ACCOMMODATIONS: TIPS FOR TREATING PATIENTS WITH DISABILITIES IN THE ED

SEMINAL STUDY

14.2

14.1 // Refugee & (Im)migrant Populations

14.3 // Care of LGBTQIA+ Populations

14 APPROACH TO SPECIAL & VULNERABLE POPULATIONS

OBJECTIVES

• Discuss why health disparities exist in patients with disabilities and those who require accommodations
• Discuss the medical and social models of disability, and the impact these opposing approaches can have on patient care
• Provide examples of strategies to deliver more equitable and culturally-sensitive care for patients with physical disabilities

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DISABILITY VS DISEASE

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Illness refers to subjective feelings of pain, compromised health or well-being

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Disease

Disability

Illness

Disease is a biomedical condition, defined in terms of underlying cause

Disability is not a disease or an illness, and may not be a distinctive biomedical condition

WHAT IS DISABILITY?

WHAT IS DISABILITY?

DISABILITY IS COMMON

MEDICAL VS SOCIAL MODEL OF DISABILITY

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TYPES OF DISABILITIES

DISPARITIES

DISPARITIES

Krahn et al 2015

WHY DO DISPARITIES EXIST?

WHY DO DISPARITIES EXIST?

GENERAL ETIQUETTE

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• Introduce yourself
• Speak to the patient first
• When in doubt, ask

Ask how they prefer to be examined or how they prefer to communicate

Ask if they need an accommodation

Ask how they refer to their disability

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INTRODUCTION- THE DEAF ASL USER

Disability?

Needs an accommodation

OVERVIEW- THE DEAF ASL USER

• Limited access to information/education
• low English skills*
• low health literacy
• Higher percentage in vocational jobs
• lower percentage with advanced degrees
• Lower socioeconomic status

LIP READING

BARRIERS TO CARE- PROVIDER

• Rely solely on lip reading*
• Tendency to focus on deafness
• No interpreter provided or ignores communication preference
• Inappropriate habits while working with an interpreter
• Use of written English and confusing medical terminology

BARRIERS TO CARE- PATIENT

• MISTRUST of the provider
• fear of inaccuracy
• fear of discordance
• FEAR of appearing uneducated--> "Deaf nod"
• INCREASED RISK of obesity, interpersonal violence/intimate Partner and suicide, lack of stroke symptom awareness

TIPS- �PROVIDE ACCOMMODATIONS

• Recognize Deaf vs deaf
• Ask about communication preferences (and follow them!)
• AVOID LIP READING

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TIPS- �PROVIDE ACCOMMODATIONS

• Page your ASL interpreter
• Use video remote interpreting*
• Don't make assumptions
• Describe/explain diseases, procedures, medications in plain language

VISUAL ACCOMMODATIONS

• DO identify yourself, especially when entering a room.
• DO touch them on the arm or use their name when addressing them.
• DO give specific directions
• DO offer to read written information

TIPS- BLINDNESS

• DON'T be afraid to use words like "blind" or "see.”
• Their eyes may not work, but it is still, "Nice to see you."

TIPS- BLINDNESS

On Guiding them:

• DO allow the person you are guiding to hold your arm and follow as you walk.
• DO hesitate briefly at a curb or at the beginning of a flight of stairs.

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• DON'T grab the person you are guiding by the hand, arm, or shoulder and try to steer him.

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TIPS- BLINDNESS

• Ask before you help: Do you want help? and How can I help you?
• Don’t push or touch a person’s wheelchair without permission
• Equipment part of their personal space
• Be aware of a person’s reach limits.
• Do not leave a person stranded
• Examine out of the wheelchair

TIPS-

WHEELCHAIR USE/ACCESSIBILITY

Types of service animals: Dogs, horses

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Types of Disabilities that may use service animals:

• blindness/seeing impaired
• physical impairment
• psychiatric (anxiety/PTSD)
• medical and medical alerts (seizure, autism etc)

**Don’t pet, feed, or distract a service animal

TIPS-

SERVICE ANIMALS

ADA Policy

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• Service animals are to accompany the individual with a disability in all areas of the medical facility
• A person cannot be asked to remove the service animal from the premises unless the dog is not housebroken, is out of control, or if the handler/owner does not take effective action to control the service animal.

TIPS-

SERVICE ANIMALS

• Treat your patients as individuals
• Be sensitive about physical contact
• Remember not all disabilities are visible
• Always speak directly to the person who requires and accommodation or with a disability
• Use patient centric language

GENERAL TIPS- PHYSICAL/VISUAL ACCOMMODATIONS

THANK YOU!

QUESTIONS??

CONTACT US:

• Jason Rotoli: @jmrotoli (twitter) or Jason_Rotoli@urmc.rochester.edu
• Anika Backster: Anika.Backster@emory.edu
• Cori Poffenberger: @coripoff (twitter) or cmc@stanford.edu

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SEMINAL STUDY

14.4 // Care of Incarcerated Populations

14.5 // Structural Vulnerability

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