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Accessible Medical Equipment a Real ReachBy Brenda Brown-Grooms June Isaacson Kailes has a question: Do disabled persons have access to the medical equipment used to examine or treat them? In “Just Hop Up, Look Here, Read This, Listen Up, Don’t Breathe & Stay Still! Access to Medical Equipment - Where Are We?” disability policy consultant Isaacson Kailes reveals the survey results from the National Consumer Needs Assessment, strategies for getting accessible equipment into offices of health-care providers, and existing accessible equipment resources. What happens if you can’t hop up, look here, read this, listen up, not breathe or stay still? To many with disabilities, experience has taught them not to assume that the medical equipment in doctors’ offices, clinics or hospitals will be accessible. The Accessibility and Usability of Medical Equipment for People with Disabilities National Survey (funded in part by the National Institute on Disability and Rehabilitation Research Grant H133E020729) and conducted by the Rehabilitation Engineering’s Research Center on Accessible Medical Instrumentation was guided by the vision statement “all people should have access to healthcare products, facilities and services and to employment in healthcare professions.” The survey established three
objectives: Aimed at health-care providers and educators, people with disabilities, advocates, manufacturers, vendors/sales reps and policy-makers, the intended outcomes are to reduce expensive health service differences between people with disabilities by removing barriers to health-care service and to establish new accessibility standards for accessible medical equipment. A total of 457 people completed part or all of the survey and 408 provided usable data. All 50 states are represented in the data. The survey was divided into three
sections: Respondents were asked about their experiences with particular pieces of equipment (examination tables, X-ray equipment, rehab/exercise equipment and weight scales); their difficulty or discomfort with the equipment; what difficulties they had with the equipment (asked to describe); and, what changes might be made to improve the ease and/or comfort of using the equipment (asked to describe). The big four of medical equipment are examination tables, X-ray equipment, rehab/exercise equipment and weight scales. X-ray equipment includes general X-ray, MRI, CT scan, PET scan, mammogram, bone-density scan, ultrasound, etc. Asked to rate both the experience (none, little, moderate, frequently, extensively) and the level of difficulty/discomfort (none, little, moderate, extreme, extensive) respondents indicated a level equal to or greater than moderate difficulty. The results (n=number of respondents): examination tables (n=291) 79.9%, X-ray equipment (n=258) 68.2%, rehab/exercise equipment (n=203) 55.1% and weight scales (n=222) 53.6%. Within this group of respondents whose information proved usable, in each category, more than 50% of those asked found the equipment to be at least moderately difficulty to use. When asked about their experience using examination tables (n=263), 0% had no problems, 7.5% had a little problem, 31.7% had a moderate problem, 31.7% had frequent problems, and 22.6% had extensive problems. That same group described their difficulty/discomfort with examination tables as none (10.3%), little (15.2%), moderate (32.3%), extreme (33.5%) and impossible (8.7%). Many indicated that examination tables were too high and too narrow, the surface was too hard, and that they had nothing to lean on and nothing to hold on to when getting off. People feared being alone and had to wait a long time to be seen once on the table. Further, the steps up to the examination table were too small and there was nothing to hold on to, stirrups were hard to use, and the paper on the table was slippery and did not offer the contrast some disabled people need. Of 181 people who responded to questions about X-ray equipment and whose information was usable, 68% experienced moderate or great difficulty. When asked about their experience using X-ray equipment (general X-ray, MRI, CT scan, PET scan, mammogram, bone-density scan, ultrasound, etc.) (n=238) 0% had no problems, 17.0% had a little problem, 40.7% had a moderate problem, 35.7% frequently had a problem, and 20.6% had extensive problems. That group described their difficulty/discomfort with X-ray equipment as none (16%), little (17%), moderate (40.7%) frequent (32), and extensive (3%). The experience of 203 of those who responded to questions about weight scales and whose information could be used indicated that 0% had no problems, 28.9% had a little problem, 37.3% had moderate problems, 18.6% had frequent problems, and 15.2% had extensive problems. Difficulty/discomfort in using weight scales (standing, chair, wheelchair, bed, etc.) was rated as none (30%), little (15.3%), moderate (25.1%), extreme (16.7%) and impossible (12.8%). Of 120 people, 54% experienced moderate to great difficulty with weight scales. Of 132 people, 50% experienced moderate to great difficulty. This same difficulty was experienced in dental exams, oral surgery, eye exams, and reclining procedures (chemotherapy, dialysis, transfusion). Radiology equipment, pill splitters and containers, blood glucose monitors and syringe dosing devices, exam tables, pads, poles and steps are among the equipment tested for usability to bridge the accessible equipment gap. Dr. Gloria Krahn of Oregon Health & Science University (“Improving Healthcare for Persons with Disabilities: What is needed now?”— work supported by grant #H133B040034 from NIDRR/DOE) looked at the health disparities of people with disabilities. She noted that “health” is different from “disability.” A person with a disability can be healthy. But those who responded to her survey (she had hoped for 200 responses and got 943 in two weeks) pointed out that people who self-report disability also report poorer health, less use of clinical preventive services and more difficulty in accessing needed health services. Contributors to health status include individual healthy behaviors, environment, genetics and social circumstances. Elements of an effective care system include consumer choice; capacity to identify persons with disabilities; prevention/intervention for secondary conditions; interdisciplinary, comprehensive care; accessible urgent care; and service integration and management. Factors reported as “very important” to good health care include health insurance (95%), provider attitudes (89%), provider knowledge (81%), attitudes of clinic staff (76%), location of clinic (38%), and aids and services (31%). Insurance issues (95%) included finding a provider who accepts the consumer’s insurance, care not covered by insurance, and other costs (e.g. co-pay) not covered by insurance (90% of people with disabilities have some form of insurance). It is difficult to find providers who have both the appropriate knowledge of and willingness to treat people with disabilities. Both transportation to health-care providers and using assistive devices in exam rooms are cited as barriers to good care. Isaacson Kailes reported that 34% of those she canvassed said there was a time in the last 12 months when they needed health care but did not get it. The most important reasons for not getting care include cost (too high), couldn’t get an appointment, not covered by insurance, couldn’t find a provider who understands or was willing to treat my disability, and no transportation or the provider’s office was too far away, The barriers for persons with disabilities and families include understanding one’s health in the context of disability, knowledge about what services are needed, fear, communication skills to advocate for what is needed, and family support and responsibility. Isaacson Kailes reported that a survey of 379 Massachusetts health-care providers found that access changes were made based on: ADA compliance (60%), state requirements (49%), patient recommendations for improvement (33%), completion of an ADA checklist (25%), and JCAHO and other certifying agencies (25%). compliance (60%), state requirements (49%), patient recommendations for improvement (33%), completion of an ADA checklist (25%), and JCAHO and other certifying agencies (25%). How do people get to use accessible medical equipment? It may only happen if they insist on having equipment that helps them hop up, look here, read this, listen up, not breathe and stay still. Brenda Brown-Grooms is an independent living coordinator with the Blue Ridge Independent Living Center in Roanoke, Va.
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