some government accessibility standards for the design, construction, and alteration of buildings (e.g., for acceptable ramp slopes) have been set by using individuals who were younger and stronger than the people served by VA facilities.6 The standards do not specially consider user populations who may be ill, elderly, or new users of wheelchairs or other assistive technologies. For example, as described in the VA document, the standards for showers barely allow the entry of a person in a wheelchair and do not allow maneuvering of the wheelchair or room for other people to provide assistance to the user. For that reason, many of the VA’s guidelines for its own facilities differ from those prepared by the Access Board. Another general study of standards for ramps (which was commissioned by the Access Board) suggested the need for further assessment of standards appropriate for facilities with high proportions of older users (Sanford, 1996).

The VA guidelines advise that “100% accessibility makes nursing simpler, puts less strain on staff, gives patients more independence, and requires less patient supervision by a limited staff” (VA, 2006a, p. 5). These observations appear to be applicable to many if not most other health care facilities.

Administrative and Judicial Responses to Continuing Problems with ADA Compliance

The committee located no formal, systematic nationwide survey or evaluation of compliance with or enforcement of ADA provisions related to medical facility accessibility.7 Reis and colleagues (2004) reviewed U.S. Department of Justice quarterly status reports from 1994 to 2003 and found 114 cases related either to the accessibility of health care facilities (including equipment and communications) or to the denial of service. Almost half (65 cases) involved access to effective communications services by people with hearing limitations. Physical access to facilities or equipment (primarily in medical or dental office settings) was the next most common problem (38 cases).

The continued lack of common accessibility features in places where


Also, VA hospitals serve a population that is a different and a considerably older population than the population in community acute care hospitals, in which, for example, 11 percent of the admissions are accounted for by childbirth (AHRQ, 2005). These and other characteristics of the population served are reflected in shorter lengths of stay in community hospitals, about 5 days in 2002 (AHRQ, 2005), in comparison with 12.5 days in VA hospitals (Pfizer Pharmaceutical Company, 2003).


In a U.S. Department of Justice status report marking the tenth anniversary of the passage of the ADA, the discussion of health care accessibility mentioned services for people with HIV infection or hearing impairments but did not cite any cases related to the physical accessibility of facilities or equipment (U.S. Department of Justice, 2000a).

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement