What legal protections do people who use wheelchairs have in healthcare settings?

Section 504 of the 1973 Rehabilitation Act and the 1990 Americans with Disabilities Act (ADA) are federal civil rights laws protecting people with disabilities from discrimination in healthcare. These laws mandate that appropriate accommodations be provided to ensure equal access to clinical care for prevention and treatment of illness, injury, and disease.

What questions should medical staff ask when a patient books an appointment and uses a wheelchair?

Medical staff should ask about the type of wheelchair, preferred transfer method from wheelchair to examination table, and whether assistance is needed with transfers, changing clothes, or other tasks. Staff should also inform patients that trained medical personnel can assist, so bringing a helper is unnecessary.

What are the key physical accessibility features needed in a clinic for wheelchair users?

Clinics need accessible parking near entrances, ramps or elevators, automatic doors with 32-inch minimum opening width, hallways at least 36 inches wide, lowered check-in desks (28-34 inches), accessible bathrooms with grab bars and enlarged stalls, and inclusive waiting rooms accommodating various mobility devices.

How should examination rooms be designed to accommodate patients who use wheelchairs?

Exam rooms need at least 30 by 48 inches of clear space beside the table for side transfers, adjustable-height tables lowering to 17-19 inches, and 60-inch turning diameter space. Specialized equipment like accessible mammography machines with adjustable height and wheelchair clearance should be available for gynecological and imaging procedures.

What communication practices create a respectful environment for patients who use wheelchairs?

Use person-first language like 'person who uses a wheelchair' instead of outdated phrases such as 'wheelchair-bound.' Ask patients their preferred form of address, speak directly to the patient rather than caregivers, sit at eye level during conversations, and let patients lead decisions about activities of daily living and transfers.

What are the proper techniques for assisting a patient transfer from a wheelchair to an examination table?

Position the wheelchair 30-45 degrees toward the table, lock brakes, and remove armrests and footrests. For slide board transfers, ensure the patient's feet face forward with firm ground contact. Ask the patient to shift weight away from the table, insert the slide board under the hip closest to the table, and instruct the patient to make fists to prevent wrist strain.

Why is it important to keep a patient's wheelchair in the examination room during clinical encounters?

Many patients report feeling stranded when their wheelchair or mobility device is removed or placed out of reach. The wheelchair should never be removed without patient consent. If removal is necessary, it must be immediately returned once the examination is complete to maintain patient dignity and independence.

Accessibility to Clinical Care for People who use Wheelchairs

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1. Creating an Accessible Clinic

When patients make an appointment, they should be asked whether they will need assistance during the examination because of their wheelchair use or disability. If they answer yes, more information should be collected about their disability, the type of wheelchair they have, the usual method for transfer (including assistive equipment needed such as a transfer board, a lift, etc.), and if they require assistance for transfers, changing clothes, and any other task during the clinical encounter.
They should also be reminded that there is no obligation for them to bring someone to help during the exam. The clinic employees are fully trained and will be able to assist them throughout the entire encounter.
There should be multiple accessible parking spots that are in close proximity to the entrance of the clinic, and they must be spacious enough to accommodate ramps along with vehicles. Also, be mindful that many patients depend on public transportation, which can make it difficult to arrive on time. In such cases, medical organizations should consider allowing flexibility for arrival times.
In order to reach the entrance of the building and clinic, there should be an alternative to steps, such as an accessible elevator and/or a ramp.
When the patient opens the door to 90-degrees, an accessible doorway should have a clear opening width of at least 32 inches. Also, the door opening system should not involve tight twisting, pinching, or grasping. Ideally, automatic door-opening systems with a wireless push-button or wave controls should be used.
Once inside, hallways in the clinic must be clear and should have an appropriate width of at least 36 inches to allow free movement of the wheelchair, with enough turning space so that the patient can turn right or left easily.
There should be a restroom with accessible features, including the door entrance, enlarged toilet stalls, faucet controls, and grab bars near the toilet.
The front desk or check-in kiosk (which is often too high for a person who uses a wheelchair) should ideally be set at a universally accessible height, between 28-34 inches to enable easy interactions with the front desk staff.

2. Accessible Waiting and Exam Rooms

Most in-person waiting rooms include a few rows of chairs, organized to best accommodate patients. However, an inclusive waiting room should be large enough to accommodate people with various types of mobility devices (e.g., a scooter, a wheelchair, a cane, a crutch, a walker, a rollator, etc.). In addition, besides chairs, there should be designated spaces where a seated person's device can fit easily.
There are physical standards for achieving accessibility in the medical environment. For instance, at least one exam room in a clinic space should meet the accessibility specifications listed below. Additional rooms may be needed based on the population being served.
1. A clear space that is at least 30 inches x 48 inches next to the exam table with access to the entryway is important. This makes it possible to complete a side transfer to the exam table. More space may be needed if using a portable patient lift or stretcher.
2. Additionally, the exam table must have an adjustable height so that transfers can be completed. Exam tables should lower to the height of the wheelchair seat, 17-19 inches from the floor, and also include items to stabilize the patient during the transfer, such as straps or adjustable support rails with gripping surfaces.
3. There also should be additional space between the wall and the table. This is useful for staff assisting in patient transfer.
4. Open floor space is needed at the end of the table. Ideally, the patient should have enough space to complete a 180-degree turn requiring either 60 inches in diameter or a 60 inches by 60 inches T-shaped space.
5. The clinic room should offer accessible routes to connect to the common areas in the clinic.
6. Doorways should be accessible, and there must be adequate space to allow for maneuvers on both sides of the door. Make sure that these areas do not have objects such as chairs or equipment that may impede clearance.
An issue that many patients bring up is that their wheelchair or mobility devices are commonly removed from the room by staff, which makes them feel stranded. The wheelchair should not be removed from the examination room without asking the patient, unless the patient wishes for it to be removed.
For clinics that complete gynecological exams or mammography studies, the necessary accessible equipment should be available for the patients. For example, in an accessible mammography machine, the height can be adjusted, and it also allows wheelchair clearance below the camera unit.
For the adjustable height exam table, there should be padded leg supports to help complete a gynecological exam for individuals who cannot move or support their legs.

3. Communicating with the Patient

Throughout the encounter, ask the individual about their needs and/or how the staff person can be of assistance.
During an encounter with a patient who uses a wheelchair, it is of paramount importance to create an inclusive environment. The healthcare team needs to prioritize creating a culture of understanding and respect. Much of this occurs through the use of appropriate verbal and non-verbal communication by all staff of the healthcare organization, as described below:
1. If a patient were to arrive at the clinic with a relative or friend, the care team needs to speak directly to the patient. This demonstrates respect and prevents paternalistic interaction during the visit.
2. During the encounter, like all encounters, standing over a patient can be intimidating and potentially hinder the patient-doctor connection or cause discomfort to the patient as they need to look upwards constantly to have a conversation. Providers should try to sit down in front of the patient at eye level and then initiate a conversation with them.
3. After the patient is roomed, the first medical staff interacting with the patient should review how the medical team can assist them during this visit. Specifically, they should review what support they need for transfers and changing clothes.
4. Responsible communication starts by asking the patient about their preferences for addressing them, such as patient-first or identity-first language. An example of person-first language is a patient with paraplegia, and an example of identity-first language is a paraplegic person.
5. Be sure to emphasize abilities and not limitations. For example, in conversation with the patient, family, and other healthcare providers, as well as in chart documentation, instead of saying "confined to a wheelchair, use the phrase a person who uses a wheelchair.
6. Avoid using language that suggests the lack of something like the term unable to walk and instead say a person with an ambulatory disability. Emphasize the need for accessibility, not the disability. An example of this would be replacing the term handicapped parking with accessible parking. Rather than using offensive language like crippled, lame, or deformed, use words like a person with a physical disability.
7. Try to avoid language that implies negative stereotypes such as a normal person and instead say a person without a disability, a non-disabled person, or an ambulant person. It is not appropriate to portray people with disabilities as inspirational because of their disability, as is the case when saying, "they have overcome their disability."

4. Accessible Medical Equipment

A clinic with accessible medical equipment greatly improves the quality of care for patients with mobility disabilities. Staff responsible for operating and maintaining these equipment will need initial training and an annual review of the content to ensure appropriate use and storage.
Measuring the patient's weight is an important part of each medical encounter, and this can be a challenge for wheelchair users. This can be done with an accessible scale that has a ramp to accommodate a wheelchair. Follow the steps given below:
1. Direct the patient into the room with the accessible scale.
2. Follow standard office protocols used for all patients to obtain accurate weight measurements, such as removing shoes and emptying pockets. If medical devices or durable medical equipment are unable to be removed (e.g., feeding tubes, orthopedic braces), make a note of this so that consistent procedures can be used for that patient for future measurements.
3. Remove all items from wheelchair compartments and pockets.
4. While remaining in the wheelchair, the patient should move the wheelchair onto the platform of the accessible scale.
5. Note the weight recorded on the scale.
6. Note the weight of the wheelchair itself by either referring to the manufacturer's instructions or weighing the chair without the patient in it (e.g., when the patient is on the exam table later in the visit). This step does not need to be repeated at every visit if the weight of the wheelchair is saved within the patient's record.
7. Subtract the weight of the wheelchair from the weight of the patient plus the wheelchair to calculate the weight of the patient.
When a patient needs to be evaluated in the prone, side-lying, or supine position (skin evaluation, for example), transfers from the wheelchair to the exam table represent one of the most important components of the patient visit. The medical staff is responsible for assisting patients when the patient indicates that they need help.
If a patient does not require an examination while lying down, it may not be necessary to transfer the patient to the examination table. However, the exam should not be compromised for a clinician or staff convenience.
If a transfer is needed, medical staff should ask the patient about their preferred method of transfer and if they need assistance. Some individuals will be able to transfer themselves independently to the exam table. This involves the patient positioning their wheelchair alongside the examination table, locking the chair, transferring from the chair to the table using their upper extremities, and transferring back to the chair once the exam is complete.
There are different techniques for transfer when patients require assistance. However, all these methods must be directed by the patient and start with the patient positioning the wheelchair alongside the exam table and then locking the chair.
Assisted transfer to the exam table can be carried out using a gait belt for a standing transfer or a slide board for a sitting transfer.
A slide board transfer starts with the wheelchair angled 30- to 45-degrees towards the table and should be close enough that the slide board can reach from the wheelchair seat to the top of the table.
In preparation for the transfer, remove the armrest of the chair and ensure that the patient's feet are facing forward with firm contact with the ground.
Next, ask the patient to shift their weight to the hip farther away from the table and then insert, or ask if they need assistance in inserting, the slide board underneath the hip closest to the table, ensuring that at least one-third of the length of the board is placed below the hip.
The patient will then lean forward and can use their arms to help with the transfer. To prevent wrist strain, ask the patient to make fists instead of moving with open hands.
The patient can also be transferred from the wheelchair to the exam table and vice versa using a portable or ceiling lift. Safe use of a Hoyer lift requires expertise and is preferred when alternative transfer methods are not safe due to the patient's overall strength, muscle control, muscle tone, and/or body habitus.