Designing Inclusive Healthcare Environments

Supporting patients with disabilities

In 2023, the Urban Institute published research concluding that four in 10 adults with disabilities experience unfair treatment in healthcare settings, at work or when applying for public benefits. The institute also reported more than 50% of those with disabilities experienced a delay in receiving care because of discrimination. These findings are inextricably linked to poorer health outcomes for disabled Americans.

As stewards of the built environment, facility owners, planners and design teams carefully translate accessibility requirements into tangible solutions. Most commonly, ADA-compliant design features include wheelchair ramps, wider doorways, accessible parking spaces and tactile signage. These are the visible features most often associated with accessibility. Beyond that, however, lies an opportunity to elevate spaces that prioritize the comfort and autonomy of all patients.

Healthcare organizations hold a profound responsibility to shape the built environment to serve the needs of all individuals. Designers must also be inclusive in approach, drawing upon the ADA principles and recognizing the broad spectrum of neurodiversity within patient populations. Thoughtful and intentional design can create spaces that provide vital services with dignity, accessibility and equality for all.

Recently, the Department of Health and Human Services finalized a new rule that “…helps protect people with disabilities from experiencing discrimination in any program or activity receiving funding from HHS because of their disability.” The changes and updates cover everything from medical treatment, child welfare programs, web and mobile accessibility and accessible medical equipment to service animals and communications.

Designing for ‘invisible’ disabilities
While striving for greater inclusivity and accessibility, remember that not all disabilities are physically visible. This new rule has a broad-reaching definition of disabilities, both physical and mental.

One aspect of disabilities often overlooked is the spectrum of neurodiversity. Neurodivergent patients may have unique sensory needs or mobility challenges. Designing medical spaces with accessibility in mind ensures these patients can navigate the environment comfortably and safely. Individuals with autism, ADHD or sensory processing disorders may experience heightened sensitivities to stimuli, requiring specialized accommodations to navigate healthcare settings comfortably. Many of the recommended solutions fall into the category of being universally good for all patients.

Soft, neutral color schemes and natural light promote relaxation. Use of sound-absorbing materials minimizes noise levels. Predictable layouts with clear sightlines and wayfinding reduce stress. Talk rooms located in less busy areas can provide all patients with a less clinical, more calming and private environment in which to engage in important, quiet conversations with their care provider that may not require an exam table.

Other non-visible disabilities may include hearing impairment, chronic conditions or mental health conditions such as anxiety or depression. A new rule is the recognition of long COVID as a physical or mental impairment and as a potential disability under the ADA, such as when it substantially limits one or more major life activities.

The corridor space at Hudson Headwaters Health Network’s health clinic in Glens Falls, New York features key accessibility elements, including low-glare flooring and lighting, handrails for stability, wider corridors/doorways to accommodate patients in wheelchairs or with walkers and wayfinding elements; e.g., wall color changes and shifts in flooring pattern. Photo by Brian Jones

Nuance and flexibility are inherent
The goal should always be for more inclusive and accessible care, but there are portions of the rule to be aware of that may afford some flexibility to adapt over time. For example, the department chose to retain a long-standing “program accessibility” requirement that mandates each program or activity, when viewed in its entirety, be readily accessible to disabled individuals. However, it also states that program access does not necessarily require a recipient to make existing facilities accessible to and usable by individuals with disabilities. Additionally, recipients are not required to make structural changes to existing facilities where other methods effectively achieve equitable program access.

The rule recognizes the potential burden of retrofitting existing facilities, and the “phasing in” of compliance over time is permitted. For example, providers may be able to shift patients to alternate accessible locations within a program, but not without consideration of placing an undue burden on patients to receive care. The new rule, for instance, emphasizes the need to treat patients in the most integrated care setting.

When it comes to medical equipment, the final rule states that within two years, recipients of federal funds using exam tables and/or weight scales must have at least one accessible version of that equipment.

There is also a safe harbor provision to be aware of relative to construction retrofit requirements. In certain instances, facilities may be entitled to a safe harbor for building elements originally constructed in compliance with the specifications of Uniform Federal Accessibility Standards or under ANSI. In short, if elements were constructed in compliance with the accessibility codes in effect at the time of construction, they may likely stay in compliance until those elements are altered.

By embracing universal design principles, healthcare spaces cater to the broadest possible range of users, fostering inclusivity and equity. Don’t shy away from exceeding the minimum requirements. Consider incorporating best practice design for geriatric populations into a universal design toolbox; e.g., lighting and flooring that reduces glare, additional handrails for people to support and lift themselves, wider corridors and doors for generous walker or wheelchair navigation and large, high-contrast signage for easy-to-read navigation.

In addition, the incorporation of calming color schemes, quiet zones, transitional spaces, tailored wayfinding elements and sensory-friendly waiting areas greatly alleviate stress and facilitate a positive healthcare experience for patients and their caregivers. There are countless best practices not yet adopted into accessibility regulations that serve to improve the patient’s experience.

Designing inclusive healthcare environments is a moral imperative. Only by adhering to inclusivity principles and embracing concepts to support neurodiversity can spaces be created that empower individuals to access healthcare with dignity and respect.