM equipment in your day-to-day work at your medical setting is another.
One recommended strategy involves organizing efforts, even if just mentally, into “the four Ps”:Projects, Process, People, and Products:
- Projects are independent investigations or objectives undertaken by healthcare staff in efforts to make a case for SPHM needs and improvement. For example, review an investigation of a mobility disability-related injury that took place in your facility: What happened? Could it have been prevented or alleviated by safe patient handling and mobility equipment? Another project is proactive involvement in a medical facility renovation or build. Get a seat at the table, even if it means inviting yourself! If you believe SPHM equipment can enhance accessibility for mobility disability patients, share your expertise and observations, and all in all encourage stakeholders to build out space that’s friendly and universal to people with mobility disability needs.
- Process is the act of observing how things are done today in efforts to identify and pursue opportunity for improvement tomorrow. As part of this, consider a “go and see” – an in-person look at current practices. What exactly happens when a wheelchair patient comes through the door of your facility, from interaction to protocol? What’s needed? Interview staff and providers for a better picture of what’s going on. Track occurrences, too. How many patients are coming in who need added assistance? Sometimes managers might not know how often their unit sees patients with a mobility disability. The goal here is to identify specific root causes of problems, what can be changed, and only then ask: What’s going on to keep patients from getting care they need?
- People is about building a network and relationships with the people around – and above – you. Who are senior leaders making decisions and handling strategic planning that can impact wheelchair-bound patients? Who are the attorneys who serve your organization? They understand laws and can explain ADA implications in practical terms. Who are quality and safety leaders, i.e. the ones tracking staff and patient injuries, who can affect reimbursement? All of these individuals and more potentially help decide what equipment becomes available to patients. And don’t forget: People also refers to patients in this scenario! If you have a success story related to SPHM equipment that can help you gain more of it, get the patient’s permission. From there, share it up the ladder in hopes of getting leadership to think, “We need more of that!”
- Product Onsite SPHM equipment demonstrations are critical to showing managers how equipment can help patients with mobility disabilities. If you already have buy-in on SPHM equipment, these demonstrations can go a long way toward evaluating equipment before spending money on it. Another tip for getting equipment under your roof: Ask vendors (existing or new to your organization) if they have refurbished equipment available at a lower price.
A WIN-WIN FOR PATIENTS AND STAFF
Something we haven’t touched on yet is the matter of SPHM and caregivers.
The same barriers experienced by patients with mobility disabilities are also reported by healthcare workers who have a demonstrated history of concern when it comes to the challenges of caring for mobility disability patients.The same barriers experienced by patients with mobility disabilities are also reported by healthcare workers, who have a demonstrated history of concern when it comes to caring and challenges with mobility disability patients. From staff shortages to the risk of staff injury, SPHM and staff well-being go hand-in-hand.
Which brings us to the last, but not least, reason to pursue SPHM equipment for patients with mobility disabilities: Its benefits and safeguards every healthcare worker. The right equipment makes handling easier. Requires fewer staff members than manual handling. All of this increases the likelihood of compliance with the Occupational Safety and Health Administration Act (OSHA) general duty clause – yet another way to safeguard medical facilities against compliance and litigation risks.
Want to hear more about opportunities for caring for mobility disability patients? Learn more and earn one free contact hour by listening to the full on-demand webinar.
